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Yoon JY, Moon JK, Kim CH, Lee S, Yoon PW. Korean epidemiology and trends in hip joint replacements. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.8.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to analyze the epidemiologic characteristics of patients who underwent hip arthroplasty using the Korean nationwide database and investigate the recent trends in implant fixation methods and bearing surface selection. We aimed to compare clinical characteristics and differences with the results from the registry of other western countries. We analyzed the data collected by the Health Insurance Review and Assessment Service database of Korea from 2007 to 2011 and the Main Surgery Statistical Yearbook from 2014 to 2018, published by the National Health Insurance Service. The number and rate of patients who underwent hip joint arthroplasty per 10,000 persons have been steadily increasing since 2007. There was a big difference in mean age and preoperative diagnosis of patients between the bipolar hemiarthroplasty and total hip arthroplasty groups. Most patients underwent surgery using a cementless biological fixation method, and the cemented fixation method was selectively used for a small portion of old aged osteoporotic patients. In relation to the use of bearing surfaces, the registry data showed that ceramic-ceramic bearings were used at an overwhelmingly high rate (81%) in Korea compared to other countries. The reason was attributable to various factors, such as patient’s age or economic status, differences in the health insurance system between countries, and recently reported complications, such as ceramic fracture or noise.
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Hernandez NM, Chalmers BP, Perry KI, Berry DJ, Yuan BJ, Abdel MP. Total Hip Arthroplasty After In Situ Fixation of Minimally Displaced Femoral Neck Fractures in Elderly Patients. J Arthroplasty 2018; 33:144-148. [PMID: 28844629 DOI: 10.1016/j.arth.2017.07.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In situ screw fixation remains the most common treatment for minimally displaced femoral neck fractures (FNFs). Total hip arthroplasty (THA) can be used as a salvage procedure, but the results of conversion THA in this population have not been evaluated. The goals of this study were to evaluate (1) unique complications associated with conversion THA, (2) implant survivorship free of revision and reoperation, (3) radiographic results, and (4) clinical outcomes in patients undergoing conversion THA after in situ fixation of nondisplaced FNFs. METHODS Between 2000 and 2014, 62 consecutive patients >65 years of age who underwent THA after in situ fixation of minimally displaced FNFs were identified. Indications were osteonecrosis (44%), post-traumatic/degenerative arthritis (35%), and nonunion (21%). Mean age was 78 years, and 73% patients were women. Mean follow-up was 5.5 years. RESULTS One patient was revised for aseptic femoral loosening at 11 years. One patient underwent debridement and modular component exchange at 10 years for acute hematogenous periprosthetic joint infection. Two patients underwent acute reoperation without component exchange (one superficial wound infection, one hematoma evacuation). Survivorship free of reoperation for any indication was 97% at 5 years. No patients with surviving implants had radiographic evidence of loosening at 5 years. Harris hip scores improved from 35-85 (P < .01) after THA. CONCLUSION Conversion THA was associated with clinical improvement, a low rate of complications, and excellent implant durability. Risks of loosening, dislocation, and periprosthetic fracture can be minimized with appropriate operative strategies and perioperative management.
