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PubMed1996

[Treatment of femoral fractures on a total hip prosthesis using Charnley's "long stem" prosthesis. Apropos of 18 cases].

PURPOSE OF THE STUDY: This study was performed to analyse the clinical and radiological results obtained after the treatment of femoral fractures after total hip arthroplasties by a Charnley's extra long-stem prosthesis, and to compare these results with those obtained by alternative treatments proposed by various authors. MATERIALS: 18 patients, whose mean age was 68.5 years (extremes: 45 to 86 years). Cooke and Newman fractures classification showed a clear prominence of type III. In 8 cases we found a femoral loosening, prior to the fracture, divided as follows: 4 in grade III and 4 in grade IV, using Vives classification. Type I fractures were always associated to complete femoral loosening. METHOD: Clinical results were analysed by Merle d'Aubigné's scoring system, giving a pre-fracture global score of 13.5. Post-operative radiological analysis was made on the appearance of femoral radiolucent lines and/or modification of the femoral implant. RESULTS: 17 patients were followed, with a mean of 5 years (extremes: 1 to 14 years). Consolidation was always obtained. The global mean functional results were of 15.2, with score improvement, essentially, of soreness and stability. We found 12 good and very good results, 4 poor and 1 bad. Age (< 75 years) and fracture type (II and III) appeared to be important factors influencing the functional result, contrary to the lesional mechanism. 6 non-evolutive bone-cement radiolucent lines appeared, in immediate post-operative phase. One cement-prosthesis radiolucent line appeared later, leading to loosening and rupture of the implant. We deplore 3 stem twistings, of which only one led to implant rupture. Walking with support was possible at the 5th postoperative days. DISCUSSION: Our functional results are encouraging (12 good results, i.e. 71 per cent), compared with other treatments. This technique improved the global functional score. This is due to the simultaneous treatment of the fracture and of the eventual pre-traumatic associated femoral loosening. The technique allows a quick resumption of autonomy, a short hospitalization time for these elderly patients. The main disadvantage of the orthopaedic treatment is the prolonged decubitus and the important risk of secondary loosening. Osteosynthesis by plate has the advantage of keeping a maximum of osseous stock, but delays weight bearing, favours the non union by a large loss of periosteum. It never permits the treatment of the associated loosening during the same operation. It is also at the origin of a cement weakening, while fixing the proximal screws, leading to the difficulty of placing the prosthesis. Major disadvantage of proposed method is the use of a high quantity of cement to ensure stability of the implants; but this has never had negative consequences in our study. CONCLUSION: This surgical technique seems to be a satisfying alternative to the treatment of femoral fractures on total hip arthroplasty, due to the advantages obtained. It is reserved for elderly patients. However, these findings should be taken with caution, due to our small series.

Aged↗

PubMed1995

[Femoral loosening of total hip prosthesis caused by pseudarthrosis resulting from trochanterotomy].

PURPOSE OF THE STUDY: This survey of 48 cases of trochanteric non-union in THR showed that this complication had not only functional consequences (one patient out of three complains of some instability and mild pain) but may also lead to stem loosening (3/48) through an original mechanism. The movements of the trochanter produce wear debris, mainly from the broken metal wires fixing the trochanter (and from rubbing of the cement on the femoral side of the osteotomy). These debris create an osteolytic granuloma between the proximal lateral endocortex and the cement, which extends progressively to the distal tip of the stem. MATERIAL AND METHODS: A continuous series of 446 cemented Charnley type prostheses by the trans trochanteric approach showed 48 trochanteric non unions (11 per cent) which were examined at an average follow up of 6.5 years. Six patients were reoperated for important hip instability. Ten who suffered only from moderate instability were not reoperated on. 32 were asymptomatic and therefore where not reoperated, but 3 of them suffered from severe femoral loosening after 6 years and required revision. RESULTS: These cases of loosening due to trochanteric non union were characterized by: clinical patterns: they occurred only after 6 years, in active patients under 50; radiological aspects: osteolysis was initially limited to the lateral cortex (without any calcar resorption or radio lucency around the cup) analysis by electronic microscopy of the granuloma (harvested at revision) showed metallic debris (under 1 mu) inside macrophages, with some cement particles (secondary to the loosening). DISCUSSION: Mechanism of loosening These cases of loosening differ from those due to granuloma caused by wear debris of PE and from granulomas resulting from deterioration of the cement around the femoral stem, which both occur only much later with the Charnley prostheses. In our consecutive series of 32 cases of Charnley THR in young active patients with an average follow up of 9.5 years, the only cases of femoral loosening observed were related to trochanteric non unions. Hyposolicitation by trochanteric non union does not lead either to bone resorption or to stem loosening, as we could notice in a series of moderately active patients over 60 with loose non unions. Loosening due to trochanteric non unions was only observed in active patients with tight non unions, as the patient's activity and contact of the surfaces increase rubbing and wear of metal wires. Prevention of trochanteric non union. Despite attentive care to fixation of trochanter there is an unavoidable percentage of non union even in simple cases (3 to 4 per cent according to Charnley). Therefore we advocate this technique only when a large exposition is necessary (revisions, THR for dislocation etc..) CONCLUSIONS: Trochanteric non union may lead to stem loosening after 6 years in active patients under 50. Therefore we recommend: to restrict the use of the trochanteric approach to some difficult THR: revisions, prostheses for dislocation, etc... to reoperate patients under 50 with a trochanteric non union: if it is clinically symptomatic if a progressive granuloma of the lateral cortex, even though asymptomatic, appears.

