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PubMedDate not supplied

[Computer-assisted navigated acetabulum placement in hip prosthesis implantation--application study in routine clinical care].

AIM: This study serves to examine the feasibility of a CAS system in clinical routine use in the field of total hip replacement. METHOD: Within a prospective study 70 total hip replacements were performed by one surgeon (KB) between March and November, 1999 using a CAS system for preoperative planning and intraoperative cup placement. RESULTS: The average operating time was 70 min. This means an average increase in total time of operation about 15-20 min. The average blood loss was 630 ml. No additional specific complications due to the use of the system were seen. There was no additional trauma created by percutaneous pointing at the spina or flxing a dynamic reference base (DRB) at the pelvis. CONCLUSION: The active application of this CAS system in clinical routine use showed very good results in feasibility and can be considered as reliable. The navigated cup placement shows the potential of improving the results in cup placement, thus improving the outcome of hip arthroplasty.

Acetabulum↗
PubMed2005

Accuracy of diagnostic imaging techniques in the diagnosis of aseptic loosening of the femoral component of a hip prosthesis: a meta-analysis.

In this meta-analysis we included 32 English-language articles published between January 1975 and June 2004 on the diagnostic performance of plain radiography, subtraction arthrography, nuclear arthrography and bone scintigraphy in detecting aseptic loosening of the femoral component, using criteria based on the Cochrane systematic review of screening and diagnostic tests. The mean sensitivity and specificity were, respectively, 82% (95% confidence interval (CI) 76 to 87) and 81% (95% CI 73 to 87) for plain radiography and 85% (95% CI 75 to 91) and 83% (95% CI 75 to 89) for nuclear arthrography. Pooled sensitivity and specificity were, respectively, 86% (95% CI 74 to 93) and 85% (95% CI 77 to 91) for subtraction arthrography and 85% (95% CI 79 to 89) and 72% (95% CI 64 to 79) for bone scintigraphy. Although the diagnostic performance of the imaging techniques was not significantly different, plain radiography and bone scintigraphy are preferred for the assessment of a femoral component because of their efficacy and lower risk of patient morbidity.

Arthrography↗
PubMed1998

[Discrepancies between the results of phlebography and Doppler ultrasonography in the diagnosis of asymptotic venous thrombosis after total hip prosthesis. False negatives of phlebography or false positives of Doppler ultrasonography].

OBJECTIVES: Assess the diagnostic performance of phlebography and discrepancies with duplex ultrasonography in screening for asymptomatic deep vein thrombosis after total hip arthroplasty. Search for arguments which would favor contributing false-negatives or false-positives to one of the two exploration methods. PATIENTS AND METHODS: The study included 24 patients who underwent the 2 explorations independently between day 7 and day 14 in a multicentric therapeutic trial of a new heparin. Discrepancies between the two techniques were recorded. Diagnostic performance of phlebography was calculated from contingency tables. The phlebograms were then reviewed with knowledge of the duplex ultrasonographic findings. The course of the venous thrombus after treatment was monitored with duplex ultrasonography. RESULTS: Phlebography allowed the diagnosis of thrombus formation in 9 patients. Ultrasonography provided the diagnosis in 14 cases out of 24. Sensitivity of phlebography compared with duplex ultrasonography was 64% (95% CI = 35.1-87.2) (9/14) and specificity was 100% (95% CI = 69.1-100) (10/10). Several localizations were not visualized with phlebography: 3 partially obstructive thrombi near the femoral junction, and 38 distal thrombi including 31 soleus thrombi (fig. 5). When the phlebograms were reviewed again, defects compatible with a partial thrombus were found for the 3 proximal localizations and for 2 of the distal localizations (fig. 1, 2, 4). None of the soleus localizations were visualized. Duplex ultrasonographic follow-up concerned 12 of the 14 patients with a thrombus identified by duplex ultrasonography involving 44 localizations. In five case, the operator was different from the operator for the initial duplex ultrasonography. Follow-up revealed: 1 new localization, 37 narrowings and 6 repermeabilizations. DISCUSSION: The coherence of the duplex ultrasonographic follow-up and the presence of images compatible with partial thrombus on the revised phlebograms which had been initially interpreted as wash out flow constitute a group of arguments suggesting that the discrepancies observed should be considered as phlebography false-negatives. This defect in the sensitivity of phlebography has been reported by others in the literature both for distal and proximal localizations.

