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PubMed1977

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.

Activities of Daily Living↗
PubMed1993

[Intrapelvic migration of a total hip prosthesis in rheumatoid arthritis].

The authors discuss the risk of mechanical loosening and protrusion of a cemented endoprosthesis of the hip joint after operation which is one of the few possibilities of palliative treatment in patients with rheumatoid arthritis. They deal in particular with specific features of surgical approaches whereby they select a modified method described by Eftekhar which makes it possible to resolve even severe grades of intrapelvic migration of the socket of a total endoprosthesis. The authors discuss possible complications which can be prevented if the relationship of intrapelvic structures to the protruded prosthesis is elucidated before operation. In a group of 1268 patients operated there were three with intrapelvic migration of a total endoprosthesis of the hip joint.

Arthritis, Rheumatoid↗
PubMed1993

Effects of porous coating, with and without collar support, on early relative motion for a cementless hip prosthesis.

In theory, porous or rough coatings could be used to reduce early post-operative relative motion about cementless hip prostheses. To investigate this theory, we used detailed, non-linear finite element analysis to compare early relative motion about a well-fit Anatomical Medullary Locking (AML) prosthesis for different amounts of porous coating (full, proximal 2/3, and no coating), both with and without collar support. Details of the model included quantitative computed tomography-derived (QCT-derived) geometric and material properties for the bone, and a no-tension interface condition at all bone-prosthesis interfaces, with Coulomb friction (mu = 1.73) over coated surfaces and zero friction elsewhere. Predicted values of relative motion for this well-fit device were in the range of approximately 1-550 microns. The distribution of relative motion was relatively insensitive to the amount of porous coating but was sensitive to collar support, while the magnitude of relative motion was sensitive to the porous coating and collar support. In addition, a reduction in the porous coating caused larger increases in relative motion when there was no collar support, indicating an interaction between the effects of porous coating and collar support. For example, distal twist increased (full vs 2/3 partial coating) by 38% with collar support and by 58% without collar support. These data suggest that porous coating, or other surface treatments which result in a high coefficient of friction at the bone-prosthesis interface, may well be used to control the magnitude of early relative motion, particularly when there is no collar support.

Biomechanical Phenomena↗
PubMed1969

[Hip prosthesis].

Explore the source record for details and available documents.

Acetabulum↗
PubMed1987

[Malignant fibrous histiocytoma of the femur after total hip prosthesis. Apropos of a case].

The development of a pathological fracture of the lower third of the femur in which a total hip arthroplasty had been cemented 20 months earlier, was followed several months later by extensive osteolysis round the prosthesis. After much discussion, a diagnosis of malignant fibrous histiocytoma was made. A review of the literature revealed a similar case and confirmed the possibility of induction of this rare tumour in one of several ways. Whilst the oncogenic effect of an implant cannot be proved, it cannot be excluded.

Aged↗
PubMed2006

Malignant tumors at the site of total hip prosthesis. Analytic review of 46 cases.

During the years 1974 to 2003, a total of 46 cases of malignant tumors at the site of total hip arthroplasty, 41 sarcomas, 4 lymphomas, and 1 epidermoid carcinoma, have been reported in the Western literature. Soft tissue sarcomas occurred in 31 and bone sarcomas in 10 cases. Malignant fibrous histiocytoma was the most common in 20 (65%) of all soft tissue sarcomas. The patients with malignant tumors had been operated on more often for secondary osteoarthritis and had more local complications than those in ordinary total hip arthroplasty series. Primary osteoarthritis was the indication in 63% and secondary osteoarthritis in 37% of the 38 reported cases. Tumor developed after 8 (17%) revisions. Deep infection complicated 4 (9%) of the cases. Four cases (9%) were preceded by a precondition for cancer, 2 postradiation necroses of the femoral head, 1 chronic sinus, and 1 Mafucci syndrome. Mean age of the patients at the time of first implantation was 59 years (range, 24-79 years). The mean latent period was 6 years (range, 0.5-20 years) from the first operation. Longer latency period did not correlate positively with the cancer risk. Sarcomas were highly aggressive. Of the 31 reported patients, 24 (77%) died within 1 year after the diagnosis. The number of reported sarcoma cases is low considering the total population behind the cases. In addition, one observed local sarcoma from Nordic cohorts was less than expected. Chronic, particle-induced inflammation around the prosthesis does not seem to increase the risk for carcinogenesis.

