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PubMed1977

[Our experiences with total hip prosthesis model "St. George"].

The advantages of the total prosthesis of the hip in the treatment of some degenerative diseases and single traumatic impairments of the hip are described, and the main characteristics of the St. Georg model total prosthesis of the hip are discussed. The results obtained in 92 cases of total prosthesis of the hip have been satisfactory. Special attention has been paid to measures for the prevention of infections. Among the patients treated only one developed infection. The author points to the fact that it is possible to replace an infected prosthesis and achieve complete cure by using bone cement mixed with an antibiotic. The functional results obtained are good: pain is either completely relived, or significantly diminished on walking and movement. During the author's five-year experience signs of wear of the prosthesis have not been recorded in any case.

Aged↗
PubMed2004

Temperature prediction in a finite element model for sliding contact analysis of total hip prosthesis.

A finite-element model for sliding contact in total hip joint prosthesis is presented in this paper. The hip prosthesis studied consists of an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup articulating against cobalt-chrome and alumina-ceramic femoral heads. Various aspects of prosthesis operation were analysed using the finite-element model. For example, bulk material and surface stresses were analysed under varying conditions of elastic modulus, friction coefficient, sliding speed, and radial clearance. The resulting variations of temperature were also recorded. The results obtained from the model are useful in understanding the operating conditions and the causes of wear in the hip prosthesis.

Computer Simulation↗
PubMed1998

Characterization of wear debris associated with aseptic loosening of a canine hip prosthesis.

A 12-month-old Golden Retriever bitch underwent unilateral hip arthroplasty following a diagnosis of coxofemoral osteoarthritis secondary to hip dysplasia. The hip prosthesis underwent aseptic loosening and was removed 6 months after implantation. Synovial biopsies taken at that time revealed scattered foci of granulomatous inflammation associated with intra-cytoplasmic and extracellular particulate material. Electron microscopical analyses demonstrated that this material contained cobalt, chromium, titanium and zirconium, which was probably wear debris from the loosened prosthesis. In human patients with hip arthroplasty, widespread dissemination of wear debris from loosened prostheses occasionally occurs, with an increased prevalence of neoplasia. A similar phenomenon may be predicted to occur with the increasing use of hip arthroplasty in the dog.

Animals↗
PubMed2001

Measurement of the migration of a cemented hip prosthesis in an in vitro test.

OBJECTIVE: To develop a method to measure the migration of a cemented hip prosthesis in an in vitro experimental test. DESIGN: A device to measure prosthesis movement relative to bone was designed and fabricated. It was tested using a Lubinus prosthesis (W. Link, Germany) implanted in a composite femur. BACKGROUND: Clinical studies using radiostereophotogrammetry have shown that those cemented hip prosthesis that migrate rapidly in the first two post-operative years are the ones that require early revision. If migration be used as a basis for a pre-clinical test, then it should be possible to screen-out inferior designs before implantation in animal or clinical trials. METHODS: The micromotion measurement device consisted of a 'target' of three spheres arranged in a cruciform structure. Six linear variable displacement transducers were aligned with the spheres so that motion of the prosthesis relative to the bone could be measured. RESULTS: The displacement and rotation of the prosthesis relative to the composite femur was recorded for two million cycles. Relative rapid initial migration was found, followed by a period of steady-state migration. Distal migration (called 'subsidence' in this paper) of up to 0.1 mm was measured; however the variability in absolute prosthesis migration was very high despite efforts to ensure that all extraneous factors were minimised. In the majority of cases, the prostheses migrated medially, distally and anteriorly. The absolute subsidence, and its variability, were similar to that recorded clinically. CONCLUSIONS: A method has been designed and tested which measures prosthesis migration in an experimental test. It provides a basis for a pre-clinical testing standard. Relevance. Hip prostheses need to be tested experimentally before implantation. However, no reliable test exists for such experimental tests. Rapid migration of a cemented prosthesis relative to bone has been shown in vivo to correlate with early failure, and in this paper a method to make such migration measurements in vitro is described and tested.

Cementation↗
PubMed1992

Phantom studies of triple photon absorptiometry and bone mineral measurement at a hip prosthesis.

