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Heinrich S, Gratza S, Eckardt A, Ilchmann T. Stepwise implementation of an enhanced recovery pathway for elective total hip arthroplasty in a Swiss hospital: a cohort study. Swiss Med Wkly 2024; 154:3537. [PMID: 38579311 DOI: 10.57187/s.3537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Enhanced recovery programs after total hip arthroplasty have been shown to reduce hospital length of stay without compromising results, but yet there is a lack of data for the Swiss population. Therefore, this retrospective cohort study evaluated whether similar positive effects on clinical outcomes are present in the context of the Swiss healthcare system. METHODS Patients who underwent elective primary total hip arthroplasty were analysed. The baseline group comprised 50 patients treated consecutively by one surgeon in 2013 according to the clinical practice guidelines. Another surgeon implemented a new standardised treatment protocol in April 2014. In January 2018, this protocol was followed by an enhanced recovery program that integrated all care providers at the hospital. The data of the baseline group (series 0) and four series of 50 patients each, two treated with the standardised treatment protocol (series 1-2) and two treated with the enhanced recovery program (series 3-4), were analysed. All patients had follow-ups at 6 weeks and 3 months after surgery. The primary outcomes were length of stay and discharge destination; the secondary outcomes were admission on the day of surgery (instead of one day prior), the use of urinary catheters, the administration of opioids, the difference between pre- and postoperative haemoglobin, blood transfusions, and adverse events within 3 months of surgery. RESULTS The median length of stay was 10 days in the baseline group and only 5 days after the implementation of the standardised protocol and enhanced recovery program in series 4 (p <0.001). The percentage of patients discharged directly home was higher in series 4 than in the baseline group (84% vs. 66%, p = 0.085). Patients admitted to the hospital on the day of surgery increased from 2% in series 0 to 98% in series 4 (p <0.001). The use of urinary catheters was significantly higher in the baseline group (100% of patients) than in series 3 and 4 (0%) (p <0.001), and the number of patients who did not require opioids was significantly higher in series 4 than in series 0 (36% vs. 10%, p = 0.007). The median blood loss (500 ml vs. 300 ml, p <0.001), median difference in pre- and postoperative haemoglobin (29 g/dl vs. 25 g/dl, p = 0.145), and number of blood transfusions (5 vs. 2 p = 0.99) were higher in the baseline group than in series 4. The number of adverse events did not differ significantly between groups (p = 0.699). CONCLUSIONS Almost all parameters examined in this study showed improvement, whereas the rate of adverse events was not affected and remained low. The presented data can be used as a benchmark, but details of these findings need to be confirmed in larger cohorts.
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Affiliation(s)
| | - Simon Gratza
- University Hospital of Basel, Basel, Switzerland
| | - Anke Eckardt
- University Hospital of Basel, Basel, Switzerland
| | - Thomas Ilchmann
- Hirslanden Klinik Birshof, Endo Team, Münchenstein, Switzerland
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Kaufmann M, Nüesch C, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Stoffel K, Mündermann A, Ismailidis P. Functional assessment of total hip arthroplasty using inertial measurement units: Improvement in gait kinematics and association with patient-reported outcome measures. J Orthop Res 2023; 41:759-770. [PMID: 35880355 DOI: 10.1002/jor.25421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 07/08/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023]
Abstract
Inertial measurement units (IMUs) are commonly used for gait assessment, yet their potential for quantifying improvements in gait function and patterns after total hip arthroplasty (THA) has not been fully explored. The primary aim of this study was to compare spatiotemporal parameters and sagittal plane kinematic patterns of patients with hip osteoarthritis (OA) before and after THA, and to asymptomatic controls. The secondary aim was to assess the association between dynamic hip range of motion (ROM) during walking and the Hip Osteoarthritis Outcome Scores (HOOS). Twenty-four patients with hip OA and 24 matched asymptomatic controls completed gait analyses using the RehaGait® sensor system. Patients were evaluated pre- and 1 year postoperatively, controls in a single visit. Differences in kinematic data were analyzed using statistical parametric mapping, and correlations between dynamic hip ROM and HOOS were calculated. Walking speed and stride length significantly increased (+0.08 m/s, p = 0.019; +0.06 m, p = 0.048) after THA but did not reach the level of asymptomatic controls (-0.11 m/s, p = 0.028; -0.14 m, p = 0.001). Preoperative hip and knee kinematics differed significantly from controls. After THA, they improved significantly and did not differ from controls. Dynamic hip flexion-extension ROM correlated positively with all HOOS subscores (r > 0.417; p ≤ 0.001). The change in HOOS symptoms in patients was explained by the combination of baseline HOOS symptoms and change in dynamic hip ROM (r2 = 0.748) suggesting that the additional information gained with IMU gait analysis helps to complement and objectify patient-reported outcome measures pre- and postoperatively and monitor treatment-related improvements.
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Affiliation(s)
- Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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Nüesch C, Ismailidis P, Koch D, Pagenstert G, Ilchmann T, Eckardt A, Stoffel K, Egloff C, Mündermann A. Assessing Site Specificity of Osteoarthritic Gait Kinematics with Wearable Sensors and Their Association with Patient Reported Outcome Measures (PROMs): Knee versus Hip Osteoarthritis. Sensors (Basel) 2021; 21:s21165363. [PMID: 34450828 PMCID: PMC8398113 DOI: 10.3390/s21165363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022]
Abstract
There is a great need for quantitative outcomes reflecting the functional status in patients with knee or hip osteoarthritis (OA) to advance the development and investigation of interventions for OA. The purpose of this study was to determine if gait kinematics specific to the disease—i.e., knee versus hip OA—can be identified using wearable sensors and statistical parametric mapping (SPM) and whether disease-related gait deviations are associated with patient reported outcome measures. 113 participants (N = 29 unilateral knee OA; N = 30 unilateral hip OA; N = 54 age-matched asymptomatic persons) completed gait analysis with wearable sensors and the Knee/Hip Osteoarthritis Outcome Score (KOOS/HOOS). Data were analyzed using SPM. Knee and hip kinematics differed between patients with knee OA and patients with hip OA (up to 14°, p < 0.001 for knee and 8°, p = 0.003 for hip kinematics), and differences from controls were more pronounced in the affected than unaffected leg of patients. The observed deviations in ankle, knee and hip kinematic trajectories from controls were associated with KOOS/HOOS in both groups. Capturing gait kinematics using wearables has a large potential for application as outcome in clinical trials and for monitoring treatment success in patients with knee or hip OA and in large cohorts representing a major advancement in research on musculoskeletal diseases.
