Some aspects of the development of the Stanmore total hip joint prosthesis.
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Arthroplasty↗
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[Transabdominal removal of femoral and acetabular components of a severely protruded and infected hip arthroplasty with urinary tract complications].
We present the first report of transabdominal removal of femoral and acetabular components of a severely loosened hip prosthesis protruding into the pelvis. In a 73-year-old woman post-operative development of urinary tract complications emphasize importance of careful assessment of the prosthetic relations with the vascular and nervous structures as well as pelvic organs before removal of the hip prosthesis. Angio-computed tomography is the most contributive exploration to assess vascular relations. In patients with particular clinical presentations or with threatened structures in the vicinity of the prosthesis, this examination must be completed by complementary opacifications (urinary and gastrointestinal tracts, joints). Ureteral catheterization may be needed if the structures are close or if there is a suspected modification of the urinary tract (retraction, mass effect). In present case, we did not opacify the urinary tract before laparatomy despite the presence of urinary signs preoperatively. A suspected ureterovaginal fistula was discovered. But they where also a ureteral lesions which can result from difficult dissection in contact with infected tissues. In this patient, urinary complications led to nephrectomy after temporary pyelostomy for urine bypass. At last follow-up, the urinary tract infection was controlled but reimplantation was not attempted because of insulin dependent diabetes mellitus and poor general condition. The spontaneous course of this infection with prosthesis loosening recalls the importance of regular surveillance of total hip replacements.
Abdomen↗
[The Paltrinieri-Trentani hip-joint prosthesis: 5-year follow-up results].
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Adult↗
Accuracy of an electromagnetic tracking device for measuring hip joint kinematics during gait: effects of metallic total hip replacement prosthesis, source-sensor distance and sensor orientation.
The present study sought to investigate the effects of source-sensor distance, sensor orientation and the effects of metallic total hip replacement (THR) prostheses on the accuracy of the 3Space Tracker System (3STS). Using a simulated hip joint, the angles measured by the 3STS with six different source-sensor distances and two source-sensor orientations were recorded. Then the angles measured in the absence and presence of three different THR prostheses were compared. Both source-sensor distance and sensor orientation affects the accuracy of the 3STS. Measurements were only affected by the presence of one type of prosthesis. The 3STS was equally reliable, but less accurate with source-sensor distances of more than 25 cm. The small angular error and insensitivity of this device to the presence of some metallic THR prostheses make it a useful measurement tool for gait studies performed before and after THR surgery.
Arthroplasty, Replacement, Hip↗
[Critical review of the results of arthroplasty of the hip by prosthesis].
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Acrylic Resins↗
Analysis of version in the acetabular cup.
To determine the amount of anteversion or retroversion of the acetabular component of the implanted total hip prosthesis, two anteroposterior radiographs of the hip are obtained, with the contralateral hip flexed to compensate for the possible existing flexion contracture. The X-ray beam is centered on the implanted total hip in one radiograph, and moved away from it toward the contralateral hip in the second radiograph. If the cup is anteverted, the opening will seem wider in the second radiograph. To calculate the angle, the location of the center of the X-ray beam on the X-ray plate must be know. The center of the X-ray beam can be marked on the radiograph by putting a metalic cross on the patient, over the centering cross of the X-ray light source. If the distance of the signature of the X-ray's center beam is less than 8 mm for the center of the cup on the X-ray film, the cup version can be calculated from the arcsin of the shortest to the largest diameter of the cup. If the central ray's signature is farther away, correction is necessary for this calculation. Also, the variable parameters, e.g., cup size, and magnification rate, should be considered in the calculations. The anteroposterior radiographs of the implanted total hip, obtained with the central beam being marked on the X-ray plate, not only are useful for evaluation of the implant but also can be used to calculate the version angle with an accuracy of +/-2 degrees. The necessary calculation is tabulated for cups with an outside diameter of 44-56 mm.
