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At least 793 records · Page 44Linked to original sources
PubMed2000

[Cemented hip prosthesis implantation--decreasing the rate of fat embolism with pulsed pressure lavage].

Intraoperative fat embolism associated with cemented total hip arthroplasty is a well recognized complication. In a new sheep model allowing for standardized bilateral, simultaneous cement pressurization we studied the effectiveness of both pulsatile and syringe lavage of equal volume with regard to their cleansing capabilities as measured by fat and bone marrow intravasation. The operative procedure involved bilateral placement of intravenous catheters into the external iliac veins via retroperitoneal approach. After femoral neck osteotomies both femoral cavities were prepared for retrograde cement application. After randomization one side was lavaged with 250 ml irrigation using a bladder syringe, the contralateral femur with the identical volume but using a pulsatile lavage. A specially designed apparatus was used to allow for bilateral simultaneous cement pressurization. Venous blood from both iliac catheters was then collected, anticoagulated and a quantitative and qualitative fat analysis was performed. Despite equal volume manual lavage produced significantly higher fat and bone marrow intravasation (P < 0.001) than pulsatile lavage thus suggesting that not only the volume but also the quality of bone lavage is an essential factor influencing the risk of fat embolism and adverse cardiorespiratory effects. Our findings further emphasize the important role of pulsatile lavage in preventing fat and bone marrow embolisation during cemented total hip arthroplasty.

Animals↗
PubMed1977

[The tolerance of the hip prosthesis evaluted through scintigraphic studies (author's transl)].

The authors assert the usefulness of the scintigraphy in the early diagnosis and/or for the confirmation of the main complications connected with the artroprosthesis of the hip. Such investigation is effective only if it is carried out at a distance of at least six months from the operation and must be completed by clinical, bio-humoral and radiographic tests. This study is based on the observation of 40 cases, of which 20 represent the control group. The isotope used is the Tc99m-pyrophosphate.

Aged↗
PubMed1999

The application of allogenic bone grafts for replantation of a hip prosthesis; an attempt at radiological evaluation of graft rebuilding.

UNLABELLED: An attempt at radiological estimation of remodelling of allogenic bone grafts used in reconstruction of bone stock in revision of hip arthroplasty. THE METHOD: x-ray pictures of the treated hips were taken immediately and at 3, 6 and 12 months after surgery. Changes of bone structure around the prosthesis were estimated. THE RESULTS: symptoms of remodelling (presence of newly formed bone trabecules between host bone and the grafts and in the surrounding area) were encountered at 3 to 6 months after reconstruction surgery. CONCLUSIONS: radiological estimation of bone remodelling remains subjective. Nevertheless it can help to determine bone graft rebuilding in revision surgery of the hip.

Adult↗
PubMedDate not supplied

[Differences in hip prosthesis implantation in a non-urban region].

AIM: The aim of the study was to analyse differences of early results after total hip replacement performed at various hospitals. METHOD: A total of 37 consecutive patients submitted for postoperative rehabilitation were examined. These patients were referred from 18 different hospitals. In an assessment sheet, personal data, age, indication, operating department (surgical or orthopedic), side, length of skin incision and early X-ray presentation with regard to cup angle, position of greater trochanter in relation to head of prosthesis, varus/valgus angle of femoral prosthesis, and cementation were recorded. RESULTS: Of the 37 patients, 26 were female, 11 male. Average age was 62.9 +/- 10.4 years. Degenerative osteoarthritis was present in 23 cases, fractures in 6 cases, there were 6 patients with osteoarthritis following hip dysplasia, 1 pathological fracture, and 1 aseptic necrosis of the femoral head. The skin incision length varied from 8 to 31 cm, averaging to 16.8 +/- 5.3 cm. Implantations were cementless in 20 cases, cemented in 12, and partly cemented in 5 cases. Using a THR-Early-Result-Score of 25 points maximum, # 7 implantations were scored as normal, 16 subnormal, 10 atypical, and 4 highly atypical. CONCLUSION: The data presented show an incidence of 81% non-ideal implantations which is considered surprisingly high. Potential reasons are discussed. It is suggested that efforts to improve the quality of total hip replacements should be made.

Adult↗
PubMed1994

[Butel's isoelastic hip prosthesis. A limited prospective study].