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Affiliation(s)
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brandon J Yuan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Shahcheraghi GH, Hashemi SA. Cementless Hip Arthroplasty in Southern Iran, Midterm Outcome and Comparison of Two Designs. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:418-24. [PMID: 26379348 PMCID: PMC4567601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 10/28/2013] [Accepted: 12/22/2013] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cementless hip prosthesis was designed to provide biologic fixation, without the use of cement. The second generation components have shown more reliable bone ingrowths and survival rates. We are reporting a midterm result of two designs of cementless prosthesis in a unique culture with different social habits and expectations. METHODS 52 primary cementless total hip arthroplasty in 42 patients with the mean age of 48.8 years were retrospectively studied. Two groups of prosthesis had been implanted: Harris-Galante II (HGII) in 15 and Versys-Trilogy (V-T) in 37 hips, both from Zimmer company. The patients were assessed clinically, radiographically and with Harris hip score, SF36, WOMAC, and MACTAR questionnaires, with 65 months (26-136) mean follow-up. RESULTS All the V-T prostheses had survived well. Eight of HG II were revised by the last follow-up in 19-102 months. All had undergone acetabular revision and 2 combined with femoral revision. Broken tines of HGII cups were seen in 4 radiographs. The 65 months overall survival was 96.2% for femoral and 84.6% for acetabular components. 90% had good or excellent Harris hip scores. The functional scores were poorer in the HG II group. Pain relief and improved walking were the two main patients' expectations fulfilled in 97.6% and 92.8%, respectively. CONCLUSIONS The outcome of cementless total hip arthroplasty (THA) is satisfactory and comparable with the literature based on the results of function and survival of this small comparative group. The use of HGII acetabular component should be abandoned.
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Affiliation(s)
- Gholam Hossein Shahcheraghi
- Professor of Orthopaedic Surgery, Bone and Joint Disease Research Center, Department of Orthopedic Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Hashemi
- Assistant professor of Orthopaedic Surgery, Bone and Joint Disease Research Center, Department of Orthopedic Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Seyed Ali Hashemi, MD; Department of Orthopedic Surgery, Chamran Hospital, Chamran Blvd., Shiraz, Iran, P.O. Box: 71948-15644 Tel: +98 71 36246093 Fax: +98 71 36231409
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Keurentjes JC, Pijls BG, Van Tol FR, Mentink JF, Mes SD, Schoones JW, Fiocco M, Sedrakyan A, Nelissen RG. Which implant should we use for primary total hip replacement? A systematic review and meta-analysis. J Bone Joint Surg Am 2014; 96 Suppl 1:79-97. [PMID: 25520423 DOI: 10.2106/jbjs.n.00397] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many total hip implants are currently available on the market worldwide. We aimed to estimate the probability of revision surgery at ten years for each individual total hip implant and to compare these estimates with the National Institute for Health and Care Excellence (NICE) benchmark. METHODS We performed a meta-analysis of cohort studies. The methodological quality was assessed with use of the Assessment of Quality in Lower Limb Arthroplasty (AQUILA) checklist. We searched PubMed, Embase, Web of Science, and the Cochrane Library. Additionally, national joint registries that were full members of the International Society of Arthroplasty Registers (ISAR) were hand searched. Studies in which the authors reported the survival probability for either the acetabular or the femoral component of primary total hip replacements with use of revision for any reason or for aseptic loosening at ten years as the end point, with at least 100 implants at baseline, and in which at least 60% of the patients had primary osteoarthritis were eligible for inclusion. RESULTS The search strategy revealed 5513 papers describing survival probabilities for thirty-four types of acetabular components and thirty-two types of femoral components. Eight types of acetabular cups and fifteen types of femoral stems performed better than the NICE benchmark. CONCLUSIONS We recommend that surgeons performing a primary total hip replacement use an implant that outperforms the NICE benchmarks.