The feasibility of using triple photon absorptiometry (TPA) for the measurement of bone mineral mass about a hip prosthesis was examined. A theoretical expression describing the variance of TPA measurements was verified using a triple photon source and phantom materials which simulate the soft tissue-bone mineral-metal prosthesis system. The expression for the variance was used to determine an optimized set of photon energies. It was shown that a precision of 3% could be obtained for reasonable measurement times using this optimized set of energies, and that TPA should be a feasible approach for measurement of bone mineral about a hip prosthesis.

Absorptiometry, Photon↗
PubMed2003

Bone-preserving prosthesis with a single axis for treating osteonecrosis of the femoral head: midterm results for the thrust plate hip prosthesis.

We studied 27 patients (31 joints) who underwent total hip arthroplasty (THA) using the thrust plate hip prosthesis (TPP) for osteonecrosis of the femoral head. The mean follow-up period was 56 months (range 38-72 months). Clinical evaluation by the Merle d'Aubigne and Postel system showed a significant improvement from a preoperative mean score of 8.1 to a final mean follow-up score of 16.6. Mechanical loosening developed about 1 year postoperatively in one joint with a bone defect. Grade 1 stress shielding was observed in four joints. Although indications for the TPP are restricted to certain cases, unlike the conventional intramedullary stem, much can be expected of TPP. It is an outstanding prosthesis for osteonecrosis of the femoral head of young patients in terms of bone preservation and physiological load transfer.

Adult↗
PubMed2003

The value of (18)FDG-PET for the detection of infected hip prosthesis.

We compared the accuracy of fluorine-18 labelled 2-fluoro-2-deoxy- d-glucose positron emission tomography ((18)FDG PET) with that of technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy (LS) in the detection of infected hip prosthesis. Seventeen patients with a hip prosthesis suspected for infection were prospectively included and underwent (99m)Tc-methylene diphosphonate bone scintigraphy (BS), LS and an (18)FDG-PET scan within a 2-week period. Seven volunteers with ten asymptomatic hip prostheses were used as a control group and underwent BS and an (18)FDG-PET scan. Bacteriology of samples obtained by surgery or by needle aspiration and/or clinical follow-up for up to 6 months were used as the gold standard. Planar images of BS and LS (4 and 24 h p.i.) were acquired, followed by single-photon emission tomography (SPET) LS images (after 4 h). These images were scored as positive or negative by two experienced readers. The (18)FDG-PET scans of the patients were compared with the tracer distribution pattern in the asymptomatic control group and with BS. A phantom study was performed in order to identify artefacts. For this purpose, three different attenuation correction methods were tested. The combined analysis of the planar BS and LS resulted in a 75% sensitivity and a 78% specificity. The SPET LS images showed a better lesion contrast, resulting in an 88% sensitivity and a 100% specificity, while 24-h planar images were of no additional value. The analysis of PET images alone resulted in an 88% sensitivity and a 78% specificity. The combination of (18)FDG-PET and BS images resulted in an 88% sensitivity and a 67% specificity. Given the presence of small errors near the edge of the metal, which can induce significant artefacts in the corrected emission image, we decided to use the data without attenuation correction. In this preliminary study, (18)FDG-PET scans alone showed the same sensitivity as combined BS and LS, although the specificity was slightly lower.

Adult↗
PubMedDate not supplied

[Clinical results following the transgluteal and anterolateral (Watson-Jones) approach to hip prosthesis implantation].

80 total hip endoprostheses with antero-lateral (Watson-Johnes) approach are compared with 77 total hip endoprostheses with transgluteal approach (Bauer) after a period of at least one year after the operation. In all cases a cementless implanted model has been used. After transgluteal approach we found less bleeding and hematoma, but slight increased periarticular ossifications. The clinical results (pain, range of motion, distance walked, walking aid, manner of walking) were only a little different. For the technic of implantation of the cementless endoprosthesis the transgluteal approach seems to be more useful.

Adult↗
PubMed2005

Design aspects of compliant, soft layer bearings for an experimental hip prosthesis.

