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Bian Y, Wang H, Huang A. Finite Element Analysis of Acetabulum Prosthesis' Lining Damage Zone with Different Implanting Angle. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2023; 2023:9350474. [PMID: 37304323 PMCID: PMC10256448 DOI: 10.1155/2023/9350474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 06/13/2023]
Abstract
Objective Research the acetabular component's construction method of a three-dimensional finite element model in THA with different angles and study the influence of polyethylene liner wearing with finite element analysis. Methods Build a model in the 3D modeling software system HyperMesh according to the artificial hip joint prosthesis' entities and data. Using a finite element analysis system, ABAQUS 6.11 reconstitute acetabular prosthesis after hip replacement joints under different implanting position angles. Simulation and load the joint load when sheet foot touchdown state. Calculate the plastic volume strain and fatigue fracture. Results The two groups of combinations of abduction angle 50° vs. anteversion angle 10° and abduction angle 55° vs. anteversion angle 15° have been found to have relatively smaller interface plastic strain and fatigue fracture volume value (2.241 × 10-7 m3, 2.443 × 10-7 m3), respectively. Conclusion The groups of combinations of abduction angle 50° vs. anteversion angle 10° have been found to have relatively smallest interface plastic strain and fatigue fracture volume value in the total hip arthroplasty.
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Affiliation(s)
| | - Hao Wang
- Liaocheng Traditional Chinese Medicine Hospital, China
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2
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Thorey F, Floerkemeier T, Windhagen H. [Short hip stem for THA in avascular necrosis of the femoral head]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:815-821. [PMID: 36069911 DOI: 10.1007/s00132-022-04304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Osteonecrosis of the femoral head or avascular necrosis of the femoral head (HKN) is a complex disease that, without treatment, leads to infraction of the femoral head in most cases. In these cases, only replacement of the hip joint will help, although there is no clear recommendation of an arthroplasty type. In the last two decades, the treatment of primary and secondary coxarthrosis with short-shaft prostheses with different anchoring philosophies has increased. Since short-shaft fitting is a possible option especially in younger patients, the question arises about possible fittings of advanced HKN with these stem types, especially with metaphyseal anchorage. The aim of this study was to review the existing literature on the results of short stem prosthesis in HKN and to present the advantages and disadvantages of short stem prosthesis in osteonecrosis of the femoral head. MATERIAL AND METHODS This review analyzes the existing studies on short stem arthroplasty for HKN. RESULTS Only a few studies exist that have analyzed clinical and radiologic outcomes of short stem replacement in HKN. CONCLUSION The existing short- and medium-term results show mostly good outcomes. However, it is difficult to draw a general conclusion due to differences in stem design and fixation. Short stems with primary diaphyseal fixation do not show an increased risk of failed osseointegration or loosening. Constructions with primary metaphyseal fixation should undergo MRI to rule out the possibility of necrosis extending beyond the femoral neck.
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Affiliation(s)
- F Thorey
- Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Deutschland.
| | - T Floerkemeier
- go:h (Gelenkchirurgie Orthopädie Hannover), Hannover, Deutschland
| | - H Windhagen
- Orthopädische Klinik, Medizinische Hochschule Hannover (MHH) im DIAKOVERE Annastift, Hannover, Deutschland
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Betsch M, Tingart M, Driessen A, Quack V, Rath B. [Total hip replacement in avascular femoral head necrosis]. DER ORTHOPADE 2019; 47:751-756. [PMID: 30094647 DOI: 10.1007/s00132-018-3617-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Avascular necrosis of the femoral head is a progressive perfusion disorder of the hip joint. Progress in avascular necrosis causes structural damage to the affected joint, often requiring total hip replacement. AIM This article is intended to give the reader an overview of the current literature on total hip replacement of patients with an avascular necrosis of the femoral head. RESULTS Before 1990, patients with avascular necrosis of the femoral head had significantly higher revision rates after total hip replacement. Recent studies, however, showed no significant differences in clinical outcomes after total hip replacement in femoral head necrosis and primary osteoarthritis. Despite the young age of the patients, good long-term clinical results can be expected even in patients with an avascular necrosis of the femoral head after total hip replacement.