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Affiliation(s)
- Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - David Koch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department for Sport, Movement and Health, University of Basel, 4052 Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Clarahof Clinic of Orthopaedic Surgery, 4058 Basel, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Correspondence:
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Ismailidis P, Kaufmann M, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Mündermann A, Nüesch C. Kinematic changes in severe hip osteoarthritis measured at matched gait speeds. J Orthop Res 2021; 39:1253-1261. [PMID: 32930435 DOI: 10.1002/jor.24858] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
Kinematic differences between patients with osteoarthritis (OA) and control participants have been reported to be influenced by gait speed. The purpose of this study was to experimentally detect the effect of walking speed on differences in spatiotemporal parameters and kinematic trajectories between patients with hip OA and age-matched asymptomatic participants using wearable sensors and statistical parametric mapping (SPM). Twenty-four patients with severe unilateral hip OA and 48 control participants were included in this study. Patients walked at a self-selected normal speed and control participants at self-selected normal and slow speeds. Spatiotemporal parameters and kinematic trajectories were measured with the inertial sensor system Rehagait®. Gait parameters were compared between patients with hip OA and control participants for normal and matched speed using SPM with independent sample t-tests. At self-selected normal speed, the patient group walked slower (-0.20 m/s, p < .001) and at lower cadence (-5.0 steps/minute, p < .001) as well as with smaller hip flexion (-7.4°, p < .001) and extension (-4.1°, p = .001), higher knee flexion during terminal stance (+8.0°, p < .001) and higher ankle dorsiflexion and plantarflexion (+7.1°, p < .001). While differences in spatiotemporal parameters and the ankle trajectory disappeared at matched speed, some clinically relevant and statistically significant differences in hip and knee trajectories remained. Most differences in sagittal plane gait kinematics between patients with hip OA and control participants were present for matched speed, and therefore appear to be associated with a disease rather than gait speed. Nevertheless, studies investigating hip kinematics in patients with hip OA should involve trials at matched speeds.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
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Ismailidis P, Hegglin L, Egloff C, Pagenstert G, Kernen R, Eckardt A, Ilchmann T, Nüesch C, Mündermann A. Side to side kinematic gait differences within patients and spatiotemporal and kinematic gait differences between patients with severe knee osteoarthritis and controls measured with inertial sensors. Gait Posture 2021; 84:24-30. [PMID: 33260078 DOI: 10.1016/j.gaitpost.2020.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kinematic changes associated with knee osteoarthritis (OA) have been traditionally measured with camera-based gait analysis. Lately, inertial sensors have become popular for gait analysis with the advantage of being less time consuming and not requiring a dedicated laboratory. RESEARCH QUESTION Do spatiotemporal and discrete kinematic gait parameters measured with the inertial sensor system RehaGait® differ between the affected and unaffected side in patients with unilateral knee OA and between patients with severe knee OA and asymptomatic control subjects? Do these differences have a similar magnitude as those reported in the literature? METHODS Twenty-two patients with unilateral knee OA scheduled for total knee replacement and 46 age matched control subjects were included in this study. Spatiotemporal parameters and sagittal kinematics at the hip, knee, and ankle joint were measured using the RehaGait® system while walking at a self-selected speed for a distance of 20 m and compared between groups. RESULTS Patients with knee OA had slower walking speed, longer stride duration, shorter stride length and lower cadence (P < 0.001). Peak knee flexion during stance and swing was lower in the affected than the unaffected leg (-4.8° and -6.1°; P < 0.01). Peak knee flexion during stance and swing (-5.2° and -8.8°; P < 0.01) and knee range of motion during loading response and swing (-3.6° and -4.4°; P < 0.01) were lower than in the control group. SIGNIFICANCE These side to side differences within patients and differences between patients with knee OA and control subjects agree with known gait alterations measured with camera-based systems. The RehaGait® inertial sensor system can detect gait alterations in patients with knee OA and is suitable for gait analysis in a clinical environment.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Lea Hegglin
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland; CLARAHOF Clinic of Orthopaedic Surgery, Clarahofweg 19a, 4058 Basel, Switzerland
| | - Rolf Kernen
- Clinic for Orthopaedics Claraortho, Claragraben 82, 4058 Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team Hirslanden Klinik Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team Hirslanden Klinik Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
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Ismailidis P, Nüesch C, Kaufmann M, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Mündermann A. Measuring gait kinematics in patients with severe hip osteoarthritis using wearable sensors. Gait Posture 2020; 81:49-55. [PMID: 32679463 DOI: 10.1016/j.gaitpost.2020.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The popularity of inertial sensors in gait analysis is steadily rising. To date, an application of a wearable inertial sensor system for assessing gait in hip osteoarthritis (OA) has not been reported. RESEARCH QUESTION Can the known kinematic differences between patients with hip OA and asymptomatic control subjects be measured using the inertial sensor system RehaGait®? METHODS The patients group consisted of 22 patients with unilateral hip OA scheduled for total hip replacement. Forty-five age matched healthy control subjects served as control group. All subjects walked for a distance of 20 m at their self-selected speed. Spatiotemporal parameters and sagittal kinematics at the hip, knee, and ankle including range of motion (ROM) were measured using the RehaGait® system. RESULTS Patients with hip OA walked at a slower walking speed (-0.18 m/s, P < 0.001) and with shorter stride length (-0.16 m, P < 0.001), smaller hip ROM during stance (-11.6°, P < 0.001) and swing (-11.3°, P < 0.001) and smaller knee ROM during terminal stance and swing (-9.0° and-11.5°, P < 0.001). Patients had a smaller hip ROM during stance and swing and smaller knee ROM during terminal stance and swing in the affected compared to the unaffected side (P < 0.001). SIGNIFICANCE The differences in spatiotemporal and kinematic gait parameters between patients with hip OA and age matched control subjects assessed using the inertial sensor system agree with those documented for camera-based systems. Hence, the RehaGait® system can measure gait kinematics characteristic for hip OA, and its use in daily clinical practice is feasible.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland; Clarahof Clinic of Orthopaedic Surgery, Clarahofweg 19a, 4058 Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik, Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik, Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
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Born P, Manzoni I, Ilchmann T, Clauss M. Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population? Orthop Rev (Pavia) 2019; 11:8263. [PMID: 31616553 PMCID: PMC6790558 DOI: 10.4081/or.2019.8263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/25/2019] [Indexed: 12/03/2022] Open
Abstract
Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.