Adult↗
PubMed1989

Cemented total hip prosthesis: radiographic and scintigraphic evaluation.

Conventional radiographs, technetium-99m bone scans, and gallium-67 scans were reviewed in 44 patients who had undergone cemented total hip joint replacement and were imaged because of suspicion of prosthesis loosening or infection. A complete radiolucent line of 2 mm or wider along the bone-cement interface or metal-cement lucency on conventional radiographs was used as the criterion for prosthetic loosening with or without infection and proved to be 54% sensitive and 96% specific. Scintigraphic criteria for prosthetic loosening were increased focal uptake of the radiopharmaceutical for the femoral component and increased focal or diffuse uptake for the acetabular component. For bone scintigraphy, sensitivity was 73% and specificity was 96%. Combining the results of conventional radiographs and bone scans increased sensitivity to 84% and decreased specificity to 92% for the diagnosis of loosening, infection, or both. The study also showed that Ga-67 scintigraphy has a low sensitivity for the detection of infection.

Acetabulum↗
PubMed2006

Hip prosthesis infection due to Mycobacterium wolinskyi.

Mycobacterium wolinskyi, first described in 1999, is a rapidly growing mycobacterium related to the Mycobacterium smegmatis group. Only eight cases of infection due to this microorganism have been reported, including three cases of bone infection. Here, we present the first case of a joint prosthesis infection cured with the combination of surgery and prolonged antibiotic therapy. The microorganism was identified by biochemical tests and 16S rRNA and Hsp65 gene sequence analysis.

Aged, 80 and over↗
PubMed1993

Failure of a well-fixed bone-ingrown titanium hip prosthesis.

A cementless titanium femoral stem was revised 5 years after implantation because of acute pain and progressive osteolysis. Substantial amounts of titanium and polyethylene wear debris were found in the surrounding tissues. Multiple sources of this debris were found as well as detachment of titanium fiber-mesh pads from the body of the femoral stem.

Adult↗
PubMed1975

Total hip prosthesis: real and apparent dislocation.

Asymmetry of the femoral head within the acetabular cup shown in an antero-posterior radiograph of the hip is an indication of dislocation of the prosthesis after a Charnley-Müller procedure. However, this rule does not apply to modifications such as the Aufranc-Turner prosthesis.

Femur Head↗
PubMed1996

[Systemic granulomatous reaction in hip prosthesis. Apropos of 2 anatomoclinical cases].

PURPOSE OF THE STUDY: The production of particulate wear debris is a recognised complication of joint arthroplasty. Focus was made on local tissue reactions. Systemic distribution of wear debris are less know. We report two new cases of distant granulomatous reaction. MATERIAL: The first case concerned a 71-year-old man with lymph node histiocytosis incidentally discovered during the staging of a prostatic carcinoma. The second case concerned a 61-year-old man with a visceral granulomatosis reaction (liver, spleen and lymph node) associated to hepatic ans splenic enlargement. METHODS: We realised an histological analysis of several tissue specimens for these two patients and for one case an inductively coupled plasma-mass spectrometry technique (ICPMS). RESULTS: In all specimens we identified a foreign body granulomatous reaction characterized by the presence of particles coming from hip arthroplasty. The ICPMS identified titanium in spleen. DISCUSSION: Distant granulomatous reaction are generally localised in regional lymph nodes and discovered by accident. A systemic granulomatous reaction attributable to wear particles raises the question of long term biocompatibility of prosthetic materials. CONCLUSION: Besides local reaction, it is of utmost importance that physicians involved in prosthetic field take into consideration the possible systemic adverse effect of wear particles from arthroplasty.

Aged↗