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At least 721 records · Page 40Linked to original sources
PubMed2002

Early failure of a press-fit carbon fiber hip prosthesis with a smooth surface.

We investigated a press-fit anatomically shaped hip stem made of carbon fiber-reinforced composite material in a prospective clinical study. The intention of the design was that a surface of interlaced carbon fibers in the proximal part would achieve metaphyseal fixation. A total of 51 carbon stems were implanted in 48 patients (30 women and 22 men). Mean age at operation was 59 years. The patients were followed clinically, radiologically, and with computed tomography. At 6-year follow-up, aseptic loosening was observed in 47 hips (92%). Forty stems were revised on average 30 months (range, 9-58 months) postoperatively. All revised carbon stems showed fibrous fixation without any bony on-growth. No osteolysis was seen. Histologically, no carbon wear or inflammatory reactions were observed. Only 4 cases had a good clinical result with bony fixation on computed tomography scan. The carbon fiber prosthesis without effective ingrowth or on-growth irregularities showed a high rate of early loosening.

Arthroplasty, Replacement, Hip↗
PubMed2006

Infection of a total hip prosthesis in a dog caused by Achromobacter(Alcaligenes) xylosoxidans.

A four-year-old male, neutered Labrador retriever was presented with progressive left hindlimb lameness 10 months following total hip replacement. Radiography revealed changes consistent with infection and culture of joint fluid from the left coxofemoral joint revealed Achromobacter (Alcaligenes) xylosoxidans. The prosthesis was removed. Culture of the acetabular cup confirmed Achromobacter xylosoxidans. Achromobacter xylosoxidans is an uncommon but serious cause of nosocomial epidemics in hospitals for human beings. To the authors' knowledge, this is the first report of total hip prosthetic infection with Achromobacter xylosoxidans. Little is reported about its pathogenicity in human beings and the authors failed to retrieve any reports of its clinical significance in animals.

Achromobacter denitrificans↗
PubMed1999

[General anesthesia or spinal anesthesia for hip prosthesis replacement? Studies of acceptance of both procedures by patients].

Patients undergoing total hip replacement are given general anaesthesia or spinal anaesthesia. The aim of this study was to investigate the experiences of patients before, during and after general anaesthesia (68 patients) or spinal anaesthesia (77 patients). Our investigation revealed that with regard to complications (nausea and vomiting, headache and back pains), no differences between the two methods occurred. Between 25 and 30% of the patients in both groups had these complications, although there were differences between both groups regarding their concomitant diseases and medication. Patients with spinal anaesthesia had a three times higher incidence of cardiac concomitant diseases and received corresponding drugs more frequently. We found that the time of postoperative analgesia after spinal anaesthesia (210 minutes) was significantly longer than after general anaesthesia (90 minutes). The majority of the patients in both groups (approximately 90%) were satisfied with the chosen method of anaesthesia and with the postoperative pain therapy. These findings make it possible to conclude that with the exception of differences in the postoperative analgesia time, there are no differences between general anaesthesia and spinal anaesthesia regarding complications and satisfaction of the patients with both methods of anaesthesia.

Aged↗
PubMed2005

A case study of radiotherapy planning for a bilateral metal hip prosthesis prostate cancer patient.

The purpose of this report is to communicate the observed advantage of intensity-modulated radiotherapy (IMRT) in a patient with bilateral metallic hip prostheses. In this patient with early-stage low-risk disease, a dose of 74 Gy was planned in two phases--an initial 50 Gy to the prostate and seminal vesicles and an additional 24 Gy to the prostate alone. Each coplanar beam avoided the prosthesis in the beam's eye view. Using the same target expansions for each phase, IMRT and 3D-conformal radiotherapy (CRT) plans were compared for target coverage and inhomogeneity as well as dose to the bladder and rectum. The results of the analysis demonstrated that IMRT provided superior target coverage with reduced dose to normal tissues for both individual phases of the treatment plan as well as for the composite treatment plan. The dose to the rectum was significantly reduced with the IMRT technique, with a composite V 80 of 35% for the IMRT plan versus 70% for 3D-CRT plan. Similarly, the dose to the bladder was significantly reduced with a V 80 of 9% versus 20%. Overall, various dosimetric parameters revealed the corresponding 3D-CRT plan would not have been acceptable. The results indicate significant success with IMRT in a clinical scenario where there were no curative alternatives for local treatment other than external beam radiotherapy. Therefore, definitive external beam radiation of prostate cancer patients with bilateral prosthesis is made feasible with IMRT. The work described herein may also have applicability to other groups of patients, such as those with gynecological or other pelvic malignancies.

Adenocarcinoma↗
PubMed1984

[Treatment of recurrent luxation of total hip prosthesis by posterior methyl methacrylate buttress].

A shelf operation using cement held by screws inserted into the posterior wall of the acetabulum is described in cases of recurrent dislocation of hip prostheses. The procedure was used in 7 cases of total prostheses and 2 of femoral prostheses. The technique is simple and reliable. It should be used when there is no obvious malposition of the prosthesis or in the elderly when a further operation to re-orientate a faulty prosthesis would be too risky. The results were satisfactory with 7 successes in 9 patients.

Bone Cements↗
PubMed2001

Accurate diagnosis of hip prosthesis loosening using a vibrational technique.