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Affiliation(s)
- Philipp Born
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal
| | - Isabella Manzoni
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal
| | - Thomas Ilchmann
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal.,Hirslanden Klinik Birshof, Münchenstein
| | - Martin Clauss
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal.,Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Switzerland
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Madörin K, Siepen W, Manzoni I, Stoffel KK, Ilchmann T, Clauss M. Five-year prospective subsidence analysis of 100 cemented polished straight stems: A concise clinical and radiological follow-up observation. Orthop Rev (Pavia) 2019; 11:7984. [PMID: 31210913 PMCID: PMC6551455 DOI: 10.4081/or.2019.7984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/02/2019] [Indexed: 12/31/2022] Open
Abstract
Early subsidence (>1.5mm) has been shown to be an indicator for later aseptic loosening of cemented hip stems. For the cemented twinSys® stem we published excellent short-term results at 2 years. Midterm data for this stem are available from national registers (NZL, NL), however in all of these sources, clinical and radiological results are missing. Aim of our study was to analyse mid-term survival and radiological changes around the cemented twinSys® stem with special emphasis on subsidence using EBRA-FCA. We conducted a prospective clinical and radiological 5- year follow-up study of 100 consecutive hybrid total hip arthroplasties (THA) using a polished, cemented collarless straight stem (twinSys®, Mathys AG® Bettlach, Switzerland) with a cementless monobloc pressfit cup (RM pressfit®, Mathys AG® Bettlach, Switzerland). Median age at surgery was 79 (69 to 93) years. No patient was lost to follow-up. Survival rates were calculated using the Kaplan-Meier method. Clinical (Harris Hip Score [HHS]) and radiological (cementing quality, alignment, osteolysis, debonding and cortical atrophy) outcomes and an in-depth subsidence analysis using EBRA-FCA were performed. 22 patients died in the course of follow-up unrelated to surgery, 21 stems had an incomplete radiological follow-up. 2 stems were revised, both due to an infection. The survival rate for the stem at 5 years was 98.0% (95% CI 95.3-100%). The survival rate of the stem for revision due to aseptic loosening at 5 years was 100%. The HHS improved from 53 (14-86) points preoperatively to 90 (49-100) points 5 years after surgery. Osteolysis was found in 2 stems without clinical symptoms. In 49 out of 55 patients with a complete radiological follow- up, the EBRA-FCA analysis was possible and showed an average subsidence of 0.66 (95% CI 0.46 to 0.86) mm 5 years after surgery. 10 patients showed a subsidence >1 mm, 5 of which bigger than 1.5 mm. Subsidence was independent from radiological changes and cementing quality. The cemented twinSys® stem showed excellent clinical and radiological mid-term results at five years' follow-up and seems to be a reliable implant.
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Affiliation(s)
- Kevin Madörin
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland
| | - Wolf Siepen
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland
| | - Isabella Manzoni
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland
| | | | | | - Martin Clauss
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland
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Mueller Greber P, Manzoni I, Ochsner PE, Ilchmann T, Zwicky L, Clauss M. Excellent long-term results of the Müller acetabular reinforcement ring in primary cup revision. Acta Orthop 2017; 88:619-626. [PMID: 28771057 PMCID: PMC5694806 DOI: 10.1080/17453674.2017.1361137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and purpose - The original Müller acetabular reinforcement ring (ARR) was developed to be used for acetabular revisions with small cavitary and/or segmental defects or poor acetabular bone quality. Long-term data for this device are scarce. We therefore investigated long-term survival and radiographic outcome for revision total hip arthroplasty using the ARR. Patients and methods - Between October 1984 and December 2005, 259 primary acetabular revisions using an ARR were performed in 245 patients (259 hips). The mean follow-up time was 10 (0-27) years; 8 hips were lost to follow-up. The cumulative incidence for revision was calculated using a competing risk model. Radiographic assessment was performed for 90 hips with minimum 10 years' follow-up. It included evaluation of osteolysis, migration and loosening. Results - 16 ARRs were re-revised: 8 for aseptic loosening, 6 for infection, 1 for suspected infection, and 1 due to malpositioning of the cup. The cumulative re-revision rate for aseptic loosening of the ARR at 20 years was 3.7% (95% CI 1.7-6.8%). Assuming all patients lost to follow-up were revised for aseptic loosening, the re-revision rate at 20 years was 6.9% (95% CI 4.1-11%). The overall re-revision rate of the ARR for any reason at 20 years was 7.0% (95% CI 4.1-11%). 21 (23%) of the 90 radiographically examined ARR had radiographic changes: 12 showed isolated signs of osteolysis but were not loose; 9 were determined loose on follow-up, of which 5 were revised. Interpretation - Our data suggest that the long-term survival and radiographic results of the ARR in primary acetabular revision are excellent.
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Affiliation(s)
- Pascal Mueller Greber
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Isabella Manzoni
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Peter E Ochsner
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Thomas Ilchmann
- Department of Orthopedics, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Lukas Zwicky
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Martin Clauss
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland,Correspondence:
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Ilchmann T. CORR Insights ®: What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis. Clin Orthop Relat Res 2017; 475:1411-1413. [PMID: 28155210 PMCID: PMC5384932 DOI: 10.1007/s11999-017-5265-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/24/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Thomas Ilchmann
- Hirslanden Klinik Birshof, Reinacherstr. 28, 4142 Münchenstein, Switzerland
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Hoffmeyer P, Simmen H, Jakob M, Sommer C, Platz A, Ilchmann T, Grossen E, Ryf C, Christofilopoulos P, Schueler M, Lassen MR, Rimle M, Gasser UE. Rivaroxaban for Thromboprophylaxis After Nonelective Orthopedic Trauma Surgery in Switzerland. Orthopedics 2017; 40:109-116. [PMID: 27874908 DOI: 10.3928/01477447-20161116-05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/03/2016] [Indexed: 02/03/2023]
Abstract
This study investigated the effectiveness and the outcomes of rivaroxaban vs the standard of care for venous thromboembolic prophylaxis in patients undergoing fracture-related surgery. A total of 413 patients undergoing fracture-related surgery from 9 Swiss orthopedic and trauma centers were enrolled. The authors selected the type of venous thromboembolic prophylaxis according to standardized medical practice at the participating centers before the inclusion of patients: 208 patients received rivaroxaban and 205 received the standard of care. Data on symptomatic thromboembolic and bleeding events, surgery-related complications, death, adverse events, time to mobilization, and hospital discharge were collected. Symptomatic thromboembolic events were reported in 1 patient (0.5%) and 2 patients (1.0%) and treatment-emergent major bleeding events were reported in 1 patient (0.5%) and 2 patients (1.0%) receiving rivaroxaban and the standard of care, respectively. The durations of hospital stay and venous thromboembolic prophylaxis were similar in the 2 groups. In both groups, adverse events related to venous thromboembolic prophylaxis were reported in 12 patients. The proportion of patients with minor and major fracture surgery was 74.3% and 25.7%, respectively. In patients undergoing minor fracture surgery receiving rivaroxaban (n=167) and the standard of care (n=140), no symptomatic thromboembolic events and no major bleeding events were reported. Outcomes of this study indicate that rivaroxaban might be an appropriate oral alternative for venous thromboembolic prophylaxis in routine medical care after fracture-related major and minor surgery. Reported results were comparable to those from other large-scale, noninterventional and randomized controlled studies. [Orthopedics. 2017; 40(2):109-116.].
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Born P, Ilchmann T, Zimmerli W, Zwicky L, Graber P, Ochsner PE, Clauss M. Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties. Acta Orthop 2016; 87:637-643. [PMID: 27658856 PMCID: PMC5119449 DOI: 10.1080/17453674.2016.1237423] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem. Patients and methods - Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2-15) years. Results - The 7-year infection-free survival was 96% (95% CI: 92-100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87-100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93-100), 97% for 1-stage revision (95% CI: 90-100) and 97% for 2-stage revision (95% CI: 92-100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures. Interpretation - Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions for aseptic loosening.