Aged↗
PubMedDate not supplied

[The gait of patients with full weightbearing capacity after hip prosthesis implantation on the treadmill with partial body weight support, during assisted walking and without crutches].

PROBLEM: Treadmill training with partial body weight support is a new promising technique in the rehabilitation in hip arthroplasty patients. With little data on the gait pattern and extent of pelvitrochanteric muscle activation, this study analysed the gait of hip arthroplasty patients walking on the treadmill and also during floor walking with and without crutches. METHOD: Gait analysis in 19 hip arthroplasty patients capable of full weight bearing included the assessment of kinematics, kinetics and kinesiologic electromyogram of relevant trunk and lower limb muscles during treadmill walking with 15% of body weight support, and during floor walking with and without crutches at comparable walking velocities. RESULTS: Both on the treadmill and with crutches, patients walked less frequent, with a longer stride and more symmetric as compared to the unaided gait. Both techniques, however, resulted in a reduced activation of most of the pelvitrochanteric muscles, particularly when using crutches. The comparison of both supporting methods revealed a higher activity of the M. gluteus medius of the affected side on the treadmill. The amount of body weight reduction was comparable ranging from 10 to 15%. CONCLUSIONS: Treadmill training with constant body weight support enables hip arthroplasty patient to entrain a dynamic and symmetric gait pattern with a better activation of the hip abductor of the affected side as compared to walking with crutches. Nevertheless, the level of activation was less than when walking without crutches which, however, resulted in a limping gait pattern.

Aged↗
PubMedDate not supplied

[Mineral density of the femoral diaphysis after hip prosthesis implantation].

The aseptic instability of endoprostheses, which occurs after their good operation, is a severe complication. All developed countries study this problem from different points of view. This paper presents the data of up to 5-year follow-ups of the mineral saturation of the microstructures of the hip bone diaphysis during endoprosthesis. The paper has been the only to be performed by latest techniques in the former Soviet Union. It is of great interest for researchers who are engaged in searching materials for endoprostheses, for their designers. It is also useful for surgeons in solving the problems how to raise patients after surgery and in giving further recommendations.

Animals↗
PubMed2000

[Shape optimization of the femoral component of hip prosthesis using the finite element method].

Aseptic loosening of implants in bone is the main reason of prosthesis failure. Stress distribution around the implant surface plays a major role in this process, which can be minimized by implant shape optimization. Numerical methods, particularly the finite element method, are an important tool in the analysis of stress distribution and design optimization. The paper presents the problem formulation for this method, illustrated by computational examples.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

[Significance of postoperative fever after hip prosthesis implantation].

INTRODUCTION: Postoperative fever is a phenomenon well-known by every orthopedic surgeon, yet its etiological background and its relation to wound infections is still unclear. The number of publications related to this topics in general and in the special field of orthopedics is quite limited. METHOD: The incidence of postoperative fever in 177 patients who underwent total hip replacement was investigated; its nature and connections to possible bacterial wound infections are described. Moreover, the effectiveness of antibiotic therapy was also taken into consideration. RESULTS: In 39% of the sample, fever exceeding 38 degrees C was noted in the immediate postoperative period; in 87% of these cases, the fever was of unknown etiology, its background could not be specified by clinical tests and examinations. In four cases of the total 177 patients, microbiologically proven wound infection occurred during the period of hospital stay, but only three of these patients had fever. The results of patients treated with antibiotics because of fever did not differ significantly from those of patients who did not receive antibiotics. This was true from the aspect of both the disappearance of fever and the frequency of complications. CONCLUSION: The results emphasise that postoperative fever is only a minor predictive factor of wound infections; at the same time absence of fever does not mean absence of septic complications. In the case of immediate postoperative fever of unknown etiology and without clinical symptoms, it is inexpedient to start antibiotic treatment or to increase the prophylactic antibiotic dosage.