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Affiliation(s)
- J Christiaan Keurentjes
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes:
| | - Bart G Pijls
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes:
| | - Floris R Van Tol
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes:
| | - Jill F Mentink
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes:
| | - Stephanie D Mes
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes:
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands
| | - Marta Fiocco
- Department of Medical Statistics and BioInformatics, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands
| | - Art Sedrakyan
- Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065
| | - Rob G Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, Leiden, the Netherlands. E-mail address for J.C. Keurentjes:
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Klotz MCM, Beckmann NA, Bitsch RG, Seebach E, Reiner T, Jäger S. Bone quality assessment for total hip arthroplasty with intraoperative trabecular torque measurements. J Orthop Surg Res 2014; 9:109. [PMID: 25391790 PMCID: PMC4251677 DOI: 10.1186/s13018-014-0109-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/24/2014] [Indexed: 11/21/2022] Open
Abstract
Background In cases of poor bone quality, intraoperative torque measurement might be an alternative to preoperative dual-energy X-ray absorptiometry (DXA) to assess bone quality in total hip arthroplasty (THA). Methods Trabecular peak torque measurement was applied in 14 paired fresh frozen human femurs. Here, a 6.5 × 23 mm wingblade was inserted into the proximal femur without harming the lateral cortical bone. Further tests of the proximal femur also evaluated bone strength (DXA, micro-computed tomography (μCT), monoaxial compression test), and the results were compared to the trabecular torque measurement. Student’s t-test was used to compare the values of the groups. Pearson product–moment was applied to correlate the values of the peak torque measurement with the bone strength measured by DXA, μCT, and monoaxial compression test. Results In the femoral head, the mean trabecular peak torque was 4.38 ± 1.86 Nm. These values showed a strong correlation with the values of the DXA, the μCT, and the biomechanical load test (Pearson’s product–moment: DXA: 0.86, μCT-BMD: 0.80, load test: 0.85). Furthermore, the torque measurement showed a more pronounced correlation with the biomechanical load test compared to the DXA. Conclusions The use of this method provides highly diagnostic information about bone quality. Since the approach was adjusted for THA, no harm of the lateral bone stock will result from this measurement during surgery. The results of this initial study employing small sample sizes indicate that this new method is as sensitive as DXA in predicting bone quality and may function as an intraoperative alternative to DXA in THA. Nevertheless, before this method will turn into clinical use, more research and clinical trials are necessary.
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Affiliation(s)
- Matthias C M Klotz
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
| | - Nicholas A Beckmann
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
| | - Elisabeth Seebach
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
| | - Tobias Reiner
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
| | - Sebastian Jäger
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
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Park MS, Chung WC, Yoon SJ, Cho HM, Kwon SH. Eleven-year follow-up of second-generation metal-on-metal total hip arthroplasty. J Orthop Surg (Hong Kong) 2010; 18:15-21. [PMID: 20427827 DOI: 10.1177/230949901001800104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the cause of failure in matte-surface cemented stems in second-generation metal-on- metal total hip arthroplasty (THA). METHODS Records of 26 men and 11 women (39 hips) aged 29 to 72 years who underwent primary cementless THAs by a single surgeon using second-generation metal-on-metal prostheses and were followed up for a mean of 122 (range, 120-141) months were reviewed. Two types of femoral stems were used: a cementless Ti-alloy stem (n=21) and a matte-surface, iron-based alloy, cemented stem (n=18). Clinical outcomes were measured using the Harris hip score. Radiographs were assessed for stem loosening and osteolysis. Patient activity levels were graded. Surfaces of the retrieved femoral stems and periprosthetic tissue samples were examined. Metallic and cement particles were studied. Hypersensitivity to metal was tested. RESULTS None of the cementless stems were revised; no osteolysis or stem loosening occurred. In contrast, 7 of 18 matte-surface cemented stems were revised owing to stem loosening or osteolysis. Periprosthetic tissues revealed abundant cement-related particles; 90% were zirconium oxides but a few were iron particles. Histological examination of periprosthetic tissues showed perivascular infiltration of lymphocytes and macrophages containing tiny foreign materials. Metal hypersensitivity was not associated with aseptic loosening. CONCLUSION Metal-on-metal THA with cementless components could be recommended for young, active patients to prevent wear and osteolysis. The matte-surface cemented stem is more likely to fail owing to friction during the earlier stage and cement-related biological processes during the later stage.
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Affiliation(s)
- Myung-Sik Park
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.