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Affiliation(s)
- Philipp Born
- Department of Orthopedics and Trauma Surgery and
| | - Thomas Ilchmann
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Liestal;,Leonardo, Ärzte für Orthopädie und Traumatologie, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Werner Zimmerli
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Liestal
| | - Lukas Zwicky
- Department of Orthopedics and Trauma Surgery and
| | - Peter Graber
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Liestal
| | - Peter E Ochsner
- Department of Orthopedics and Trauma Surgery and;,Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Liestal
| | - Martin Clauss
- Department of Orthopedics and Trauma Surgery and;,Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Liestal;,Correspondence:
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Ilchmann T, Zimmerli W, Bolliger L, Graber P, Clauss M. Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips. BMC Musculoskelet Disord 2016; 17:471. [PMID: 27842584 PMCID: PMC5109646 DOI: 10.1186/s12891-016-1332-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023] Open
Abstract
Background The direct anterior approach (DAA) is increasingly popular for hip replacement. However, the small incision and the location near to the groin might increase the risk of periprosthetic joint infection (PJI). We asked the questions (i) whether there is an increased risk of infection for this approach, and (ii) whether the spectrum of microorganisms differs between patients with DAA and those with lateral transgluteal approach (LAT). Methods All patients operated between 08/2006 and 12/2013 were followed prospectively in an in house register. The DAA was introduced as routine in 02/2009 at our hospital. Patients with primary elective hip replacement without previous operations were included. Follow-up was scheduled after 6, 12 weeks and 1, 2 years. PJI was defined according to standardized criteria. Results One thousand one hundred four patients were studied, 700 were operated with DAA and 404 with LAT. No patient was lost to follow-up. PJI was diagnosed in 23/1104 (2.1 %) patients, 16 (2.3 %) in the group with DAA, and 7 (1.7 %) in the group with LAT. Patients with infection had a higher BMI (p < 0.001) and a higher ASA score (p < 0.001). Only patients with the DAA had exogenous PJI caused by gramnegative bacilli (35.7 % vs 0 %, p = 0.26). In the DAA-group, the fraction of patients with polymicrobial infection was somewhat higher than in the LAT-group (50 % vs 33 %, P = 0.64). Conclusion There was no increased risk of infection for the DAA.
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Affiliation(s)
- Thomas Ilchmann
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.,Leonardo, Hirslanden Klinik Birshof, Reinacherstrasse 28, 4142, Münchenstein, Switzerland
| | - Werner Zimmerli
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Lilianna Bolliger
- Department for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Peter Graber
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Martin Clauss
- Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland. .,Department for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.
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Siepen W, Zwicky L, Stoffel KK, Ilchmann T, Clauss M. Prospective two-year subsidence analysis of 100 cemented polished straight stems - a short-term clinical and radiological observation. BMC Musculoskelet Disord 2016; 17:395. [PMID: 27640188 PMCID: PMC5027091 DOI: 10.1186/s12891-016-1247-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 09/09/2016] [Indexed: 01/14/2023] Open
Abstract
Background Cemented stems show good long-term results and the survival of new implants can be predicted by their early subsidence. With EBRA-FCA (Femoral Component Analysis using Einzel-Bild-Röntgen-Analyse) early subsidence as an early indicator for later aseptic loosening can be analysed. For the cemented TwinSys stem mid- and long-term data is only avalible from the New Zeeland Arthroplasty register, thus close monitoring of this implant system is still mandatory. Methods We conducted a 2 year follow up of 100 consecutive hybrid THA (Total hip arthroplasty) of a series of 285 primary THA operated between Jan 2009 und Oct 2010. These 100 received a polished, cemented collarless straight stem (twinSys®, Mathys AG® Bettlach, Switzerland) with an uncemented monobloc pressfit cup (RM pressfit®, Mathys AG® Bettlach, Switzerland). The other patients were treated with the uncemented version of this stem and the same cup. Clinical (Harris Hip Score) and radiological (ap and axial x-rays, cementing quality according to Barrack, alignment) outcomes besides an EBRA-FCA subsidence analysis were performed. Results Median age at operation was 78 (68 to 93) years. 5 patients died in the course of follow-up unrelated to surgery. The KM (Kaplan-Meier) survival at 2 years for the endpoint reoperation for any reason was 94.9 (95 % confidence interval 90.6–100 %). Survival for the endpoint aseptic loosening at 2 years was 100 %. The HHS (Harris Hip Score) improved from 56 (14–86) preoperatively to 95 (60–100) 2 years after the operation. Cementing results were judged 47 % Grade A, 45 % Grade B and 7 % Grade C. Osteolysis was found in 2 stems without clinical symptoms or correlation to subsidence or cementing quality. The EBRA-FCA analysis showed an average subsidence of -0.30 mm (95 % CI -0.5 mm to -0.1 mm). 11 patients showed a subsidence of more than 1 mm. In this group one patient showed a subsidence of 1.5 mm and one of 3.1 mm without further radiological changes. Conclusions The twinSys stem showed excellent clinical and radiologic short term results at 2 years follow-up and seems to be a reliable implant.
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Affiliation(s)
- Wolf Siepen
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland.
| | - Lukas Zwicky
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
| | - Karl Kilian Stoffel
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
| | - Thomas Ilchmann
- LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Martin Clauss
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
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Sirka A, Clauss M, Tarasevicius S, Wingstrand H, Stucinskas J, Robertsson O, Emil Ochsner P, Ilchmann T. Excellent long-term results of the Müller acetabular reinforcement ring in primary total hip arthroplasty: A prospective study on radiology and survival of 321 hips with a mean follow-up of 11 years. Acta Orthop 2016; 87:100-5. [PMID: 26471881 PMCID: PMC4812069 DOI: 10.3109/17453674.2015.1103607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The original Müller acetabular reinforcement ring (ARR) shows favorable medium-term results for acetabular reconstruction in total hip arthroplasty, where it is used when the acetabular bone stock is deficient. However, there are no data regarding long-term survival of the device. We therefore investigated long-term survival and analyzed radiological modes of failure. PATIENTS AND METHODS Between 1984 and 2002, 321 consecutive primary arthroplasties using an ARR were performed in 291 patients. The mean follow-up time was 11 (0-25) years, and 24 hips were lost to follow-up. For survival analysis, we investigated 321 hips and the end of the follow-up was the date of revision, date of death, or the last patient contact date with implant still in situ. Radiological assessment was performed for 160 hips with a minimum of 10 years of follow-up and with radiographs of sufficient quality. It included evaluation of osteolysis, migration, and loosening. RESULTS 12 ARR THAs were revised: 1 isolated ARR revision for aseptic loosening, 4 revisions of the ARR and the stem for aseptic loosening, 6 for infection, and 1 for recurrent dislocation. The cumulative revision rate for all components, for any reason, at 20 years was 15% (95% CI: 10-22), while for the ARR only it was 7% (95% CI: 4-12) for any reason and 3.4% (95% CI: 1-9) for aseptic loosening. 21 (13%) of 160 ARR THAs examined had radiological changes: 7 had osteolysis but were not loose, and 14 were radiologically loose but were not painful and not revised. INTERPRETATION Our data suggest that the long-term survival of the ARR is excellent.