Adult↗

PubMed1991

The noncemented porous-coated hip prosthesis. A three-year clinical follow-up study and roentgenographic analysis.

This was a retrospective study reviewing 68 hip arthroplasties performed with noncemented, porous-coated components at three institutions in the period between December 1983 and June 1987. Fifty of these were available for follow-up study. The mean follow-up period was three years (range, 18-56 months). Thirty-seven patients were treated by total hip arthroplasty (THA) with porous-coated components, and thirteen were implanted with porous-coated femoral stems with bipolar endoprostheses using a porous-coated femoral stem and a universal head. The mean Harris hip score at follow-up evaluation for the entire group was 85.7 points. Eighty percent of the patients had either a good or excellent result. Those patients implanted with a porous femoral stem with bipolar acetabular components had only 54% good or excellent results compared with 90% good or excellent results for those having THA. Roentgenographic findings included a 59% rate of femoral neck cortex osteopenia, an 80% rate of medial or lateral distal cortical hypertrophy, and an 80% rate of distal bone bridging. All of these roentgenographic changes were secondary to changes in stress transference to the proximal femur. There was no correlation between thigh pain or the degree of bone-prosthesis radiolucencies and the fit of the femoral stem.

Adult↗

PubMed2001

[Developments in hip hemi-arthroplasty and theory of the link-chain dimeric hip prosthesis].

Aim of the study was to analyze the developments of hemiarthroplasties from the femur prosthesis to the bicentric bipolar prosthesis of today. Using the theories published 1990 by Nägerl about "dimeric link chains", nineteen bipolar-head systems were analyzed and biomechanically explained. Clinical findings, such as the problems of luxation and varus positioning of the monocentric bipolars, as well as the valgus, "self-centric" positioning of the bicentric prosthesis are discussed and explained correctly by physics. The hemiarthoplasty with the bicentric bipolar system of today has realized the principles of the dimeric link chains and is superior concept. Eleven of the sixteen today available systems work like this concept which was reached by try and error. The function of a bicentric system is solved now and explained by physics.

Equipment Failure Analysis↗

PubMed1988

[A hip prosthesis with a non-rigid femoral implant. The Butel iso-elastic prosthesis].

A new type of femoral prosthesis is described by the authors. This non-rigid implant respects the natural elasticity of bone and, because of this, avoids excessive stress protection of the bone. In addition, bone atrophy caused by rigid components and osteolysis provoked by cement are eliminated. Experimental studies and the clinical and radiological results five years after insertion seem to confirm the value of this concept.

Adolescent↗

PubMed1997

[Fully automated generation of hip prosthesis voxel models of the femur for finite element analysis. Comparison of direct and subsequent prosthesis implantation].

Two means of generating implant-bearing FE voxel models of the human femur are described and compared. The first method consists in the fully automatic production of a femur model from CT data and subsequent implantation of a prosthesis stem on the basis of a redefinition of existing voxel elements using geometrical data control. The second method processes the CT data of a femur already bearing a prosthesis. Here, the prosthesis elements are generated separately from the surrounding bony elements on the basis of the differing CT density thresholds. Although the two implantation algorithms produce comparable results, they have different fields of application. The method of numerical stress analysis involving automatic generation of voxel models can be applied to implant-bearing femurs. Clinical follow-up observations of patients with prostheses made of titanium can be supported by FE calculations.