Currently, an artificial hip joint can be expected to last, on average, in excess of 15 years with failure due, in the majority of cases, to late aseptic loosening of the acetabular component. A realistic alternative to the problem of wear in conventional joints is the introduction of bearing surfaces that exhibit low wear and operate in the full fluid-film lubrication regime. Contact analyses and friction tests were performed on compliant layer joints (metal-on-polyurethane) and the design of a prototype ovine arthroplasty model was investigated. When optimized, these components have been shown to achieve full fluid-film lubrication.

Animals↗
PubMed2001

Treatment of dysplastic and congenitally dislocated hips with the Zweymueller total hip prosthesis.

Uncemented Zweymueller total hip prostheses were implanted in 35 dysplastic or dislocated hips in 33 patients. Sixteen hips were dislocated and 19 hips were dysplastic; in 12 hips, an intertrochanteric or pelvic osteotomy was performed in early childhood. In all cases, the titanium screw socket was implanted at the level of the original cotyloid cavity. Osteotomy of the greater trochanter, shortening osteotomy, or roof acetabuloplasty were not performed. In cases in which the femoral cavity was too narrow for the Zweymueller stem, an anterolateral longitudinal window-shaped osteotomy was performed. In cases of severe dysplasia, cotyloid cavity bone grafts from the resected femoral head were placed medially to reinforce the acetabular bottom. Clinical and radiographic follow-up ranged from 3-8 years. Average Harris hip score improved from 47 points preoperatively to 86.2 points postoperatively. Complications included two primary anterior dislocations, two temporary femoral nerve pareses, and two deep vein thromboses. At longest follow-up evaluation, no revision was indicated in any of the hips. Satisfactory results in this series were attributed to careful patient selection, precise preoperative radiographic planning, and an operative technique that included implantation of the socket at the primary acetabulum and achievement of primary stability using press-fit fixation.

Adult↗
PubMed1992

Ten- to 14-year results of a ceramic hip prosthesis.

One hundred total hip arthroplasties with a cementless aluminum oxide socket and ball with different types of cemented metal femoral stems were performed from 1974 to 1979. All were primary implantations. These cases were recently reviewed in a ten- to 14-year follow-up evaluation. Despite extensive laboratory testing of the ceramic material, a significant number of cases resulted in a very unfavorable result such as extensive wear, ball fracture, or migration of the socket. Whereas the patients had died or could no longer be traced in the case of 23 prostheses, there were 25 prostheses that had already been exchanged at the time of review for mechanical reasons (two stem fractures, eight ceramic ball fractures) and for component loosening attributable to wear of the alumina components. The remaining 52 prostheses still in place had good clinical results in 80%. However, roentgenographic evaluation of these prostheses revealed signs of loosening in six femoral components and in three sockets. Migration of more than 5 mm was evident in 24 sockets (46% of surviving prostheses). Although this had caused loosening in only three sockets at the time of review, further migration up to the limits of the acetabular region would be a major reason for future failures.

Adult↗
PubMed2002

Painful infection at the site of hip prosthesis: CT imaging.

PURPOSE: To prospectively determine the accuracy of computed tomography (CT) in the detection of painful infection at the site of hip prosthesis before surgery. MATERIALS AND METHODS: Helical CT examinations of hip prostheses were prospectively performed before surgery after a standard clinical and radiologic examination of 65 patients. CT scans and conventional radiographs were reviewed for periprosthetic bone abnormalities, and CT scans were reviewed for periprosthetic soft-tissue abnormalities (joint distention, fluid-filled bursae, and fluid collection in muscles and perimuscular fat). Patients subsequently underwent revision arthroplasty within 1 month, and infection was diagnosed in 12 (19%) patients. RESULTS: Infection was detected clinically in 25% of patients. Periprosthetic bone abnormalities did not allow differentiation of infection from complications not related to sepsis, except for periostitis, with 100% specificity but only 16% sensitivity. Soft-tissue findings were accurate for detection of infection, with 100% sensitivity and 87% specificity. Fluid collection in muscles and perimuscular fat had a 100% positive predictive value, and absence of joint distention had a 96% negative predictive value. CONCLUSION: CT is accurate in the diagnosis of painful infection at the site of a hip prosthesis on the basis of soft-tissue findings, whereas periprosthetic bone abnormalities are not useful.

Adult↗
PubMed1983

Mittelmeier hip prosthesis autopsy study 2 years after implantation.