Acetabulum↗
[Is osteolysis associated with a stable total hip replacement asymptomatic?].
PURPOSE OF THE STUDY: It has been reported that periprosthetic osteolysis in a stable cementless total hip prosthesis is often free from symptoms. The aim of this study is to check this assumption and provide details on the clinical presentation of this troublesome and worrying complication of hip arthroplasty. MATERIAL: Between March 1999 and June 2002, 76 hips in 72 patients underwent revision arthroplasty for periprosthetic osteolysis associated with stable ABG I prostheses. This patient group included 53 females and 19 males. The average age at the time of revision was 49 years (range, 32 to 63). The average time between the primary and revision surgery was 54.6 months (range, 23 to 85). The average cup size was 49.7 mm (range, 44 to 60), the modular 28-mm CoCr head was used in 69 hips, 28-mm ceramic head in six hips, and 22-mm CoCr head in one patient. METHODS: The following characteristics were recorded: gender, age, type of patient, height, weight, symptoms, diagnosis, ERS, CRP, Harris hip score, cup size, abduction angle and extent of bony defects. The data of symptomatic and asymptomatic patients were compared by parametric or non-parametric tests. RESULTS: Before revision, 61 hips (80%) were symptomatic. The patients complained of pain or signs of instability or both, and these complaints were taken as indications for revision surgery. The remaining 15 hips (20%) were asymptomatic. The average period from the primary surgery to the appearance of the first symptoms was 43 months (range, 5 to 80). The average Harris hip score before revision was 68 points (range, 37 to 90) and 82 points (range, 10 to 98) in the symptomatic and asymptomatic patients, respectively (p = 0.002). There were no other significant differences between these patients. DISCUSSION: The results of our study are in agreement with the findings of Hozack et al., but not with those of Maloney et al. and others who have reported that the progression of osteolysis developing in association with hip arthroplasty can be without symptoms. CONCLUSIONS: Osteolysis developing around a stable cementless hip prosthesis is generally symptomatic, with pain being the most frequent symptom. Even without a periprosthetic fracture, osteolysis may seriously impair the function of a joint and comfort of the patient. Since symptomatic patients are likely to see their attending physicians, it is emphasized that attention should also be paid to asymptomatic patients who have prostheses with unsuitable designs or pairings.
Adult↗
X-ray diffraction of newly formed bone close to alumina- or hydroxyapatite-coated femoral stem.
The study was focused on the bone tissue response to two types of ceramic coating [alumina and hydroxyapatite (HA)] obtained with a plasma-spray technique. The HA coating was performed on titanium stems, while the alumina coating was on chromium-cobalt-molybdenum stems. The investigation was carried out by means of micro-area X-ray diffractometric analyses and microdiffractometric analyses at the bone-implant interface. Moreover, the coating before and after implantation was analysed by means of the conventional powder X-ray diffractometric technique. This study demonstrated that 1 yr after implantation in animals the newly formed bone adjacent to the HA-coated hip prosthesis stems was mineralized as much as the pre-existing bone, while 24-64 months after surgery in humans the newly formed bone close to the alumina-coated hip prosthesis stems showed a lamellar and Haversian structure strongly demineralized, probably due to the release of aluminum ions from the alumina covering. The authors conclude that the X-ray diffraction allows the evaluation of the structural modifications of the ceramic coating, the bone formation rate close to the coating and the chemical nature of the particles released from the coating.
Aluminum Oxide↗
The influence of the oscillation angle and the neck anteversion of the prosthesis on the cup safe-zone that fulfills the criteria for range of motion in total hip replacements. The required oscillation angle for an acceptable cup safe-zone.