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Affiliation(s)
| | - Martin Clauss
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Sarunas Tarasevicius
- Department of Orthopedics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hans Wingstrand
- Department of Orthopedics, Lund University and Lund University Hospital, Lund, Sweden
| | | | - Otto Robertsson
- Department of Orthopedics, Lund University and Lund University Hospital, Lund, Sweden
| | - Peter Emil Ochsner
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
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Clauss M, Bolliger L, Brandenberger D, Ochsner PE, Ilchmann T. Similar effect of stem geometry on radiological changes with 2 types of cemented straight stem: The Müller stem and the Virtec stem compared in 711 hips. Acta Orthop 2016; 87:120-5. [PMID: 26471977 PMCID: PMC4812072 DOI: 10.3109/17453674.2015.1104153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE There are 2 basic principles in cemented stem fixation: shape-closed and force-closed. We investigated 2 shape-closed straight stems, the Müller (MSS) and the Virtec (VSS), which differ only in geometrical cross section, to determine whether the difference in stem shape would affect the radiological results or long-term survival. PATIENTS AND METHODS We included 711 hips (in 646 patients) that were operated on between July 1996 and July 2003. Patients randomly received either an MSS (n = 356) or a VSS (n = 355) and were followed prospectively. Radiographs taken at a follow-up of > 10 years were analyzed for osteolysis. Kaplan-Meier (KM) survival analysis was performed using various endpoints. We also performed Cox regression analysis to identify risk factors for aseptic loosening and osteolysis of the stem. RESULTS After 10 years, KM survival with "revision of any component for any reason" was 92% (95% CI: 88-95) for the MSS and 95% (CI: 92-97) for the VSS (p = 0.1). With "revision for aseptic loosening of the stem" as the endpoint, KM survival was 96% (CI: 9-98) for the MSS and 98% (CI: 97-100) for the VSS (p = 0.2). Cox regression showed that none of the risk factors analyzed were independent regarding aseptic loosening of the stem or regarding osteolysis. INTERPRETATION The MSS and the VSS showed excellent survival for aseptic loosening after 10 years. For the 2 different stem designs, we did not find any independent risk factors for aseptic loosening or development of osteolysis.
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Baur J, Zwicky L, Hirschmann MT, Ilchmann T, Clauss M. Metal backed fixed-bearing unicondylar knee arthroplasties using minimal invasive surgery: a promising outcome analysis of 132 cases. BMC Musculoskelet Disord 2015; 16:177. [PMID: 26228779 PMCID: PMC4521357 DOI: 10.1186/s12891-015-0651-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Unicondylar knee arthroplasty (UKA) is a well-established treatment for isolated osteoarthritis (OA) of the medial knee compartment. Aim of this retrospective study was to evaluate the early clinical and radiological outcomes of a consecutive series of patients treated with medial metal backed fixed-bearing UKA. Furthermore, the influence of the component orientation on the outcome was analyzed. METHODS From 09/2006 to 11/2010 106 patients (132 knees; 69 ± 9 years) were treated using a metal backed fixed-bearing UKA with a MIS approach. All patients underwent a standardized clinical and radiological follow-up at 6 weeks, 1, 2 and 5 years. Mean follow-up was 3.4 ± 1.0 years. Two patients (three UKAs) deceased and two patients (two UKAs) were lost to follow-up. Three different survival analyses were performed using three different endpoints defining failure: (a) revision with exchange of any UKA component (b) aseptic loosening and (c), a worst case scenario, where it was assumed that all progressive radiolucencies would lead to aseptic loosening and thus these were additionally counted. Clinical outcome was assessed using the American knee society score (AKS) and the Oxford knee score (OKS). Radiographic analysis was done according to the American Knee Society Evaluation and Scoring System adapted for UKA and correlated with the AKS and OKS. RESULTS Five UKAs (3.8 %) were revised to total knee arthroplasties (TKAs) after a median of 25 (10-33) months. Five year survival was 95.2, 97.5 and 87.7% for the aforementioned endpoints. At final follow-up the median AKS knee score was 99 (50-100) points and the median AKS function score was 100 (60-100) points. The median OKS was 43 (8-48) points. Clinical outcome was independent of the component orientation. CONCLUSION Fixed-bearing UKA showed excellent clinical and radiological results at up to 5 years follow-up. Outcome was independent of component orientation.
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Affiliation(s)
- Joel Baur
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
| | - Lukas Zwicky
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
| | - Michael Tobias Hirschmann
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
| | - Thomas Ilchmann
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
- Leonardo - Klinik Birshof, CH-4142, Muenchenstein, Switzerland.
| | - Martin Clauss
- Kantonsspital Baselland, Clinics for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410, Liestal, Switzerland.
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Furustrand Tafin U, Betrisey B, Bohner M, Ilchmann T, Trampuz A, Clauss M. Staphylococcal biofilm formation on the surface of three different calcium phosphate bone grafts: a qualitative and quantitative in vivo analysis. J Mater Sci Mater Med 2015; 26:130. [PMID: 25693675 PMCID: PMC4333228 DOI: 10.1007/s10856-015-5467-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Abstract
Differences in physico-chemical characteristics of bone grafts to fill bone defects have been demonstrated to influence in vitro bacterial biofilm formation. Aim of the study was to investigate in vivo staphylococcal biofilm formation on different calcium phosphate bone substitutes. A foreign-body guinea-pig infection model was used. Teflon cages prefilled with β-tricalcium phosphate, calcium-deficient hydroxyapatite, or dicalcium phosphate (DCP) scaffold were implanted subcutaneously. Scaffolds were infected with 2 × 10(3) colony-forming unit of Staphylococcus aureus (two strains) or S. epidermidis and explanted after 3, 24 or 72 h of biofilm formation. Quantitative and qualitative biofilm analysis was performed by sonication followed by viable counts, and microcalorimetry, respectively. Independently of the material, S. aureus formed increasing amounts of biofilm on the surface of all scaffolds over time as determined by both methods. For S. epidermidis, the biofilm amount decreased over time, and no biofilm was detected by microcalorimetry on the DCP scaffolds after 72 h of infection. However, when using a higher S. epidermidis inoculum, increasing amounts of biofilm were formed on all scaffolds as determined by microcalorimetry. No significant variation in staphylococcal in vivo biofilm formation was observed between the different materials tested. This study highlights the importance of in vivo studies, in addition to in vitro studies, when investigating biofilm formation of bone grafts.