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Affiliation(s)
- M Betsch
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - M Tingart
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - A Driessen
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - V Quack
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - B Rath
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Hart A, Janz V, Trousdale RT, Sierra RJ, Berry DJ, Abdel MP. Long-Term Survivorship of Total Hip Arthroplasty with Highly Cross-Linked Polyethylene for Osteonecrosis. J Bone Joint Surg Am 2019; 101:1563-1568. [PMID: 31483399 DOI: 10.2106/jbjs.18.01218] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteonecrosis of the hip is the underlying etiology for 3% to 12% of total hip arthroplasties (THAs). Compared with patients who undergo THA because of osteoarthritis, those who do so because of osteonecrosis typically are younger, have a greater number of underlying diagnoses, and have inferior clinical outcomes and implant survivorship. The purpose of this study was to compare the long-term implant survivorship (median follow-up, 10 years), functional outcomes, and radiographic results of contemporary THAs with a highly cross-linked polyethylene (HXLPE) liner between patients with osteonecrosis and those with osteoarthritis. METHODS All patients who underwent primary THA with an HXLPE liner from 1999 to 2007 were identified from our institutional total joint registry. Patients with a primary diagnosis of osteonecrosis were matched 1:1, on the basis of age, sex, and body mass index (BMI), to patients with a diagnosis of osteoarthritis. This resulted in 461 hips in 413 patients with osteonecrosis matched to 461 hips in 427 patients with osteoarthritis (mean age, 59 years; 47% female; and mean BMI, 29 kg/m). Long-term implant survivorship, patient-reported outcomes, and radiographic findings were compared. In addition, a subgroup analysis of the osteonecrosis group was performed to see whether certain underlying etiologies portended poor outcomes. The median follow-up was 10 years. RESULTS The 15-year cumulative rates of revision were 6.6% and 4.5% in the osteonecrosis and osteoarthritis groups, respectively (hazard ratio [HR] = 1.8, p = 0.09). The 15-year cumulative rates of any reoperation were 10.5% and 6.4% in the osteonecrosis and osteoarthritis groups, respectively (HR = 2.2, p = 0.008). There were no radiographic signs of component loosening or osteolysis in the entire cohort. Despite a lower median preoperative Harris hip score (HHS) for patients with osteonecrosis, both groups had marked improvements in their scores, which were similar at all time points after surgery. The cumulative rate of reoperations at 15 years was 0% for hips with radiation-induced osteonecrosis, 6.3% for those with alcohol-induced osteonecrosis, 9.0% for those with posttraumatic osteonecrosis, 12.1% for those with steroid-induced osteonecrosis, and 25% for those with idiopathic osteonecrosis. CONCLUSIONS Contemporary THA with an HXLPE liner offers excellent long-term implant survivorship and functional outcomes for patients with osteonecrosis; however, the risk of a reoperation is higher when compared with patients with osteoarthritis. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam Hart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Viktor Janz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Miladi M, Villain B, Mebtouche N, Bégué T, Aurégan JC. Interest of short implants in hip arthroplasty for osteonecrosis of the femoral head: comparative study "uncemented short" vs "cemented conventional" femoral stems. INTERNATIONAL ORTHOPAEDICS 2018; 42:1669-1674. [PMID: 29761221 DOI: 10.1007/s00264-018-3981-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 12/27/2022]
Abstract
PURPOSES Osteonecrosis of the femoral head (ONFH) is a dramatic condition resulting in joint destruction in the late stages. Total hip arthroplasty allows function recovery with satisfactory implant survival. Recently, the use of uncemented short stems has been suggested to improve the conservation of bone stock. METHODS We performed a retrospective study on 16 hip arthroplasties-11 patients-implanted for ONFH between 2008 and 2017. We aimed to compare the outcomes of the two types of arthroplasty-"uncemented short" vs "cemented conventional" femoral stem-in terms of pain (visual analogue scale), function (Harris Hip Score), and survival (radiography). RESULTS We included six "uncemented short" and ten "cemented conventional" femoral stems. Mean pre-operative EVA was 7.5 and the mean HHS was 40.3. At last follow-up of seven years, mean VAS was 1.2 (SD ± 0.83) in the "uncemented short" group and 1.6 (SD ± 0.97) in the "cemented conventional" group. Mean HHS was 94 (SD ± 0.81) in the "uncemented short" group and 92.6 (SD ± 2.69) in the "cemented conventional" group. However, radiographic analysis revealed a lower stress shielding in the "uncemented short" stem group. One complication occurred (hip dislocation in the "cemented conventional" stem group). CONCLUSION Uncemented short stems total hip arthroplasties may be an interesting alternative to more conventional implants with similar functional results but less stress shielding and a bone stock economy in this young population of patients.