A normal hip joint has more than 120 degrees flexion. The reduced range of motion (ROM) of total hip arthroplast leads to frequent prosthetic impingement, subluxation and dislocation. Prosthetic impingement may be more serious for metal-on-metal and ceramic-on-ceramic total hip prosthesis (THP). A larger oscillation angle of THP (OsA) and proper cup and neck positions make a larger theoretical ROM of a patient's artificial hip joint. But what OsA is required and what range of cup positions is kinetically accepted are not clearly understood. A ROM of more than 120 degrees flexion, 45 degrees internal-rotation at 90 degrees flexion, 30 degrees extension and 40 degrees external-rotation was defined as severe criteria for an acceptable ROM. Theoretical cup safe-zones were created that fulfill the severe criteria of ROM for (OsA=110 degrees , 120 degrees , 135 degrees ) by the mathematical formulas. The size of the cup safe-zone mainly depends on the size of the OsA. There is no cup safe-zone for 110 degrees OsA, an extremely small safe-zone for 120 degrees OsA and an acceptable safe-zone for 135 degrees OsA. Each THP has its own OsA, because OsA is the function of head and neck diameter and cup design. More than 135 degrees OsA enlarges the safe-zone of the prosthetic position, so it extends the acceptable range of error that surgeons cannot avoid completely. However, few THPs with more than 135 degrees OsA are currently clinically available. Both surgeons and manufacturers must realize that OsA is as essential as cup and neck orientations for ROM.
Arthroplasty, Replacement, Hip↗
Intracapsular hip fractures in patients with rheumatoid arthritis.
We reviewed the treatment of 43 patients with rheumatoid arthritis and femoral neck fracture. Patients' average age was 66.4 (36-80) years and average duration of RA was 20.3 (4-42) years. Thirteen patients were treated with primary total hip arthroplasty (THA), and the clinical results were comparable to patients treated conservatively or by osteosynthesis. Eighteen patients were treated with primary bipolar hip prosthesis and after an average of 6.1 (1-13) years there was no acetabular destruction. However, long-term results were inferior to patients treated with THA. Nine patients were treated with osteosynthesis, of which two later had a hip prosthesis. Three cases with impacted fractures were treated conservatively with successful union in all.
Adult↗
[Superselective electronic subtraction angiography. Experience in 6 surgically treated hips using the double cup prosthesis].
Six hips in five patients with Wagner double cup surface replacement prostheses were examined by superselective angiography of the medial femoral circumflex artery to determine a possible relationship between a lesion of the artery and loosening of one or other components of the prosthesis. Electronic subtraction of the angiographic images allowed a precise appreciation to be made of the condition of the vessels. No relationship was found. Lesions of the medial femoral circumflex artery were found, even when the prosthesis was firmly in place. This finding is contrary to that of authors who consider that an extra-osseous vascular lesion always leads to bone necrosis and loosening in double cup surface replacement prostheses.
Adult↗
[Changes of biomechanical parameters in dysplasia of the hip by total hip replacement].
AIM: Dysplastic hips or dislocated hips lead to loss of muscle strength claudication, and finally to coxarthrosis. This study analytically compares the hip joint forces in normal, dysplastic hips and hips after implantation of a hip prosthesis for several positions. METHOD: The results of 173 total hip replacements in 153 cases of either severe congenital dysplasia or dislocation were analyzed. A 2 dimensional mathematical model of the hip was developed to evaluate the effects of surgically achievable mechanical alterations such as acetabular placement, femoral shaft-prosthetic neck angle, and neck length of the femoral prosthesis. RESULTS: 63 % of the hip prosthesis were implanted on the right, 72 % on the left. Before implantation, the femoral shaft-prosthetic neck angle in mean was 146 degrees +/- 10 degrees, after implantation it was 135 degrees. The hip centre was displaced on in average 10 mm distally. Postoperatively hip joint force was increased 21 %. CONCLUSION: Minimum joint contact forces occurred when the femoral shaft prosthetic neck angles were small. The loads on the hip were lowered significantly by placing the centre of the acetabulum as far inferiorly and medially as possible. Another important finding is that displacement of the hip centre distally has a great effect on muscle performance and hip joint force.
Adult↗
Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer.