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Affiliation(s)
- Ulrika Furustrand Tafin
- Infectious Diseases Service, Department of Internal Medicine, University Hospital Lausanne (CHUV), Lausanne, Switzerland
- Unit of Septic Surgery, Department of Surgery and Anaesthesiology, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Bertrand Betrisey
- Infectious Diseases Service, Department of Internal Medicine, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | | | - Thomas Ilchmann
- Department for Orthopaedics and Trauma Surgery, Clinic for Orthopaedics and Trauma Surgery, Kantonsspital Baselland Liestal, Rheinstreet 26, 4410 Liestal, Switzerland
| | - Andrej Trampuz
- Infectious Diseases Service, Department of Internal Medicine, University Hospital Lausanne (CHUV), Lausanne, Switzerland
- Department of Traumatology and Reconstructive Surgery including Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Clauss
- Infectious Diseases Service, Department of Internal Medicine, University Hospital Lausanne (CHUV), Lausanne, Switzerland
- Unit of Septic Surgery, Department of Surgery and Anaesthesiology, University Hospital Lausanne (CHUV), Lausanne, Switzerland
- RMS Foundation, Bettlach, Switzerland
- Department for Orthopaedics and Trauma Surgery, Clinic for Orthopaedics and Trauma Surgery, Kantonsspital Baselland Liestal, Rheinstreet 26, 4410 Liestal, Switzerland
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Clauss M, Furustrand Tafin U, Betrisey B, van Garderen N, Trampuz A, Ilchmann T, Bohner M. Influence of physico-chemical material characteristics on staphylococcal biofilm formation--a qualitative and quantitative in vitro analysis of five different calcium phosphate bone grafts. Eur Cell Mater 2014; 28:39-49; discussion 49-50. [PMID: 25036054 DOI: 10.22203/ecm.v028a04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Various compositions of synthetic calcium phosphates (CaP) have been proposed and their use has considerably increased over the past decades. Besides differences in physico-chemical properties, resorption and osseointegration, artificial CaP bone graft might differ in their resistance against biofilm formation. We investigated standardised cylinders of 5 different CaP bone grafts (cyclOS, chronOS (both β-TCP (tricalcium phosphate)), dicalcium phosphate (DCP), calcium-deficient hydroxyapatite (CDHA) and α-TCP). Various physico-chemical characterisations e.g., geometrical density, porosity, and specific surface area were investigated. Biofilm formation was carried out in tryptic soy broth (TSB) and human serum (SE) using Staphylococcus aureus (ATCC 29213) and S. epidermidis RP62A (ATCC 35984). The amount of biofilm was analysed by an established protocol using sonication and microcalorimetry. Physico-chemical characterisation showed marked differences concerning macro- and micropore size, specific surface area and porosity accessible to bacteria between the 5 scaffolds. Biofilm formation was found on all scaffolds and was comparable for α-TCP, chronOS, CDHA and DCP at corresponding time points when the scaffolds were incubated with the same germ and/or growth media, but much lower for cyclOS. This is peculiar because cyclOS had an intermediate porosity, mean pore size, specific surface area, and porosity accessible to bacteria. Our results suggest that biofilm formation is not influenced by a single physico-chemical parameter alone but is a multi-step process influenced by several factors in parallel. Transfer from in vitro data to clinical situations is difficult; thus, advocating the use of cyclOS scaffolds over the four other CaP bone grafts in clinical situations with a high risk of infection cannot be clearly supported based on our data.
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Affiliation(s)
- M Clauss
- Kantonsspital Baselland Liestal, Clinic for Orthopaedics and Trauma Surgery, Rheinstrasse 26, CH-4410 Liestal,
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Moser A, Ilchmann T, Mendelin R, Clauss M. [Knee pain of unknown origin after total knee prosthesis in a patient with chronic polyarthritis]. Praxis (Bern 1994) 2014; 103:161-164. [PMID: 24468456 DOI: 10.1024/1661-8157/a001550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Persisting pain after TKA is a frequent problem. The most frequent differential diagnoses are aseptic loosening, malpositioning or a prosthetic joint infection. Retropatellar pain, functional or psychosomatic cause should be taken into account, too. An acute episode in patients with a rheumatoid arthritis should be ruled out. Insufficiency fractures, which can also be found in the presented case, are more often in patients with rheumatoid arthritis. The insufficiency fracture was detectable in the MRI and shows an uncommon, non-described localization. To prevent a loss of mobility of fractures close to the joint a surgical stabilizing is recommended, leading to quick healing.
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MESH Headings
- Aged
- Arthritis/complications
- Arthritis/diagnosis
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Femoral Fractures/diagnosis
- Humans
- Image Interpretation, Computer-Assisted
- Knee Joint/pathology
- Magnetic Resonance Imaging
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/surgery
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Prosthesis Design
- Prosthesis Failure
- Reoperation
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed
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Affiliation(s)
- Annette Moser
- Klinik für Orthopädie und Traumatologie des Bewegungsapparats, Kantonsspital Baselland, Liestal
| | - Thomas Ilchmann
- Klinik für Orthopädie und Traumatologie des Bewegungsapparats, Kantonsspital Baselland, Liestal
| | | | - Martin Clauss
- Klinik für Orthopädie und Traumatologie des Bewegungsapparats, Kantonsspital Baselland, Liestal
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Ilchmann T, Gersbach S, Zwicky L, Clauss M. Standard Transgluteal versus Minimal Invasive Anterior Approach in hip Arthroplasty: A Prospective, Consecutive Cohort Study. Orthop Rev (Pavia) 2013; 5:e31. [PMID: 24416475 PMCID: PMC3883072 DOI: 10.4081/or.2013.e31] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/14/2013] [Accepted: 08/20/2013] [Indexed: 02/07/2023] Open
Abstract
A minimally invasive anterior approach (MIS) was compared to a standard lateral approach in primary total hip arthroplasty. Clinical and radiological outcomes were analyzed 6 weeks, 12 weeks, one year and two years after surgery. The duration of surgery was longer, mobility one week after surgery was better and time of hospitalization was shorter for minimally invasive-treated patients. They had less pain during movement, limping, better Harris Hip Score and satisfaction after 6 weeks, which remained after 12 weeks and 1 year, but not after two years. There were two deep infections in the MIS group. Radiological results were not affected. The infections might be a point of concern, but there were no other disadvantages of the MIS approach. In fact, early rehabilitation was facilitated and clinical results were improved. Our results encourage the continuous use of the MIS anterior approach instead of the lateral approach.
