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Won H, Baek SH, Kim J, Lee WK, Lee YS, Kim SY. Average 22-Year Results of Total Hip Arthroplasty Using Harris-Galante Prosthesis in Patients under 50 Years. Clin Orthop Surg 2022; 14:335-343. [PMID: 36061837 PMCID: PMC9393279 DOI: 10.4055/cios21176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/18/2021] [Accepted: 12/31/2021] [Indexed: 11/06/2022] Open
Abstract
Background The Harris-Galante (HG) prosthesis is a first-generation, cementless total hip arthroplasty (THA) prosthesis. Considering the recent increase in the demand for THA in young patients and their life expectancy, a study with a follow-up duration of longer than 20 years in a young population is needed. Therefore, we evaluated the long-term clinical and radiographic results after cementless THA using the HG prosthesis in patients younger than 50 years. Methods A total of 61 THAs performed using the HG with a minimum follow-up of 10 years were included. There were 38 men and 11 women with an average age of 46 years and the mean follow-up duration was 22 years. Clinical evaluation included modified Harris Hip Score (HHS) and radiographic analysis consisted of cup inclination, anteversion angle, component stability, osteolysis, liner wear rate, wear-through, liner dissociation, and heterotopic ossification. Complications included recurrent dislocation, periprosthetic femoral fracture, and periprosthetic joint infection. Survivorship analysis included cup and stem revision for aseptic loosening, as well as any revision. Results The HHS improved from 46.5 preoperatively to 81.8 postoperatively (p < 0.001). The average linear wear rate was 0.36 mm/yr. A total of 34 hips (56%) were revised: stem revision in 10 (16.4%), cup revision in 9 (14.8%), exchange limited to bearing surface in 8 (13.1%), and revision of all components in 7 (11.5%). Estimated survivorship at 34 years postoperatively was 90.9% for cup revision for aseptic loosening, 80.5% for stem revision for aseptic loosening, and 22.1% for any revision. Conclusions THA using the HG prosthesis showed satisfactory estimated survivorship of the acetabular and femoral components at 34 years postoperatively with good clinical outcomes. Bearing-related problems, such as osteolysis and liner dissociation, accounted for 56% of revision operations and were concerns in patients younger than 50 years.
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Affiliation(s)
- Heejae Won
- Department of Orthopedic Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Junekyu Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Won Kee Lee
- Department of Medical Statistics, Kyungpook National University, Daegu, Korea
| | - Yeon Soo Lee
- Department of Biomedical Engineering, College of Medical Science, Catholic University of Daegu, Gyeongsan, Korea
| | - Shin-Yoon Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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Knappe K, Stadler C, Innmann MM, Schonhoff M, Gotterbarm T, Renkawitz T, Jaeger S. Does Additive Pressurized Carbon Dioxide Lavage Improve Cement Penetration and Bond Strength in Cemented Arthroplasty? J Clin Med 2021; 10:5361. [PMID: 34830643 PMCID: PMC8620516 DOI: 10.3390/jcm10225361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022] Open
Abstract
The modern cementing technique in cemented arthroplasty is a highly standardized and, therefore, safe procedure. Nevertheless, aseptic loosening is still the main reason for revision after cemented total knee or cemented total hip arthroplasty. To investigate whether an additional carbon dioxide lavage after a high-pressure pulsatile saline lavage has a positive effect on the bone-cement interface or cement penetration, we set up a standardized laboratory experiment with 28 human femoral heads. After a standardized cleaning procedure, the test implants were cemented onto the cancellous bone. Subsequently, the maximum failure load of the bone-cement interface was determined using a material testing machine to pull off the implant, and the cement penetration was determined using computed tomography. Neither the maximum failure load nor cement penetration into the cancellous bone revealed significant differences between the groups. In conclusion, according to our experiments, the additive use of the carbon dioxide lavage after the high-pressure pulsatile lavage has no additional benefit for the cleaning of the cancellous bone and, therefore, cannot be recommended without restrictions.
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Affiliation(s)
- Kevin Knappe
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.M.I.); (T.R.)