Infected hip prosthesis, a serious complication of primary total hip arthroplasty (THA), can have severe consequences. We report the treatment outcome of two-stage revision THA for infected hip arthroplasty, including hemiarthroplasty, using an antibiotic-impregnated cement spacer for the interval between the first and second stages. Between 1996 and 2000 we performed this procedure on nine hips in eight patients. Cementless revision THA was performed as the second-stage procedure. Bone defects were restored with frozen allografts. The outcome was evaluated using the hip score of the Japanese Orthopaedic Association (JOA hip score). The mean duration of follow-up was 35.7 months (range 10-55 months). The mean JOA hip score at follow-up improved from 30.1 (range 10-74) to 73.2 (24-96). The mean interval between the first and second stages was 10.1 weeks (range 6-19 weeks). Eight of the nine hips achieved a successful outcome. One hip, with methicillin-resistant Staphylococcus aureus infection, experienced recurrence 4 months after revision THA. This patient was successfully treated 14 months after the first revision THA with a second two-stage procedure using a vancomycin- and arbekacin-impregnated cement spacer and beads. These results suggest that two-stage revision THA using an antibiotic-impregnated cement spacer is a useful technique for treating infected hip arthroplasty.
Aged↗
Adverse impact of surgical site infections in English hospitals.
Between October 1997 and June 2001, 140 English hospitals participating in the surveillance of surgical site infection (SSI) with the Nosocomial Infection National Surveillance Service (NINSS) reported 2832 SSIs following 67 410 surgical procedures in nine defined categories of surgery. Limb amputation had the highest incidence of SSI with 14.3 SSIs per 100 operations. For all categories of surgery, except knee prosthesis (P=0.128), there was a linear increase in the incidence of SSI when the American National Nosocomial Infections Surveillance risk index increased. Superficial incisional SSI was more common than deep incisional and organ/space SSI, and accounted for more than half of all SSIs for all categories of surgery. The postoperative length of stay (LOS) was longer for patients with SSI, and when adjusted for other factors influencing LOS, the extra LOS due to SSI ranged from 3.3 days for abdominal hysterectomy to 21.0 days for limb amputation, and was at least nine days for the other categories. The additional cost attributable to SSI ranged from pound959 for abdominal hysterectomy to pound6103 for limb amputation. Deep incisional and organ/space SSI combined incurred a greater extra LOS and cost than superficial incisional SSI for all categories of surgery, except limb amputation. The crude mortality rate was higher for patients with SSI for all categories of surgery but, after controlling for confounding, only patients with SSI following hip prosthesis had a mortality rate that was significantly higher than those without SSI [odds ratio (OR)=1.8, P=0.002]. However, the adjusted mortality rate for patients with deep incisional and organ/space SSI compared with those without SSI was significantly higher for vascular surgery (OR=6.8, P<0.001), hip prosthesis (OR=2.5, P=0.005) and large bowel surgery (OR=1.8, P=0.04). This study shows that the adverse impact of SSI differs greatly for different categories of surgery, and highlights the importance of measuring the impact for defined categories rather than for all SSIs and all surgical procedures.
Amputation, Surgical↗
Hip arthroplasty for ochronosis.
Alkaptonuria is a metabolic disorder in which homogentisic acid oxidase is absent. Therefore, homogentisic acid accumulates in cartilage and connective tissues. We can diagnose ochronotic arthropathy, a manifestation of long standing alkaptonuria, through careful radiological, physical, and laboratory examination. In this report, we describe 4 cases of ochronotic arthropathy to which we applied cementless total hip prosthesis due to severe hip involvement.
Aged↗
Severe wear from retrieved alumina-on-alumina coupled implant: a case report.
This study details the in vivo wear behavior of an alumina acetabular cup and a femoral head on a retrieved non-cemented hip prosthesis. A commercial alumina ceramic-on-ceramic prosthesis was retrieved from a patient previously treated for bilateral hip arthrosis in "coxa profunda". Massive wear was found on the retrieved alumina ceramic head and acetabular cup. The total measured penetration depth was 1.9 mm while the total calculated weight loss for the acetabular cup was 6.06 g. The study underlines the head-cup instability caused by cup loosening as major cause of severe ceramic wear.