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Affiliation(s)
- Thomas Ilchmann
- Department of Orthopedic Surgery, Kantonsspital Baselland , Liestal, Switzerland
| | - Silke Gersbach
- Department of Orthopedic Surgery, Kantonsspital Baselland , Liestal, Switzerland
| | - Lukas Zwicky
- Department of Orthopedic Surgery, Kantonsspital Baselland , Liestal, Switzerland
| | - Martin Clauss
- Department of Orthopedic Surgery, Kantonsspital Baselland , Liestal, Switzerland
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Bachmann M, Bolliger L, Ilchmann T, Clauss M. Long-term survival and radiological results of the Duracon™ total knee arthroplasty. Int Orthop 2013; 38:747-52. [PMID: 24178063 PMCID: PMC3971257 DOI: 10.1007/s00264-013-2154-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/08/2013] [Indexed: 01/27/2023]
Abstract
Purpose The aim of this study was to analyse the long-term (>ten years) survival rate and radiological results of the Duracon TKA. Methods Between 1992 and 1999 159 Duracon TKA were implanted at our institution. A Kaplan-Meier survival analysis for the endpoints exchange, addition or removal of any component for any reason, revision due to aseptic loosening and mechanical failure was performed. Radiological long-term (>ten years) follow-up (FU) analysis was performed according to the Knee Society Radiographic Evaluation and Scoring System. Results Mean age at surgery was 74.3 years, 28 % were male, and 89 % had primary osteoarthritis as diagnosis. Mean FU for survival analysis was 10.9 years (SD 4.2). A total of 58 % of the patients died during follow-up. Three patients (2.1 %) were lost to follow-up and five TKA (3.1 %) were revised. After ten years the mean survival was 97.7 %, 99.4 % and 98.3 % for the aforementioned endpoints, respectively. Mean radiological FU was 11.8 years (SD 2.3). We found no significant change in alignment of the components or axis over time. Progressive radiolucencies were found in nine TKA (17 %), mainly around the tibial component (95 %). Conclusion The Duracon TKA showed excellent long-term survival comparable to data from national registers and to other successful designs. Radiological changes found on plain radiographs were scarce after almost 12 years of radiological follow-up indicating good implant stability.
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Affiliation(s)
- Matthias Bachmann
- Clinic for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, Liestal, Rheinstrasse 26, 4410, Liestal, Switzerland
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Clauss M, Gersbach S, Butscher A, Ilchmann T. Risk factors for aseptic loosening of Müller-type straight stems: a registry-based analysis of 828 consecutive cases with a minimum follow-up of 16 years. Acta Orthop 2013; 84:353-9. [PMID: 23799347 PMCID: PMC3768033 DOI: 10.3109/17453674.2013.810517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose Even small differences in design variables for the femoral stem may influence the outcome of a hip arthroplasty. We performed a risk factor analysis for aseptic loosening of 4 different versions of cemented Müller-type straight stems with special emphasis on design modifications (2 shapes, MSS or SL, and 2 materials, CoNiCrMo (Co) or Ti-6Al-7Nb (Ti)). Methods We investigated 828 total hip replacements, which were followed prospectively in our in-house register. All stems were operated in the same setup, using Sulfix-6 bone cement and a second-generation cementing technique. Demographic and design-specific risk factors were analyzed using an adjusted Cox regression model. Results The 4 versions showed marked differences in 15-year stem survival with aseptic loosening as the endpoint: 94% (95% CI: 89-99) for MSS Co, 83% (CI: 75-91) for SL Co, 81% (CI: 76-87) for MSS Ti and 63% (CI: 56-71) for SL Ti. Cox regression analysis showed a relative risk (RR) for aseptic loosening of 3 (CI: 2-5) for stems made of Ti and of 2 (CI: 1-2) for the SL design. The RR for aseptic stem loosening increased to 8 (CI: 4-15) when comparing the most and the least successful designs (MSS Co and SL Ti). Interpretation Cemented Müller-type straight stems should be MSS-shaped and made of a material with high flexural strength (e.g. cobalt-chrome). The surface finish should be polished (Ra < 0.4 µm). These technical aspects combined with modern cementing techniques would improve the survival of Müller-type straight stems. This may be true for all types of cemented stems.
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Affiliation(s)
- Martin Clauss
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland Liestal
| | - Silke Gersbach
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland Liestal
| | | | - Thomas Ilchmann
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland Liestal
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Clauss M, Tafin UF, Bizzini A, Trampuz A, Ilchmann T, Ilchmann T. Biofilm formation by staphylococci on fresh, fresh-frozen and processed human and bovine bone grafts. Eur Cell Mater 2013; 25:159-66. [PMID: 23361610 DOI: 10.22203/ecm.v025a11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Biofilm formation is a multi-step process influenced by surface properties. We investigated early and mature biofilm of Staphylococcus aureus on 4 different biological calcium phosphate (CaP) bone grafts used for filling bone defects. We investigated standardised cylinders of fresh and fresh-frozen human bone grafts were harvested from femoral heads; processed humanand bovine bone grafts were obtained preformed. Biofilm formation was done in tryptic soy broth (TSB) using S. aureus (ATCC 29213) with static conditions. Biofilm density after 3 h (early biofilm) and 24 h (mature biofilm) was investigated by sonication and microcalorimetry. After 3 h, bacterial density was highest on fresh-frozenandfresh bone grafts. After 24 h, biofilm density was lowest on freshbone grafts (p < 0.001) compared to the other 3 materials, which did not differ quantitatively (p > 0.05). The lowest increase in bacterial density was detected on fresh bone grafts (p < 0.001). Despite normal shaped colonies, we found additional small colonies on the surface of the fresh and fresh-frozen samples by sonication. This was also apparent in microcalorimetric heat-flow curves. The four investigated CaP bone grafts showed minor structural differences in architecture but marked differences concerning serum coverage and the content of bone marrow, fibrous tissue and bone cells. These variations resulted in a decreased biofilm density on freshand fresh-frozenbone grafts after 24 h, despite an increased early biofilm formation and might also be responsible for the variations in colony morphology (small colonies). Detection of small colony variants by microcalorimetry might be a new approach to improve the understanding of biofilm formation.
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Affiliation(s)
- M Clauss
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland Liestal,Liestal, Switzerland.
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Stucinskas J, Clauss M, Tarasevicius S, Wingstrand H, Ilchmann T. Long-term femoral bone remodeling after cemented hip arthroplasty with the Müller straight stem in the operated and nonoperated femora. J Arthroplasty 2012; 27:927-33. [PMID: 22085798 DOI: 10.1016/j.arth.2011.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/21/2011] [Indexed: 02/01/2023] Open
Abstract
We investigated the cortical bone changes in 35 patients with total hip arthroplasty operated on only for osteoarthritis with more than 10 years of follow-up and with nonrevised femoral components and without radiologic signs of loosening. The mean follow-up was 16 ± 5 years. The thicknesses of femoral cortices were measured medially and laterally at 6 levels from the first postoperative and the last follow-up x-rays. A comparison with 10 patients who had a nonoperated contralateral hip was performed. We found a significant decrease in cortical thicknesses in total hip arthroplasty. The cortical thinning was significant at all periprosthetic levels but less expressed distally. Prosthetic femora were associated with greater cortical thinning as compared with the contralateral nonoperated femora, exceeding that caused by natural aging.