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Christian Stadler
- Department of Orthopedic and Trauma Surgery, Linz University, 4020 Linz, Austria; (C.S.); (T.G.)
| | - Moritz M. Innmann
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.M.I.); (T.R.)
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Mareike Schonhoff
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Tobias Gotterbarm
- Department of Orthopedic and Trauma Surgery, Linz University, 4020 Linz, Austria; (C.S.); (T.G.)
| | - Tobias Renkawitz
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.M.I.); (T.R.)
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
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Carkci E, Polat AE, Ozturkmen Y, Tuzuner T. Long-Term results of total Hip Arthroplasty performed using a cementless expansive Acetabular Cup and Spotorno Femoral Stem. Pak J Med Sci 2020; 37:52-58. [PMID: 33437250 PMCID: PMC7794123 DOI: 10.12669/pjms.37.1.3089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective In this study we aimed to investigate the long-term clinical and radiological results, revision rates and causes, and the rate of implant survival in total hip arthroplasty performed using CLS® expansion cup and Spotorno® cementless femoral stem. Methods Clinical results of total hip arthroplasty performed on 131 hips of 114 patients in Istanbul Training and Research Hospital between 1993 and 2003 were retrospectively evaluated according to the Harris Hip Score. Revision rates were determined and implant survival rates were identified using the Kaplan-Meier estimator. Results Of the patients, 39 were males and 75 were females. The average age of the patients at surgery was 48.7±11.3 years. Patients were followed up for a mean period of 13.9±2.4 years. The mean Harris Hip Score was 34.35±6.09 preoperatively and 88.20±7.11 at the final follow-up (p<0.001). The Kaplan-Meier survivorship estimate for the cup at 13.9 years, taking revision for any reason as the end point was 95.6% (95% CI), while the 15th and 17th year survival rates were 90% and 85%, respectively. Conclusion In total hip arthroplasty using a cementless expansive acetabular cup, a 95.6% survival rate is achieved after an average of 14 years, whereas the rate decreases to 85% after 17 years. Even if the incidence of cup breakage is reduced with proper implantation, particle disease and periacetabular osteolysis remains a problem for the long-term survival.
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Affiliation(s)
- Engin Carkci
- Engin Carkci, Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ayse Esin Polat
- Ayse Esin Polat, Department of Orthopaedics and Traumatology, Dr. Akcicek State Hospital, Kyrenia, Turkish Republic of Northern Cyprus
| | - Yusuf Ozturkmen
- Yusuf Oztürkmen, Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Tolga Tuzuner
- Tolga Tuzuner, Department of Orthopaedics and Traumatology, Acibadem Bakirkoy Hospital, Istanbul, Turkey
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Prosthetic femoral head erosion through an acetabular component treated with revision and implant preservation. Arthroplast Today 2020; 6:9-13. [PMID: 32211468 PMCID: PMC7083747 DOI: 10.1016/j.artd.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/20/2022] Open
Abstract
We present a case report of the rare complication of a femoral head prosthesis eroding through the acetabular liner and shell resulting in a clinical presentation of pseudo-dislocation. The patient presented with a 1-month history of progressive anterior and peritrochanteric hip pain without antecedent trauma. Radiographs demonstrated presumed hip dislocation with superior-posterior superimposition of the femoral head over the acetabular component. The patient underwent revision total hip arthroplasty with intraoperative evidence of extensive metallosis, osteolysis, and femoral head erosion through the acetabular polyethylene liner, acetabular shell, and implantation into the ilium. The femoral stem and acetabular shell were well-fixed, allowing for filling of the defect with bone void filler and cementation of a new polyethylene liner into the acetabular shell.