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Meding JB, Galley MR, Ritter MA. High survival of uncemented proximally porous-coated titanium alloy femoral stems in osteoporotic bone. Clin Orthop Relat Res 2010; 468:441-7. [PMID: 19727996 PMCID: PMC2806973 DOI: 10.1007/s11999-009-1035-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 07/27/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Because the initial fixation of an uncemented stem may be compromised in patients with osteoporotic bone (Class C, Dorr et al.), many surgeons prefer a cemented stem in this setting. We therefore determined the survival of an uncemented, proximally porous-coated, straight-stemmed, titanium alloy femoral component in patients with Class C bone when compared with Class A and B bone. We implanted proximally plasma-sprayed, straight-stemmed titanium alloy stems in 1994 patients (2321 hips). Of these, 625 hips (27%), 1569 hips (67%), and 127 hips (6%) were classified as Classes A, B, and C, respectively. Minimum followup was 2 years (mean, 5.9 years; range, 2-19.5 years). We identified no differences in Harris hip scores, pain, radiolucencies, or osteolysis among Classes A, B, and C hips. Stem survival at 5, 10, and 15 years for aseptic loosening (failure) was 100% in all patients with Class A bone; 99+% in all patients with Class B bone; and 100% in all patients with Class C bone. Initial stability and durable fixation can be achieved with the use of this uncemented stem in patients in whom a cemented stem traditionally has been preferred as a result of poor bone quality. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John B. Meding
- The Center for Hip and Knee Surgery, St Francis Hospital, Mooresville, 1199 Hadley Road, Mooresville, IN 46158 USA
| | - Matthew R. Galley
- The Center for Hip and Knee Surgery, St Francis Hospital, Mooresville, 1199 Hadley Road, Mooresville, IN 46158 USA
| | - Merrill A. Ritter
- The Center for Hip and Knee Surgery, St Francis Hospital, Mooresville, 1199 Hadley Road, Mooresville, IN 46158 USA
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Computer-assisted vs conventional mechanical jig technique in hip resurfacing arthroplasty. J Arthroplasty 2009; 24:341-50. [PMID: 18534413 DOI: 10.1016/j.arth.2007.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Accepted: 12/17/2007] [Indexed: 02/01/2023] Open
Abstract
To compare the effectiveness of computer-assisted surgery (CAS) and mechanical jig technique in hip resurfacing arthroplasty, we reviewed 176 hip resurfacing arthroplasty performed in 158 patients. The initial 131 hips were resurfaced using the conventional mechanical jig technique, and the remaining 45 hips with the CAS technique. The demographic data of the patients were similar for both techniques. Follow-up radiographs taken 2 months after the surgery showed patients in the CAS technique having a significantly better alignment of the femoral component on the frontal and sagittal planes. There was no difference in the risk of implant notching on the femoral neck for both techniques. The implant sizes were similar for both techniques; thus, the amount of bone stock preserved was not technique specific.
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Karatosun V, Unver B, Gunal I. Hip arthroplasty with the thrust plate prosthesis in patients of 65 years of age or older: 67 patients followed 2-7 years. Arch Orthop Trauma Surg 2008; 128:377-81. [PMID: 17985151 DOI: 10.1007/s00402-007-0487-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Thrust plate prosthesis (TPP) is a relatively new concept in total hip arthroplasty and advocated to be used in young patients. We retrospectively evaluated the results of 67 patients (71 hips) who were older than 65 years of age and underwent hip arthroplasty using the TPP. PATIENTS AND METHODS There were 50 female and 17 male patients with a mean age 71 (range 65-89) years. All patients received accelerated rehabilitation program either with full weight bearing in the second postoperative day or at 6 weeks. All patients were followed-up for at least 2 years (range 28-87 months). RESULTS The average Harris hip score improved from 43 (range 8-72) to 93 (range 64-100) at the latest follow-up (p < 0.001). The overall revision rate was 8.4%. However, when the patients with definitive history of trauma were excluded the rate for loosening and technical errors decreased to 4.2%. There was no significant difference between the Harris hip score of patients with full weight bearing in the second postoperative day or 6 weeks (p = 0.57). CONCLUSION We conclude that the TPP could be indicated for older patients without age limit and that an accelerated rehabilitation program with early weight bearing can be applied to these patients.
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Affiliation(s)
- Vasfi Karatosun
- Department of Orthopedics, Dokuz Eylül University Hospital, Balcova, 35340 Izmir, Turkey.