OBJECTIVE: To examine the potential role of vibration testing as a non-invasive method of diagnosing loosening of total hip replacements in the clinical setting. DESIGN: Single blind cohort study in two hospitals. BACKGROUND: Diagnosing loosening of total hip replacements is heavily dependent on investigative techniques that are unreliable. Previous studies into the use of vibration testing have produced conflicting results. METHODS: Comparison of vibration testing and radiographs in patients with a total hip replacement experiencing hip pain symptomatic of loosening, with patients showing evidence of a secure prosthesis. RESULTS: Vibration testing has a sensitivity of 80% and a specificity of 89%. The positive predictive value was 92% and the negative predictive value was 73%; it was unable to produce a definitive diagnosis in 8% of patients. When compared with radiographs from the same patients, vibration testing was shown to be 20% more sensitive and able to diagnose 13% more patients. CONCLUSIONS: Vibration testing can deliver more accurate information on the stability of total hip replacements than radiographs in the clinical setting, despite being in the early stages of development. Relevance. This study shows that 70 more patients may be provided with the correct diagnosis and 46 fewer patients may be undiagnosed each year, when using vibrometry as opposed to radiographs. In view of the relative disparity between the level of development between the two techniques and the encouraging results hitherto presented, it is felt that by improving vibration testing it may supersede radiographs in the detection of prosthesis loosening.

Adult↗
PubMed1976

[Study of factors favoring infection in total hip prosthesis. Twenty-five observations].

The authors report 25 cases of infection following total hip replacement and individual factors are analysed. The role of immunological abnormalities is discussed. They distinguish early infection due to the operative conditions from late infection where individual factors are the most important. A few preventive measures are proposed, they emphasise the necessity of a large scale study of factors favouring late infection.

Hip Joint↗
PubMed1993

Effects of porous coating and collar support on early load transfer for a cementless hip prosthesis.

We used a new postprocessing method with the results from a three-dimensional finite element analysis to describe the general load transfer patterns for a cementless hip arthroplasty in the early postoperative situation, and to determine the effects of porous coating [full, partial (2/3), and none] and calcar-collar support (ideal initial contact with separation allowed upon loading, no collar) on this early load transfer. No-tension interfaces were modeled over the entire bone-prosthesis interface, with an upper bound on the Coulomb-friction over coated surfaces, and zero friction over smooth surfaces to accentuate the frictional effects of the coating. The results indicate that the anteroposterior, mediolateral, and axial forces acting on each cross section of the bone were substantially different from the corresponding homeostatic (no prosthesis) forces for the fully coated device with collar support. The frontal bending moments acting on the bone were substantially less than the homeostatic values all along the prosthesis, while the sagittal bending and torsional loads were relatively similar to the homeostatic values. By far, the largest change in these loading patterns occurred with the loss of collar support, where axial loads acting on the bone were so low that over half the bone was in net tension because appreciable transfer of the compressive head force did not occur until well below the lesser trochanter. Both axial and torsional loads were transferred more distally for devices with more coating, and torsional loading of the bone was also sensitive to the degree of collar support. The frontal bending moments acting over most of the bone were insensitive to the coating or collar support. The strain energy density in the endosteal bone was most sensitive to these design variables in the proximal region, and the largest values occurred without a collar and without coating. These findings indicate that all load components acting on the proximal bone in the early postoperative situation (no bone-ingrowth or fibrous tissue at the interface) are altered by the frictional coefficient of the bone-prosthesis interface (i.e. the presence of porous coating or some other surface treatment) and the degree of collar support, while only the axial and torsional loads are altered in the distal bone. From a prosthesis design perspective this implies that surface treatments and collar support can be used to control the axial forces and the torsional moments acting all along the bone. By contrast, the distal frontal bending moment, which dominates stresses in the diaphysis, cannot be altered by these design variables.

Bone Remodeling↗
PubMed2002

Bone turnover markers and cytokines in joint fluid: analyses in 10 patients with loose hip prosthesis and 39 with coxarthrosis.

We analyzed bone turnover markers (osteocalcin, bone ALP, beta-crosslaps-CTX) and cytokines (IL-1, IL-8 and IL-10) in hip joint fluid in 10 patients before revision surgery and in 39 with idiopathic coxarthrosis. Patients with loose implants had lower concentrations of resorption marker than those with arthrosis (0.8 vs 1.3 ng/mL), but bone formation marker osteocalcin was reduced (4.2 vs 22.6 ng/mL). IL-8 and IL-10 levels were elevated in patients with implant failure (870 vs 340 pg/mL; 14.3 vs 4.0 pg/mL). We found a negative correlation between the bone resorption marker (CTX) and IL-10 in cases with prosthesis loosening and a positive correlation between IL-10 and time-to-revision. We conclude that enhanced local production of inflammatory cytokines leading to suppressed bone formation is a part of the loosening process. The expression of anti-inflammatory mediators is not sufficient to counteract the imbalance in bone turnover.

Aged↗
PubMed1980

A new approach towards hip-prosthesis design.

A new femoral prosthesis with a stemless design, different from conventional types, has been conceived in an effort to preserve the physiological stress distribution in magnitude and direction within the living bone as far as possible. The most important feature is that the hip joint forces are transmitted directly to the cortical bone of the resected femoral neck by means of a thrust plate, which maintains the physiological stress an the proximal end of the femur. The prosthesis, the instruments required for its implantation and the surgical technique are described in detail. Up to now, 3 patients have received this new prosthesis.

Hip Joint↗