A Mittelmeier hip prosthesis was removed at autopsy 2 years after implantation in a patient who was fatally injured. Macroscopic, histological, radiographic, and metrological studies revealed interesting new aspects on the remodelling of bone and the behaviour of the components of the prosthesis.

Acetabulum↗
PubMed2001

Results with the M. E. Müller cemented, straight-stem total hip prosthesis: a 10-year historical cohort study in 180 women.

In 1986, 242 M. E. Muller (MEM) cemented, straight-stem total hip arthroplasty prostheses were implanted in 229 patients; 15 hips (13 patients) were lost to follow-up. Of the remaining 227 implants, 180 were placed in women, and 47 were placed in men (each with mean age, 71 +/- 7.7 years). After 10 years, 66 patients had died, and 152 implants were still in situ. As a result of aseptic loosening, 9 hips were revised (5 femoral and 4 acetabular components); two of these patients had a Girdlestone as a result of postoperative infection. Because 50% of the men died during follow-up, further analysis was performed with the 180 implants in women. The incidence of revision for aseptic loosening was 5.9 per 1,000 implants. The cumulative survival rate after 10 years was 94%. Survival was not influenced significantly by age, indication for operation, or having a contralateral hip prosthesis. The 10-year follow-up results for the MEM straight-stem total hip prosthesis in our hospital are satisfactory despite the probability that the cement mantle produced with this stem is not uniform in thickness.

Aged↗
PubMed1988

Cutaneous fistula communicating with the hip in a patient with a painful total hip prosthesis. Demonstration by radionuclide arthrography.

Radionuclide arthrography is becoming increasingly useful in the evaluation of femoral component loosening in patients with a painful total hip prosthesis. Additional potential advantages of radionuclide arthrography include detection of abnormal communications with the hip, such as bursae, abscess cavities, and fistulas. A case of cutaneous fistula communicating with the hip in a patient with loosening and infection of the femoral component of the total hip prosthesis that is clearly demonstrated by radionuclide arthrography is presented.

Aged↗
PubMed1999

Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series.

We performed a prospective study in 108 consecutive patients (116 hips) who were followed for a minimum of 10 years (10-12 years) after primary total hip arthroplasty using an uncemented porous-coated anatomic (PCA) hip prosthesis. The average age of the patients at operation was 48.4 years (range, 19-85 years), and the diagnosis was avascular necrosis of the femoral head in 46 hips, neglected femoral neck fracture in 27, osteoarthrosis secondary to childhood pyogenic arthritis in 24, childhood tuberculous arthritis in 5, and miscellaneous in 14. The average preoperative Harris Hip Score was 55 points, which improved to 87 points at 11 years. Seventy-five hips (65%) were excellent, 11 (9%) were good, and 30 (39%) were poor. The overall rate of revision was 15% (17 of 116 hips). The rate of revision of the femoral component was 11% (13 of 116 hips), and the rate of revision of the acetabular component was 15% (17 of 116 hips). The prevalence of thigh pain was 28% at 11 years. The increase in the incidence of aseptic loosening of the femoral component was found to explain the high incidence of severe thigh pain at 11 years' follow-up. At 11 years, there was femoral osteolysis in 69 hips (59%) and acetabular osteolysis in 65 hips (56%). At 6 years, 20 hips (17%) showed definite wear of the polyethylene liner. At 11 years, 81 hips (70%) showed definite wear of the polyethylene liner. Because the complication rate of the PCA hip prosthesis with respect to loosening, osteolysis, and excessive wear in the polyethylene liner is high, we abandoned the use of this implant.

Adult↗
PubMed2001

[The role of cytokines in aseptic loosening of total hip prosthesis].

The aim of this study was estimation of the secretory activity of macrophages isolated from granulomatotic tissue in aseptic total hip prosthesis loosening (particularly in regard to IL-6, TNF-alpha and OSM secretion). A considerable increase of IL-6 and TNF-alpha (proosteolytic cytokines) content was noted. At the same time a prominent decrease in OSM (an osteoprotective cytokine) was noted. The obtained results seem to suggest that the changed immunobiology of macrophages consisting of increase osteolytic activity and decreased osteoprotective abilities could be responsible for the loosening of hip prosthesis.

Arthroplasty, Replacement, Hip↗