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Affiliation(s)
- Mehdi Miladi
- Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud Saclay University, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Benoît Villain
- Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud Saclay University, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Nasser Mebtouche
- Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud Saclay University, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Thierry Bégué
- Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud Saclay University, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Jean-Charles Aurégan
- Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud Saclay University, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
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Chughtai M, Piuzzi NS, Khlopas A, Jones LC, Goodman SB, Mont MA. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J 2017; 99-B:1267-1279. [PMID: 28963146 DOI: 10.1302/0301-620x.99b10.bjj-2017-0233.r2] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/09/2017] [Indexed: 12/24/2022]
Abstract
Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively. The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head. Cite this article: Bone Joint J 2017;99-B:1267-79.
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Affiliation(s)
| | | | - A Khlopas
- Cleveland Clinic, Cleveland, Ohio, USA
| | - L C Jones
- Johns Hopkins University, Baltimore, Maryland, USA
| | - S B Goodman
- Stanford University, Stanford, California, USA
| | - M A Mont
- Cleveland Clinic, Cleveland, Ohio, USA
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7
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Capone A, Bienati F, Torchia S, Podda D, Marongiu G. Short stem total hip arthroplasty for osteonecrosis of the femoral head in patients 60 years or younger: a 3- to 10-year follow-up study. BMC Musculoskelet Disord 2017; 18:301. [PMID: 28716026 PMCID: PMC5513025 DOI: 10.1186/s12891-017-1662-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/09/2017] [Indexed: 12/18/2022] Open
Abstract
Background In young patients with osteonecrosis of the femoral head (ONFH), short-stem total hip arthroplasty (THA) could allow a potential advantage in preserving metaphyseal bone-stock, when revision surgery might become necessary. However, only a few studies have evaluated the outcome of short-stem THAs in ONFH. We reviewed the prospectively collected data of a cementless partial neck-retaining short-stem with ceramic-on-ceramic bearings in ONFH patients. Methods Thirty patients (37 hips) younger than 60 years (mean age at surgery, 51.5 years) underwent THA with the NANOS® stem (Smith and Nephew, Marl, Germany) from January 2006 to December 2012. All patients received a 32-mm or 36 mm ceramic femoral head. Harris hip score, WOMAC and UCLA activity score were recorded. Postoperative radiographs were evaluated for bone-implant fixation and osteolysis. Further analysis correlated clinical findings with implants characteristics and patient demographics at mean 5.6 years’ follow-up (range, 3–10 years). Results The clinical and functional results improved significantly (p < 0.001). At latest follow-up, mean HHS, WOMAC, and UCLA activity scores were 90 (range, 71–100), 94 (range, 76–100), and 6.3 (range, 4–10) points, respectively. The diameter of the femoral head did not influence the clinical outcome (p = 0.661). All hips showed bone ingrowth fixation of the acetabular and femoral components. No patients showed osteolysis. No revision for any reason was performed during the study period. Conclusions The excellent clinical results and fixation pattern at mean 5.6 years’ follow-up reveal this implant as a reliable option in advanced stage of ONFH either. Further investigations are crucial to determine the long-term durability and to assess whether the association of ceramic-on-ceramic bearings, can be useful to achieve longer survivorship and lower complications rates. Trial registration Registry number: ISRCTN 91336248; date of registration: 04/07/2017.