Algorithms↗

PubMed2002

Photoelastic and thermoelastic measurement of stress on the proximal femur before and after implantation of a hip prosthesis with retention of the femoral neck.

This study demonstrated the improved medial support and the transfer of load onto the retained neck of the femur using seven fresh frozen femurs. Results confirm the reliability of the thermoelastic stress analysis method, which is comparable to the photoelastic surface coating method, but with greater sensitivity. The loading pattern after stem implantation shows a homogeneous transfer of force onto the preserved femoral neck. After femoral neck removal, an inhomogeneous increase of the intertrochanteric compression loading was observed. Therefore, improved biomechanical conditions are created for a permanently stable implantation of stem prostheses with retention of the femoral neck.

Femur↗

PubMed1991

[Non-cemented reimplantation of failed hip prosthesis].

After reviewing their series of prosthetic revisions and comparing it with other reports in literature, the authors reassess, where possible, classic conservative intervention as well as the indications for cemented prostheses given the poor long-term reliability of the bone-cement interface. The authors emphasize the always more frequent incidence of prosthetic loosening and the resulting need for surgical revision, especially in patients who were under 65 years of age at the time of primary prosthetic replacement. Finally, the authors present their clinical and surgical experience in revision using cementless implants, which they prefer in this type of operation.

Aged↗

PubMed1996

[A simple technique of removal of femoral cement plug in total hip prosthesis revision].

During replacement of loosened or painful cemented femoral prosthetic stem, the extraction of a large size distal cement plug is rarely an easy matter. To make it simple, quick and safe (no wide surgical exposure, no X-ray exposure) we propose a new technique based upon the perforation of the cement plug by a drill which crosses a jig inserted into the cavity where the femoral stem had been removed. Correctly used the procedure can help the surgeon to solve the difficult problem of removing the femoral cement plug and consequently it can allow the placement of a biomechanically ideal conventional length femoral component into a femur not weakened by a perforation, a fenestration or an osteotomy.

Bone Cements↗

PubMed1990

[Girlestone's arthroplasty with resection of the femur head in the management of infection as a complication of hip prosthesis].

From the endoprosthesis material with early and late complication and treated with Girdlestone's method (resection arthroplasty of the femoral head) n 36 cases, 27 were available for follow-up after 1-11 years (in average 5 years). The assessment was made with an own point-system. 3 categories were differentiated on the base of these points. From the 27 patients 7 were satisfied, 14 "reconciled", 6 dissatisfied. It could be stated that Girdlestone's operation does not mean a catastrophe, as the major part of the patients has no pain and sinus, is able to walk and to make the domestic work and is not reduced to the care of others.

Arthroplasty↗

PubMed1980

The painful hip prosthesis: value of nuclear imaging in the diagnosis of late complications.

Loosening of the prosthesis and infection are the most common late complications of the Charnley low friction arthroplasty. A noninvasive diagnostic approach to the symptomatic patient, using plain radiographs and nuclear imaging with a bone imaging agent, is presented. Nuclear imaging is a more sensitive indicator than plain radiography, but the two studies supplement each other. The nuclear study may be positive when radiographs are normal and in no patient with loosening was the nuclear image normal. In the presence of a normal nuclear image and a normal radiograph, there is an extremely small probability that either complication is present.

Aged↗

PubMed1987

Uncemented hip prosthesis: a new screw stem model with a review of 73 cases.

A new uncemented prosthetic stem based on a screw system is presented. The biomechanical, metallurgic and technical principles on which this innovation is based are discussed. The indication and surgical technique are described and 73 cases are reported. The new stem is easy to apply and makes it possible to regulate anteversion precisely, and above all, to satisfy the preconceived biomechanical requirements. Some cases with a shorter follow-up are included because we allowed a suitable time lapse after our earlier cases before extending our indication. However, there is considerable documentation of screw stems in the literature on the long term toleration of screw stems.

Adult↗

PubMed2004

JIDE: a new software for computer-aided design of hip prosthesis.