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Ilizaliturri Sánchez VM, Mangino Pariente G, Camacho Galindo J. [Surgical treatment of hip osteoarthritis: update in total hip arthroplasty]. ACTA ACUST UNITED AC 2007; 3 Suppl 3:S57-62. [PMID: 21794483 DOI: 10.1016/s1699-258x(07)73657-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Total hip replacement is one of the most successful procedures in orthopaedic surgery. There are two different technologies for implant fixation in total hip replacement: cemented and cementless, both can be combined, which is called Hybrid arthroplasty. Long term implant stability results in long term function. The most important factor that limits longevity of well-fixed implants is the wear of the articular surfaces. Wear of the polyethylene from the acetabulum generates particles that access the implant bone or the implant-cement-bone interface. This produces an inflammatory reaction, osteolysis and implant loosening. Polyethylene of higher resistance to wear and prosthetic articulations without polyethylene (hard on hard bearings), have been introduced to improve wear particle generation. Minimally invasive surgical techniques minimize surgical trauma to sort tissue around the hip joint, facilitating a better and more rapid recovery.
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Jones CA, Beaupre LA, Johnston DWC, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am 2007; 33:71-86. [PMID: 17367693 DOI: 10.1016/j.rdc.2006.12.008] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Total hip and knee arthroplasties are effective surgical interventions for relieving hip pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all report gains or are satisfied after receiving total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis, and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no single patient-related or perioperative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.
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Affiliation(s)
- C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta T6G 2G4, Canada.
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Rasquinha VJ, Ranawat CS, Weiskopf J, Rodriguez JA, Skipor AK, Jacobs JJ. Serum metal levels and bearing surfaces in total hip arthroplasty. J Arthroplasty 2006; 21:47-52. [PMID: 16950061 DOI: 10.1016/j.arth.2006.05.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Accepted: 05/01/2006] [Indexed: 02/01/2023] Open
Abstract
This study evaluates steady-state serum metal levels in patients with 4 different combinations of fixation modalities, materials, and bearing couples. Forty patients with a minimum of 5 years of follow-up and with well-functioning primary total hip arthroplasty were recruited to have serum metal levels measured. Serum chromium and cobalt levels in the metal-on-metal cohort were significantly higher (P < .05) than the other 3 cohorts. The noncemented ceramic-polyethylene cohort had significantly lower (P < .05) serum chromium levels compared to cemented and noncemented metal-polyethylene cohorts and significantly higher serum titanium levels compared to the cemented metal-polyethylene cohort which had no titanium-containing implants. Debris generated at the metal head/neck modular junction likely accounts for the significantly lower serum chromium concentration in ceramic-polyethylene bearing couples.
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Affiliation(s)
- Vijay J Rasquinha
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA
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Grose A, González Della Valle A, Bullough P, Lyman S, Tomek I, Pellicci P. High failure rate of a modern, proximally roughened, cemented stem for total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2006; 30:243-7. [PMID: 16683113 PMCID: PMC2532124 DOI: 10.1007/s00264-005-0066-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 12/07/2005] [Accepted: 12/16/2005] [Indexed: 01/31/2023]
Abstract
The role of surface finish on the survivorship of cemented femoral stems continues to be debated. A total of 34 proximally roughened cemented stems were implanted in 33 consecutive patients undergoing total hip arthroplasty by a single surgeon. An alarmingly high failure rate was observed, prompting a retrospective chart review, analysis of radiographs, and evaluation of retrieved stems and pathological specimens. Nineteen patients were available with more than two years follow-up. Of these 19 patients, nine stems had failed (47%) due to severe osteolysis and stem loosening. Failures were significantly more common in the male gender (p<0.005), and young (p=0.05), tall (p<0.002), and heavy patients (p<0.004). All failed revised hips showed severe metallosis, with both gross and microscopic evidence of metallic shedding from the stems. Our findings suggest that this proximally roughened stem is susceptible to early failure. Failure is characterized by stem debonding, subsidence within the cement mantle, shedding of metallic and cement particles due to fretting, and rapidly progressive osteolysis. These findings have been observed with other rough surface finish cemented stems.