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Affiliation(s)
- Antonio Capone
- Orthopaedic Clinic of the Department of Surgical Science, University of Cagliari, Ospedale Marino, Lungomare Poetto 12, 09126, Cagliari, Italy
| | - Fabrizio Bienati
- Orthopaedic Clinic of the Department of Surgical Science, University of Cagliari, Ospedale Marino, Lungomare Poetto 12, 09126, Cagliari, Italy
| | - Stefania Torchia
- Orthopaedic Clinic of the Department of Surgical Science, University of Cagliari, Ospedale Marino, Lungomare Poetto 12, 09126, Cagliari, Italy
| | - Daniele Podda
- Trauma and Orthopaedic Department, Ospedale Santissima Trinità, Via Is Mirrionis 92, 09121, Cagliari, Italy
| | - Giuseppe Marongiu
- Orthopaedic Clinic of the Department of Surgical Science, University of Cagliari, Ospedale Marino, Lungomare Poetto 12, 09126, Cagliari, Italy.
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8
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Dilogo IH, Chandra W. Short-term outcome of ceramic-on-ceramic total hip replacement in young adult patients. MEDICAL JOURNAL OF INDONESIA 2015. [DOI: 10.13181/mji.v24i3.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Ceramic-on-ceramic (CoC) total hip replacement (THR) was developed to minimize debris and osteolytic reaction. The major concern is its brittleness. The aim of this study was to evaluate the short-term outcome of CoC THR in young adult patients. Methods: 11 patients, 13 THR procedures, were followed up until six months after surgery in Cipto Mangunkusumo Hospital. Evaluation included Harris hip score (HHS), visual analog scale (VAS), patients’ complaint, short form-36 (SF-36), and acetabular and femoral component angles. Data were analyzed using Wilcoxon signed rank test, paired t-test, and Spearman test. Results: The average age of the patients was 33.6 years old and 55% of them were female. Systemic lupus erythematosus was the main causative disease for THR. The VAS average decreased before surgery and after six months of surgery (5 to 1). Pre- and post-operative HHS and SF-36 increased significantly by (25 to 92) and (21 to 54) respectively. Squeaking sound was reported by two patients. No correlation was found between acetabular and femoral component and squeaking incidence.Conclusion: CoC THR showed excellent short term outcome for young adult patients. With proper indications, CoC THR ensures excellent clinical outcomes and promising survivorship.
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Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015; 97:1604-27. [PMID: 26446969 DOI: 10.2106/jbjs.o.00071] [Citation(s) in RCA: 300] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Rafael J Sierra
- Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, JHOC 5245, Baltimore, MD 21287
| | - Jay R Lieberman
- Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033
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Pierce TP, Elmallah RK, Jauregui JJ, Verna DF, Mont MA. Outcomes of total hip arthroplasty in patients with osteonecrosis of the femoral head-a current review. Curr Rev Musculoskelet Med 2015; 8:246-51. [PMID: 26045086 DOI: 10.1007/s12178-015-9283-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this review was to analyze (1) patient-reported outcomes and implant survivorship of osteonecrosis (ON) patients following total hip arthroplasty (THA), (2) if prior hip-preserving procedures influence these outcomes, (3) if resurfacing procedures alter outcomes; and (4) how these outcomes may have been impacted by the choice of different bearing surfaces. Today, with implant innovations such as cementless constructs, ceramic bearing surfaces, and highly cross-linked polyethylene, ON patients derive great benefit and have high survivorship following THA. Most studies have shown that previous hip-preserving procedures do not have a deleterious effect on outcomes. Literature on the use of ceramic and highly cross-linked polyethylene bearing surfaces have shown that these implant designs are useful in younger and more active patients. Future research should evaluate the long-term outcomes and survivorship of these new THA constructs.