Adult↗
PubMed1998

[Effect of administration of recombinant human erythropoietin in acute normovolemic hemodilution on transfusion needs during total hip prosthesis implantation].

Acute normovolaemic haemodilution (ANH) is used to avoid perioperative blood loss and consists of the withdrawal of whole blood just before or just after anaesthesia induction and its simultaneous replacement by synthetic colloids and crystalloid solutions. In an attempt to improve the efficiency of this technique while at the same time avoiding cardiovascular complications, we set up a pilot study to test the association of rHuEpo/ANH during elective surgery for total hip replacement. Five patients (3 males, 2 females) were included in this study. The amount of whole blood drawn was 3 x 450 ml from the men and 2 x 450 ml from the women. Before blood was taken, the mean increase in haemoglobin was 1.2 +/- 0.9 g/dl and mean increase in reticulocytes 106 +/- 34 G/l. No patient received homologous transfusion during the perioperative period; 3 patients received the totality of predonated blood and one patient 2 of the 3 units taken. The mean fall in haemoglobin at day 1 post-surgery was 3.6 g/dl. In conclusion, the stimulation of erythropoiesis by rHuEpo in the pre-surgery phase led on average to a 1 g/dl gain in haemoglobin, permitting an isovolaemic withdrawal of 900 to 1350 ml of blood depending on body weight without the development of severe anaemia. It was thus possible to perform total hip replacement in all the patients without homologous blood support and with a post-surgery haemoglobin value of > 10 g/dl. This protocol should be further tested in a prospective randomised study (rHuEpo versus placebo) in order to assess the real benefit of rHuEpo.

Adult↗
PubMed2002

[Revision arthroplasty in aseptic loosening of cemented sockets of hip prosthesis].

The aim of this paper was to assess early results of revision arthroplasty in aseptic loosening of cemented sockets. A group of 67 patients (53 females and 14 males) age ranging from 47 to 78 years (average: 72 years) who underwent revision arthroplasty because of aseptic loosening of cemented sockets. Early surgical treatment can spare the patient from a risky procedure and lead to better end results. In cases with massive bone destruction of the pelvis good results can be achieved by using bone grafts and anti-protrusion cages.

Aged↗
PubMed2003

[Fat embolism after total hip prosthesis replacement preserving the femoral stem].

Fat embolism is a known complication of traumatology, especially in long bone fractures. It may also occur in liposuction and articular surgery (0.1%). Fat embolic events are most often clinically insignificant and difficult to recognize since clinical manifestations are varied and there is no routine laboratory or radiographic diagnosis. Classically, fat embolism syndrome presents with the triad of pulmonary distress, mental status changes, and cutaneous manifestations. We report the case of a 33-year-old woman who developed acute respiratory distress 10 days after hip arthroplasty. Several aetiologies such as fibrinocruoric pulmonary embolism, pulmonary aspiration and bacterial pneumonia were discussed. Fat embolism was diagnosed, based on suggestive clinical manifestations, radiographic and laboratory findings, although fat embolism after hip arthroplasty without intramedullary pressurization is infrequent.

Adult↗
PubMed2001

[Using robots in hip prosthesis implantation. Precision with the wrong concept?].

Robot-assisted milling permits more precise preparation of the proximal femur, without necessarily optimizing stem placement. Currently propagated implantation concepts involving maximized implant-cortical bone contact may result in major biomechanical disadvantages, such as unphysiological load transfer in the proximal femur and increased stiffening in this region and subsequent stress shielding. While equipment procurement and running costs are higher, evidence of longer prosthetic life over the long-term has not been forthcoming. Against this background, present efforts to propagate this system for general use in hip replacement surgery cannot be justified.

Arthroplasty, Replacement, Hip↗