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Grupp TM, Baxmann M, Jansson V, Windhagen H, Heller KD, Morlock MM, Knaebel HP. How to proceed with asymptomatic modular dual taper hip stems in the case of acetabular revision. MATERIALS 2020; 13:ma13051098. [PMID: 32121627 PMCID: PMC7084958 DOI: 10.3390/ma13051098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
How to proceed with a clinically asymptomatic modular Metha® Ti alloy stem with dual taper CoCr neck adapter in case of acetabular revision? To systematically answer this question the status of research and appropriate diagnostic methods in context to clinically symptomatic and asymptomatic dual taper stem-neck couplings has been evaluated based on a systematic literature review. A retrieval analysis of thirteen Metha® modular dual taper CoCr/Ti alloy hip stems has been performed and a rational decision making model as basis for a clinical recommendation was developed. From our observations we propose that in cases of acetabular revision, that for patients with a serum cobalt level of > 4 µg/L and a Co/Cr ratio > 3.6, the revision of the modular dual taper stem may be considered. Prior to acetabular revision surgery a systematic diagnostic evaluation should be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs and cross-sectional imaging modalities (Metal Artefact Reduction Sequence Magnetic Resonance Imaging). For an asymptomatic Metha® dual taper Ti alloy/CoCr stem-neck coupling at the stage of acetabular revision careful clinical decision making according to the proposed model should be followed and overreliance on any single examination should be avoided, considering the complete individual differential diagnosis and patient situation.
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Affiliation(s)
- Thomas M. Grupp
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
- Correspondence: ; Tel.: +49-7461-95-2667; Fax: +49-7461-95-382667
| | - Marc Baxmann
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany;
| | - Karl-Dieter Heller
- Department of Orthopaedic Surgery, Herzogin-Elisabeth-Hospital, 38124 Braunschweig, Germany;
| | - Michael M. Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, 21073 Hamburg, Germany;
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Catelas I, Lehoux EA, Ning Z, Figeys D, Baskey SJ, Beaulé PE. Differential proteomic analysis of synovial fluid from hip arthroplasty patients with a pseudotumor vs. Periprosthetic osteolysis . J Orthop Res 2018; 36:1849-1859. [PMID: 29352728 DOI: 10.1002/jor.23858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 01/08/2018] [Indexed: 02/04/2023]
Abstract
Adverse tissue reactions to metal implants, including pseudotumors, can compromise implant functionality and survivorship. The identification of specific proteins in the synovial fluid (SF) of hip arthroplasty patients with a pseudotumor may lead to a better understanding of the underlying pathomechanisms. The objective of the present study was to compare the protein content of SF from patients with a short-term metal-on-metal hip implant associated with a pseudotumor and patients with a long-term metal-on-polyethylene hip implant associated with periprosthetic osteolysis. Discovery proteomics was used to identify differentially abundant proteins in albumin-depleted SF. In toto, 452 distinct proteins (present in at least half of the patients in one or both groups) were identified. Thirty of these 452 proteins were differentially abundant between the two groups, including two potential biomarkers: 6-phosphogluconate dehydrogenase (which plays a major protective role against oxidative stress) for the pseudotumor group, and scavenger receptor cysteine-rich type 1 protein M130 (which is involved in low-grade inflammation) for the periprosthetic osteolysis group. Other differentially abundant proteins identified suggest the presence of an adaptive immune response (particularly a type-IV hypersensitivity reaction), necrosis, and greater oxidative stress in patients with a pseudotumor. They also suggest the presence of an innate immune response, oxidative stress, tissue remodeling, and apoptosis in both patient groups, although differences in the specific proteins identified in each group point to differences in the pathomechanisms. Overall, results provide insights into the molecular mechanisms underlying metal-related pseudotumors and periprosthetic osteolysis, and may ultimately help elucidate pseudotumor etiology and assess the risk that asymptomatic pseudotumors will develop into an aggressive lesion. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1849-1859, 2018.
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Affiliation(s)
- Isabelle Catelas
- Department of Mechanical Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario, Canada, K1N 6N5.,Department of Surgery, Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, Ontario, Canada, K1H 8L6.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5
| | - Eric A Lehoux
- Department of Mechanical Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario, Canada, K1N 6N5
| | - Zhibin Ning
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5.,Ottawa Institute of Systems Biology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5
| | - Daniel Figeys
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5.,Ottawa Institute of Systems Biology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5
| | - Stephen J Baskey
- Department of Mechanical Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario, Canada, K1N 6N5
| | - Paul E Beaulé
- Department of Surgery, Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, Ontario, Canada, K1H 8L6
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Shaaban AM, Rezvani M, Olpin JD, Kennedy AM, Gaballah AH, Foster BR, Menias CO, Elsayes KM. Nongynecologic Findings Seen at Pelvic US. Radiographics 2017; 37:2045-2062. [PMID: 29131764 DOI: 10.1148/rg.2017170083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Ultrasonography (US) is frequently the first imaging modality used to examine women with symptoms involving the pelvis. It is widely available and involves no exposure to ionizing radiation. Images can be acquired with a transabdominal, endovaginal, or translabial approach, and the use of video clips and three-dimensional reconstructions can be helpful. US is excellent for assessment of the uterus, ovaries, and adnexa. Occasionally, nongynecologic pelvic diseases arising from the gastrointestinal, genitourinary, and musculoskeletal systems and the pelvic peritoneal and extraperitoneal spaces may be detected and can be a source of diagnostic dilemma. US can be helpful not only in the detection but also occasionally in the characterization of such entities. Computed tomography and magnetic resonance imaging are useful in complicated cases. In this article, the normal US appearance of the bowel and US signs of bowel disease and specific entities, including appendicitis, diverticular disease, bowel obstruction, appendiceal mucocele, and intestinal tumors, are reviewed. The lower urinary tract is included in the field of view in every pelvic US examination; commonly encountered entities related to the urinary bladder, distal ureter, and urethra are illustrated. In addition to arising in the gastrointestinal and genitourinary tracts, pathologic conditions in the pelvis can arise in the peritoneal or extraperitoneal space. Although conditions of the pelvic peritoneal and extraperitoneal spaces are rare, it is important to recognize these entities and distinguish them from the more common gynecologic diseases. Owing to the implications for diagnosis and management, radiologists and other physicians who perform pelvic US should be aware of the spectrum of nongynecologic pathologic entities that can be detected. ©RSNA, 2017.
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Affiliation(s)
- Akram M Shaaban
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Maryam Rezvani
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Jeffrey D Olpin
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Anne M Kennedy
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Ayman H Gaballah
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Bryan R Foster
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Christine O Menias
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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