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Affiliation(s)
- Todd P Pierce
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
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Nie L, Chen D, Fu J, Yang S, Hou R, Suo J. Macroporous biphasic calcium phosphate scaffolds reinforced by poly-L-lactic acid/hydroxyapatite nanocomposite coatings for bone regeneration. Biochem Eng J 2015. [DOI: 10.1016/j.bej.2015.02.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Floerkemeier T, Budde S, Gronewold J, Radtke K, Ettinger M, Windhagen H, von Lewinski G. Short-stem hip arthroplasty in osteonecrosis of the femoral head. Arch Orthop Trauma Surg 2015; 135:715-22. [PMID: 25801808 DOI: 10.1007/s00402-015-2195-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Osteonecrosis of the femoral head (ONFH) is a locally destructive and complex disorder. Without treatment, infraction of the femoral head is likely. There is also a lack of consensus in the literature about the most appropriate arthroplasty method in patients with progressive ONFH. During the last decade, the number of short-stem prostheses has increased. Some short-stem designs have a metaphyseal anchorage. It is questionable whether ONFH represents a risk factor for failure after implantation of short stems. The aim of this study was to review existing literature regarding the outcome of short-stem arthroplasty in ONFH and to present the pros and cons of short-stem hip arthroplasty in osteonecrosis of the femoral head. MATERIALS AND METHODS This review summarises existing studies on short-stem hip arthroplasty in osteonecrosis of the femoral head. RESULTS Few studies have analysed the clinical and radiological outcome of short-stem THA in patients with ONFH. Only a handful of studies present clinical and radiological outcome after implantation of a short-stem arthroplasty in patients with the underlying diagnosis of osteonecrosis of the femoral head. CONCLUSION The short- to medium-term results show predominantly good outcomes. However, due to differences in the design of short stems and their fixation, it is hard to draw a general conclusion. Short stems with primary diaphyseal fixation do not reveal a high increased risk of failed osseointegration or loosening. For designs with a primary metaphyseal anchorage, an MRI should be conducted to exclude that the ostenecrosis exceeds the femoral neck.
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Affiliation(s)
- Thilo Floerkemeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany,
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13
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Jeffers JRT, Walter WL. Ceramic-on-ceramic bearings in hip arthroplasty: state of the art and the future. ACTA ACUST UNITED AC 2012; 94:735-45. [PMID: 22628586 DOI: 10.1302/0301-620x.94b6.28801] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This systematic review of the literature summarises the clinical experience with ceramic-on-ceramic hip bearings over the past 40 years and discusses the concerns that exist in relation to the bearing combination. Loosening, fracture, liner chipping on insertion, liner canting and dissociation, edge-loading and squeaking have all been reported, and the relationship between these issues and implant design and surgical technique is investigated. New design concepts are introduced and analysed with respect to previous clinical experience.
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Affiliation(s)
- J R T Jeffers
- Imperial College, Department of Mechanical Engineering, South Kensington, London SW7 2AZ, UK.