Aluminum Oxide↗
[Treatment experience with chronic spinal pain in involutional osteoporosis].
The back pain syndrome which accompanies involutional osteoporosis presents a marked heterogeneity. Acute pain may be due to vertebral fractures, whereas chronic pain may eventually accompany established osteoporosis in which clinical and instrumental evidence are present. Back pain is the consequence of the mechanical (internal or external pressure) or chemical stimulation of pain receptors present in bone tissue, along the vessels, in cartilage, joints, disk, ligaments, and also in soft tissue and muscle (with secondary antalgic contracture). The compression of spinal nerves may contribute to the pain as well. An evident alteration of mood is usually present and represents an important element in the syndrome. This phenomenon interferes with the evolution of pain, in particular as regards its intensity. Besides scales for the evaluation of pain and inability, it is possible to check objective data by means of particular algometers (not easy to employ) or by electromyographic measurements of antalgic secondary contracture of spinal muscle. Gait examination (basography) of patients with painful hip prosthesis may provide objective evaluation regarding specific antalgic activity on bone of drugs. Usually the effective drugs for osteoporosis possess antalgic properties as well, with different mechanisms of action. Three drugs with evident activity are taken into consideration: calcitonin, ipriflavon, aminobutane-bisphosphonate (alendronate). Though each of them possesses some particular activity, the main mechanism of action is dependent on their effect on the local microenvironment, particularly at the level of bone tissue (calcium, cytokine and prostaglandin local concentration), on the modulation of osteoclast activity. In particular alendronate (intermittently administered intravenously) exerts the most evident antalgic activity. Subjective chronic back pain relief is accompanied by (secondary) reduction of antalgic contracture at vertebral muscle level. The activity of the substance against the painful hip prosthesis (documented by basographic gait recording) leads us to conclude that the substance really exerts a direct antalgic action at the level of bone tissue.
Analgesics↗
Clear cell chondrosarcoma of the proximal femur with intrapelvic extension.
Clear cell chondrosarcoma is a rare tumor that can be easily confused with benign tumors. The aim of this report is to present a case that is rare, initially diagnosed as aneurysmal bone cyst and then chondroblastoma, and has an interesting extension pattern. A 41-year-old male patient was treated for an apparently benign cystic lesion of the right proximal femur by intralesional excision and bone grafting. The pathological diagnosis was aneurysmal bone cyst. Two years later, the patient presented with a pathological fracture at the same site and a total hip arthroplasty was performed. The pathological specimen was diagnosed as chondroblastoma. Three years later, clinical and radiological examination of the patient revealed a large mass located on the intrapelvic side of the acetabulum. There was no evidence of distant metastases. Both tumors were resected with a wide margin on the femoral side and a marginal margin on the intrapelvic side. The extremity was reconstructed with a resection-type total hip prosthesis. Again, the pathological diagnosis was chondroblastoma. The patient developed a deep infection that was treated by antibiotic therapy and surgical debridement. One year later, there was recurrence of the femoral and intrapelvic masses and right hemipelvectomy was performed; the specimen was reported as clear cell chondrosarcoma. Since then, the patient has been leading an active life, and there is no evidence of local recurrence or distant metastasis. Clinically and pathologically, clear cell chondrosarcoma may be confused with benign bone tumors. This caused a delay in the final diagnosis of this patient and he received inadequate surgical treatment, leading to a hemipelvectomy. We also found that the intrapelvic mass seemed to have developed independently on the intrapelvic side of the acetabulum. We were unable to find an exact explanation for this finding and postulated that tumor cells might have been seeded into the inner wall of the acetabulum during acetabular preparation of the total hip prosthesis.
Adult↗