This work is aimed at developing an innovative simulation environment supporting and improving the design of standard joint implants (JPD integrated design environment (JIDE)). The conceptual workflow starts from the design of a new implant, by using conventional CAD programmes and completes with the generation of a report that summarises the goodness for a new implant against a database of human bone anatomies. For each dataset in the database, the JPD application calculates a set of quantitative indicators that will support the designer in the evaluation of its design on a statistical basis. The resulting system is thus directed to prostheses manufacturers and addresses a market segment that appears to have a steady growth in the future.

Computer Simulation↗

PubMed1986

[Periarticular ossification. Complication of total hip prosthesis].

The authors analyse peri-prosthetic ossification, a complication which can occur in the presence of certain risk factors. Grades I and II calcifications are frequent and do not interfere with the final post-operative result. On the other hand, grades II and IV result in a progressive stiffening of the coxo-femoral joint within one year after the operation. They may be bilateral and can sometimes be responsible for serious handicap. These cases should be re-operated in order to restore joint mobility, but surgical treatment should be completed by radiotherapy according to a defined protocol. Non-steroidal anti-inflammatory agents and diphosphonates also have a preventative action. Subjects at risk (ankylosing vertebral hyperostosis, spondyloarthritis, alcoholism, patients with a history of ossification of the first side) require effective prophylactic treatment. In the authors' own series, 49 cases of ossification were observed in a retrospective analysis of 100 patients, including 6 cases of grades III and IV ossification. They analyse their results in relation to the initial hip pathology treated by prosthesis, but their series is too small to allow an statistically valid conclusions. Complementary studies are required.

Anti-Inflammatory Agents↗

PubMedDate not supplied

[Results of scintigraphy with labeled leukocytes for the diagnosis of infectious hip prosthesis loosening].

The present paper reports on the results of a specific scintigraphic examination method for diagnosing infections in cases of loosening of hip prostheses by means of labeled granulocytes. In 103 patients the result of the examination was compared with the result of the bacteriological and/or histological investigation following removal or replacement of the implant. Where there was an infectious loosening of the prosthesis the findings were in agreement with the results of the scintigraphic examination in 83.1% of the cases. It was possible to rule out infectious loosening of the prosthesis in 93% of the cases thus investigated.

Adult↗

PubMed1995

Austin Moore hip prosthesis replacement in Ratchaburi Hospital.

From 1992 to 1994, eighty-two patients with 82 displaced femoral neck fractures were operated on with Austin Moore prosthesis replacement at the Department of Orthopedics, Ratchaburi Hospital. There were 31 males and 51 females, their mean age was 68.4 years (range: 21-91 years). Sixty-two patients were seen at the average of 12.36 months' follow-up (range: 6-31 months). The clinical result was excellent 51.61 per cent, good 25.81 per cent, fair 11.29 per cent and poor 11.29 per cent. There were three cases of superficial wound infection, two cases of minor fissures or fractures during surgery, and two cases of stem loosening. Two patients died within 2 weeks post-operatively due to recurrent myocardial infarction.

Adult↗

PubMed2000

[Anchoring principles in hip prosthesis implantation. II: Acetabulum components].

In this review the different anchorage concepts of cemented and cementless acetabular components are presented and clinical long-term results--if available--are discussed. Despite numerous design improvements and modifications the long-term durability of acetabular components remains a major concern with results being clearly inferior than achieved with femoral components. Until valid, prospective long-term success is proven for cementless designs cemented acetabular fixation using modern cementing technique must be regarded as standard treatment. However, successful fixation over 15-20 years very much depends on the quality of operative and cementing technique. Some cementless systems appear easier to use and have been documented to offer reliable mid-term survival rates. In young patients cementless devices have been well established and for some systems promising 10-year results have been published.

Acetabulum↗

PubMed1990

[Hip prosthesis: idea, indications, development].

The authors describe the evolution and the successive stages that were necessary until the present total substitution of the hip joint could be worked out. The earliest attempts were made in 1923, but only in 1953, professor Marino Zuco, of Rome University Orthopedic Department started to carry out operations of arthroplasty, after 3 years of experimental research. In 1960, Charnley introduced the use of cement (methyl methacrylate), thus initiating the practice of total hip substitution. This surgery is indicated in a variety of joint pathologies of which osteoarthritis is the most frequent one. The implant of a cemented or non cemented prosthesis is conditioned both by the patient's age and by bone structure. Differences between the two types of prostheses are illustrated as well as the causes of failure or subsequent pathology and their diagnosis.

Arthritis↗