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Floerkemeier T, Tscheuschner N, Calliess T, Ezechieli M, Floerkemeier S, Budde S, Windhagen H, von Lewinski G. Cementless short stem hip arthroplasty METHA® as an encouraging option in adults with osteonecrosis of the femoral head. Arch Orthop Trauma Surg 2012; 132:1125-31. [PMID: 22546932 DOI: 10.1007/s00402-012-1524-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The implantation of a total hip arthroplasty is the standard treatment for patients with progressive osteonecrosis. However, there is uncertainty about the type of arthroplasty that provides the best outcome and whether short stem arthroplasty represents a reasonable alternative for young patients in order to have more options in case of revision. This uncertainty exists due to the lack of studies analysing contemporary short stem arthroplasty in osteonecrosis. AIM The aim of this study was to determine the outcome of the METHA(®) short stem arthroplasty in patients with progressive osteonecrosis. PATIENTS AND METHODS This study evaluated the clinical and radiological short- to midterm results after implantation of the cementless short stem arthroplasty METHA(®). 73 hips in 64 patients with progessive osteonecrosis after implantation of the METHA(®) arthroplasty were investigated by measuring the clinical outcome, the Harris Hip Score (HHS) and visual analogue pain scale for the preoperative stage and follow-up. Radiological analyses of X-rays were conducted to assess the bone ingrowth as well as subsidence, osteolysis or fracture. RESULTS The pain scale improved from preoperatively 7.8 to postoperatively 1.7, while the HHS increased from 41.4 to 90.6 points 34 months post-surgery. Complications associated with revision of the METHA(®) short stem included two traumatic femoral shaft fracture and one deep infection. The radiological assessment showed good bone ingrowth in all patients despite osteonecrosis. CONCLUSION The study confirms encouraging results as well as good bone ingrowth of the cementless short stem arthroplasty METHA(®) even in patients with osteonecrosis.
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Affiliation(s)
- Thilo Floerkemeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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Kaushik AP, Das A, Cui Q. Osteonecrosis of the femoral head: An update in year 2012. World J Orthop 2012; 3:49-57. [PMID: 22655222 PMCID: PMC3364317 DOI: 10.5312/wjo.v3.i5.49] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 02/20/2012] [Accepted: 05/13/2012] [Indexed: 02/06/2023] Open
Abstract
Osteonecrosis is a phenomenon involving disruption to the vascular supply to the femoral head, resulting in articular surface collapse and eventual osteoarthritis. Although alcoholism, steroid use, and hip trauma remain the most common causes, several other etiologies for osteonecrosis have been identified. Basic science research utilizing animal models and stem cell applications continue to further elucidate the pathophysiology of osteonecrosis and promise novel treatment options in the future. Clinical studies evaluating modern joint-sparing procedures have demonstrated significant improvements in outcomes, but hip arthroplasty is still the most common procedure performed in these affected younger adults. Further advances in joint-preserving procedures are required and will be widely studied in the coming decade.
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Solarino G, Piazzolla A, Notarnicola A, Moretti L, Tafuri S, De Giorgi S, Moretti B. Long-term results of 32-mm alumina-on-alumina THA for avascular necrosis of the femoral head. J Orthop Traumatol 2012; 13:21-7. [PMID: 22249776 PMCID: PMC3284675 DOI: 10.1007/s10195-011-0174-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 12/04/2011] [Indexed: 11/17/2022] Open
Abstract
Background Ceramic bearings in total hip arthroplasty (THA) have been introduced in clinical practice to minimize the problem of polyethylene particle–induced osteolysis. The aim of the study is to report the results of 68 consecutive alumina-on-alumina THAs done in 61 patients for avascular necrosis (AVN) of the femoral head. Materials and methods In all implants a press-fit cup was used; it was combined with a 32-mm alumina head and with titanium-alloy stems. The mean age at surgery was 50 years. At an average follow-up of 13 years two hips have been revised, one for periprosthetic infection and one for excessive abduction of the cup. Results No revision for aseptic loosening is recorded; one anatomical cementless femoral stem had radiological evidence of definite aseptic loosening. No dislocations occurred, and no osteolysis was observed. Conclusions The results support the application of alumina-alumina THA for long-lasting replacements.
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Affiliation(s)
- Giuseppe Solarino
- Department of Neuroscience and Sense Organs, Orthopaedic and Traumatology Unit, Faculty of Medicine and Surgery, General Hospital, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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