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Yoshioka S, Nakano S, Kinoshita Y, Nakamura M, Goto T, Hamada D, Sairyo K. Comparison of a highly porous titanium cup (Tritanium) and a conventional hydroxyapatite-coated porous titanium cup: A retrospective analysis of clinical and radiological outcomes in hip arthroplasty among Japanese patients. J Orthop Sci 2018; 23:967-972. [PMID: 30055877 DOI: 10.1016/j.jos.2018.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The use of 3-dimensional highly porous acetabular cups is increasing. Their structure and mechanical properties mimic those of natural bone; therefore, they should promote stronger biological fixation. In our experience with total hip arthroplasty, radiolucent lines are observed when a 3-dimensional highly porous cup (Stryker Tritanium) is used. We compared the clinical and radiographic results between a Tritanium cup and a conventional cup (Stryker Trident HA) over a short time period. METHOD We retrospectively compared consecutive cases of primary total hip arthroplasty using a Tritanium cup (130 cases in 118 patients) and a matched cohort using a Trident cap (130 cases in 130 patients) between January 2011 and December 2014. RESULTS The mean follow-up duration was 41.3 and 38.1 months (p = 0.06) for the Tritanium and Trident groups, respectively. There were significant differences between the groups for radiolucent lines, cup abduction angle, and cup-center-edge angle. There were no significant differences in the clinical results. Radiolucent lines increased in the Tritanium group (36.1% at 3 months and 60.7% at final follow-up), whereas they decreased in the Trident group (2.5% at 3 months and 0.8% at final follow-up). The occurrence of radiolucent lines was significantly higher in the Tritanium group than in the Trident group at each follow-up period. Radiolucent lines were seen in 36.1% of patients in the Tritanium group during follow-up, without initial gaps. One cup loosening in the Tritanium group was identified at the final follow-up evaluation. CONCLUSION Both groups showed successful clinical results over short-term follow-up; however, the Tritanium group had a significantly higher rate of radiolucent line occurrence around the cups than did the Trident group. Thus, radiolucent lines can occur when using highly porous titanium cups; these lines indicate the possibility of future cup loosening. Longer follow-up and assessment of the results of using this implant are necessary.
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Affiliation(s)
| | | | | | | | - Tomohiro Goto
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
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Kurcz B, Lyons J, Sayeed Z, Anoushiravani AA, Iorio R. Osteolysis as it Pertains to Total Hip Arthroplasty. Orthop Clin North Am 2018; 49:419-435. [PMID: 30224004 DOI: 10.1016/j.ocl.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteolysis is a long-term complication of total hip arthroplasty (THA). As the projected number of THAs performed annually increases, osteolysis will likely continue to occur. However, because of advancements in prosthesis design, metallurgy, and enhanced bearing surfaces, fewer revision THAs will be linked to osteolysis and aseptic loosening. Despite these improvements, no preventative therapies are currently available for the management of osteolysis other than removing and replacing the source of bearing wear.
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Affiliation(s)
- Brian Kurcz
- Division of Orthopaedic Surgery, Southern Illinois University, 701 North 1st Street, Springfield, IL 62781, USA
| | - Joseph Lyons
- Department of Surgery, Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Zain Sayeed
- Department of Orthopaedic Surgery, Detroit Medical Center, 4201 Saint Antoine, Detroit, MI 48201, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA
| | - Richard Iorio
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA.
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Ren L, Wang W. Effect of risedronate on femoral periprosthetic bone loss following total hip replacement: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e0379. [PMID: 29702983 PMCID: PMC5944478 DOI: 10.1097/md.0000000000010379] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent study has reported that risedronate was effective in reducing periprosthesis bone loss after total hip arthroplasty (THA). The meta-analysis was performed to compare the clinical outcomes of THA with oral risedronate versus placebo. METHODS Electronic databases: PubMed (1950-March 2018), EMBASE (1974-March 2018), the Cochrane Central Register of Controlled Trials, Web of Science (1950-March 2018) were systematically searched. Two authors independently graded the methodological quality of each eligible study using the Cochrane Collaboration tool and extracted relevant data. Statistical heterogeneity among the trials were evaluated with chi-square and I-square tests. This meta-analysis was performed using STATA 14.0. RESULTS A total of 4 randomized controlled trials (RCTs) published between 2006 and 2015 were included in our study. The meta-analysis demonstrated that risedronate was associated with a significantly reduction of periprosthetic bone mineral density after THA. No increased postoperative complications were observed. CONCLUSION Oral risedronate might reduce the periprosthetic bone resorption after cementless THA. Additionally, no severe adverse effects were observed. High-quality RCTs with large sample size were still required.
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