INTRODUCTION: A limited prospective study was undertaken at the Centre Hospitalier de l'Université Laval to assess the outcome of 21 isoelastic prostheses described by Butel. MATERIAL AND METHODS: The femoral component consisted of a one-piece forged stainless steel stem with four metallic rods ranging in diameter from 11 to 18 mm, in 1 mm increments. The two lateral and medial rods, 20 cm in length, were linked distally. The 2 mm gap between the medial and lateral rods was obliterated at insertion, allowing the component to be firmly seated in the femoral canal. Twenty-one Butel isoelastic prostheses were inserted in 20 patients (14 men and 6 women with an average age of 51 years). The preoperative diagnosis was aseptic total hip prosthetic loosening in three cases, rheumatoid arthritis in five cases, avascular necrosis in six cases and degenerative arthritis in six cases. A standard postero-lateral approach was used in all cases. Postoperatively, the patients were mobilized immediately, with partial weight bearing on the affected side for six weeks. RESULTS: Follow-up ranged from 24 to 34 months with an average of 28 months. One patient, who developed a late infection, was excluded from the study. Nineteen patients with 20 prostheses were reviewed clinically and roentgenographically by independent observers in the absence of the senior author. Clinically, the patients rated 11 to 58 on the preoperative Harris scale with an average of 34 while they rated 39 to 96 postoperatively with an average of 67. Eight patients were below 70 on the Harris scale postoperatively and were rated unsatisfactory. Eleven patients complained of postoperative thigh pain which was still present in three patients after two years. None complained of pain related to the acetabular component. On roentgenograms, prosthetic seating seemed to be inadequate in 14 cases but with good clinical results in 9 cases. Seating seemed to be adequate in six cases but with an unsatisfactory outcome in three cases. DISCUSSION: The concept of isoelasticity is that the implant and bone should deform as one unit. However, clinical results of an implant must be validated by investigators who are not developers of their own implant. The results in this series do not corroborate with those reported by Butel. A number of technical problems occurring at or after surgery precluded the safety, efficacy and durability of the surgical procedure and its successful outcome. A substantial incidence of thigh pain was found in this series. This has also been noted by a variety of authors using femoral designs with a large intramedullary rod which has less torsional stability than a flat wedge shaped femoral implant. CONCLUSION: The isoelastic prosthesis used in this series did not fulfill the expectations and was considered marginal in regards to quality and efficiency.

Adult↗
PubMed2001

[Effect of graduate education on complication rate and costs of hip prosthesis implantation].

PURPOSE: We studied the effect of surgical experience with regard to complications and costs after 3290 primary total hip arthroplasties (diagnosis: osteoarthritis). METHODS: We retrospectively analysed duration of clinical treatment and anaesthesia, blood loss, number of banked blood and perioperative complications (fractures of the shaft and acetabulum, dislocations, peripheral nerve injuries, thrombosis of the deep veins, embolism and deep wound infections) related to the experience of the surgeon (junior surgeons in comparison to the consultant) after 3290 primary THA's from 1974 to 1997. Cost analysis was performed by measurement of time and material expenditure. RESULTS: 39.2% of all operations were performed by junior surgeons. This number emphasizes the realisation of the order of education in our clinic. Both groups showed just few differences in number of duration of clinical treatment, banked blood, nerve leasions and embolism. We found statistically not significant increased rates of fractures and dislocations in the THA's performed by an unexperienced surgeon, however the rates decreased the last 14 years. Significantly higher rates of deep wound infection at the beginning decreased in the last 9 years to the level of experienced surgeons. Due to longer operation times, we calculated higher expenses of DM 85 per case in the group of junior surgeons. CONCLUSIONS: Using an educational program, carried out with an experienced surgeon, there is nearly no additional risk for the patient regarding the complication rates in THA's. However, there are higher financial expenses that have to be calculated.

Aged↗
PubMed1975

Evaluation of a metal-ceramic composite hip prosthesis.

This investigation attempts to apply the concept of direct skeletal attachment via tissue ingrowth to the attachment of femoral head prostheses to the femur. Stainless steel (316L) canine femoral head prostheses with a ceramic coated stem were implanted into the femora of dogs and their results compared to those obtained by the impaction of stainless steel prostheses and acrylic-stabilized prostheses. The implants were tested in vivo for time periods ranging from 2 to 13 months, after which time the animals were sacrificed and the femora excised. The femora were sectioned with the implants in place and prepared for examination by light microscopy. Bone was in closer approximation to the ceramic coated implants than to the other two types of implantations. The uncoated and acrylic-stabilized implants were usually characterized by the presence of a relatively thick fibrous sequestering membrane.

Aluminum↗
PubMed2003

Plasma levels of coagulation inhibitors, fibrinolytic markers and platelet-derived growth factor-AB in patients with failed hip prosthesis.

We studied the plasma levels of coagulation inhibitors, of fibrinolysis and PDGF-AB, in patients with aseptic loosening of the hip replacement. 23 patients having loose hip prostheses were compared to patients having 15 stable hip prostheses, and 26 undergoing primary hip replacement. The levels of the coagulation inhibitors antithrombin III and protein C were determined by chromogenic assays. Fibrinolysis was evaluated by the changes in fibrin degradation products (D-dimer), determined by enzyme immunoassay, and in the plasminogen activator inhibitor-1 (PAl-1), by enzymatic assay. PDGF-AB was determined by enzyme immunoassay. In patients with failed prostheses, we found fibrinolysis activation, as shown by a statistically significant increase in D-dimer and a significant decrease of PAI-1. No significant differences were obseved in antithrombin III, protein C, and PDGF-AB. PAI-1 and D-dimer assays in failed prostheses may be useful for the pathogenetic evaluation, because the continuous inflammatory stimulus associated with fibrin deposition may also affect the systemic levels.

Adult↗