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Affiliation(s)
- A. Grose
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Medical College of Cornell University, New York, NY USA
| | - A. González Della Valle
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Medical College of Cornell University, New York, NY USA
| | - P. Bullough
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Medical College of Cornell University, New York, NY USA
| | - S. Lyman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Medical College of Cornell University, New York, NY USA
| | - I. Tomek
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Medical College of Cornell University, New York, NY USA
| | - P. Pellicci
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Medical College of Cornell University, New York, NY USA
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Jones CA, Beaupre LA, Johnston DWC, Suarez-Almazor ME. Total Joint Arthroplasties: Current Concepts of Patient Outcomes after Surgery. Clin Geriatr Med 2005; 21:527-41, vi. [PMID: 15911205 DOI: 10.1016/j.cger.2005.02.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Total hip and knee arthroplasties are effective surgical interventions for relieving pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all reports gains or are satisfied after receiving a total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no one patient-related or peri-operative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.
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Affiliation(s)
- C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta T6G 2G4, Canada.
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15
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Della Valle AG, Zoppi A, Peterson MGE, Salvati EA. A rough surface finish adversely affects the survivorship of a cemented femoral stem. Clin Orthop Relat Res 2005:158-63. [PMID: 15995435 DOI: 10.1097/00003086-200507000-00024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED To assess the role of surface finish in the survivorship of a cemented femoral stem, we evaluated the midterm clinical and radiographic performances of a cohort of patients who had total hip arthroplasties with two cemented femoral stems that differed only in surface finish. One hundred seventy-five patients [64 total hip arthroplasties with rough, textured stems (radius, 1.75-2.5 microm) and 138 total hip arthroplasties with satin finish, textured stems (radius, 0.5 microm)] were followed up clinically and radiographically for 4-8 years. All surgeries were done by one surgeon using the same surgical technique, acetabular cup, cement type, and cementing technique. The groups had similar demographics, diagnoses, preoperative clinical scores, cement mantle qualities, alignments, and lengths of followup. Seven hips in the rough surface group and none in the satin surface group had aseptic loosening. The femoral bone-cement interface showed progressive radiolucent lines or osteolysis in eight of 64 rough stems and in three of 138 satin stems. A rough, textured stem of this design is more likely to fail at intermediate followup than a satin surface stem. We recommend that the surface of cemented stems should be satin or polished with a radius less than 0.5 microm. LEVEL OF EVIDENCE Therapeutic study, Level III-1 (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.
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16
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Abstract
Immunosuppression following intra-articular injections of steroid into the hip may interfere with asepsis in a subsequent total hip arthroplasty (THA). We have undertaken a retrospective, matched, cohort study of infective complications after THA, in 40 patients who had received such an injection and 40 who had not. In the injection group there were five revisions, four of which were for deep infection. There were none in the matched group. The overall rate of revision in our database of 979 primary THAs was 1.02%. Six additional patients who had received injections underwent investigation for infection because of persistent problems in the hip as compared with one in the control group.
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Affiliation(s)
- S Kaspar
- McMaster University, Hamilton, Ontario K8V 1C3, Canada.
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17
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Abstract
Cemented femoral stem fixation is reproducible and provides excellent early recovery of hip function in patients 60 to 80 years old. The durability of fixation has been evaluated up to 20 years with 90% survivorship. Achieving a uniform cement mantle and minimizing polyethylene wear has been shown to reduce the incidence of fixation failure. This article describes the senior author's (C.S.R.) technique for cemented total hip arthroplasty with particular emphasis on the art of cemented femoral stem fixation and his experience with 3 different cemented stem designs over 30 years. The results of using this cement technique with a modern stem design with a surface roughness of 30 to 40 microinches have produced a 95% survivorship at 10- to 20-year follow-up in patients 60 to 80 years old.
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