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Affiliation(s)
- Justinas Stucinskas
- Department of Orthopedic Surgery, Kantonsspital Liestal, Liestal, Switzerland
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Heim U, Clauss M, Graber P, Ilchmann T. [An unexpected case of lower left-side abdominal pain. Acute reactivation of chronic osteomyelitis]. Praxis (Bern 1994) 2012; 101:603-607. [PMID: 22535457 DOI: 10.1024/1661-8157/a000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Osteomyelitis caused by S. aureus can be reactivated after decades. Our patient presented with an acute episode of lower left-side abdominal pain and subfebrile temperature due to a reactivation of a S. aureus osteomyelitis in the iliac bone which was initially misinterpreted as a sigma diverticulitis. Diagnosis was established by conventional radiographs as well as CT and MR scans. Harvesting the responsible germ by a bone biopsy prior to therapy is mandatory. Therapy consists of a surgical debridement combined with a long-lasting antibiotic therapy. Relapse can be found after long latency.
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Affiliation(s)
- U Heim
- Klinik für Orthopädie und Traumatologie des Bewegungsapparats, Kantonsspital Liestal
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De Man FHR, Sendi P, Zimmerli W, Maurer TB, Ochsner PE, Ilchmann T. Infectiological, functional, and radiographic outcome after revision for prosthetic hip infection according to a strict algorithm. Acta Orthop 2011; 82:27-34. [PMID: 21189099 PMCID: PMC3229994 DOI: 10.3109/17453674.2010.548025] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Successful treatment of prosthetic hip joint infection (PI) means elimination of infection and restored hip function. However, functional outcome is rarely studied. We analyzed the outcome of the strict use of a treatment algorithm for PI. PATIENTS AND METHODS The study groups included 22 hips with 1-stage exchange for PI (group 1), 22 matched hips revised for aseptic loosening (controls), and 50 hips with 2-stage exchange (group 2). Relapse of infection, Harris hip score (HHS), limping, use of crutches, reoperations, complications, and radiographic changes were compared between the groups. RESULTS There was 1 relapse of infection, which occurred in group 2. In group 1, the mean HHS was 84; 4 of 19 patients were limping and 2 required 2 crutches, which was similar to the control results. In group 2, scores were lower and complication rates higher. The use of a Burch-Schneider ring and the presence of a deficient trochanter impaired function. There were no differences in radiographic outcome between the groups. INTERPRETATION With the algorithm used, infection can be cured with high reliability. With a 1-stage procedure, mobility is maintained. After 2-stage procedures, function was impaired due to there being more previous surgery and more serious infection.
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Affiliation(s)
- F Harald R De Man
- Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Parham Sendi
- Clinic of Orthopaedic Surgery, Kantonsspital, and the Infectious Diseases Unit, Basel University Medical Clinic, Liestal, Switzerland
| | - Werner Zimmerli
- Clinic of Orthopaedic Surgery, Kantonsspital, and the Infectious Diseases Unit, Basel University Medical Clinic, Liestal, Switzerland
| | - Thomas B Maurer
- Clinic of Orthopaedic Surgery, Kantonsspital, and the Infectious Diseases Unit, Basel University Medical Clinic, Liestal, Switzerland
| | - Peter E Ochsner
- Clinic of Orthopaedic Surgery, Kantonsspital, and the Infectious Diseases Unit, Basel University Medical Clinic, Liestal, Switzerland
| | - Thomas Ilchmann
- Clinic of Orthopaedic Surgery, Kantonsspital, and the Infectious Diseases Unit, Basel University Medical Clinic, Liestal, Switzerland
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Clauss M, Ilchmann T, Zimmermann P, Ochsner PE. The histology around the cemented Müller straight stem: A post-mortem analysis of eight well-fixed stems with a mean follow-up of 12.1 years. ACTA ACUST UNITED AC 2010; 92:1515-21. [PMID: 21037345 DOI: 10.1302/0301-620x.92b11.25342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to obtain detailed long-term data on the cement-bone interface in patients with cemented stems, implanted using the constrained fixation technique. A total of eight stems were removed together with adjacent bone during post-mortem examinations of patients with well-functioning prostheses. Specimens were cut at four defined levels, contact radiographs were obtained for each level, and slices were prepared for histological analysis. Clinical data, clinical radiographs, contact radiographs and histological samples were examined for signs of loosening and remodelling. The mean radiological follow-up was 9.6 years and all stems were well-fixed, based on clinical and radiological criteria. Contact radiographs revealed an incomplete cement mantle but a complete filling of the medullary canal for all implants. Various amounts of polyethylene particles were evident at the cement-bone interface of seven stems, with no accompanying inflammatory reaction. Cortical atrophy and the formation of an 'inner cortex' were confirmed in six of eight stems by contact radiographs and histology, but were only visible on two clinical radiographs. Our results confirm that a complete cement mantle is not essential for the survival of Müller straight stems into the mid term, and support our hypothesis that no benefit to long-term survival can be expected from modern cementing techniques.
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Affiliation(s)
- M Clauss
- Kantonsspital Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
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Clauss M, Trampuz A, Borens O, Bohner M, Ilchmann T. Biofilm formation on bone grafts and bone graft substitutes: comparison of different materials by a standard in vitro test and microcalorimetry. Acta Biomater 2010; 6:3791-7. [PMID: 20226886 DOI: 10.1016/j.actbio.2010.03.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 02/14/2010] [Accepted: 03/05/2010] [Indexed: 02/03/2023]
Abstract
We analyzed the initial adhesion and biofilm formation of Staphylococcus aureus (ATCC 29213) and S. epidermidis RP62A (ATCC 35984) on various bone grafts and bone graft substitutes under standardized in vitro conditions. In parallel, microcalorimetry was evaluated as a real-time microbiological assay in the investigation of biofilm formation and material science research. The materials beta-tricalcium phosphate (beta-TCP), processed human spongiosa (Tutoplast) and poly(methyl methacrylate) (PMMA) were investigated and compared with polyethylene (PE). Bacterial counts (log(10) cfu per sample) were highest on beta-TCP (S. aureus 7.67 +/- 0.17; S. epidermidis 8.14 +/- 0.05) while bacterial density (log(10) cfu per surface) was highest on PMMA (S. aureus 6.12 +/- 0.2, S. epidermidis 7.65 +/- 0.13). Detection time for S. aureus biofilms was shorter for the porous materials (beta-TCP and processed human spongiosa, p < 0.001) compared to the smooth materials (PMMA and PE), with no differences between beta-TCP and processed human spongiosa (p > 0.05) or PMMA and PE (p > 0.05). In contrast, for S. epidermidis biofilms the detection time was different (p < 0.001) between all materials except between processed human spongiosa and PE (p > 0.05). The quantitative analysis by quantitative culture after washing and sonication of the material demonstrated the importance of monitoring factors like specific surface or porosity of the test materials. Isothermal microcalorimetry proved to be a suitable tool for an accurate, non-invasive and real-time microbiological assay, allowing the detection of bacterial biomass without removing the biofilm from the surface.
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Affiliation(s)
- Martin Clauss
- Department of Orthopedic Surgery, Kantonsspital Liestal, Liestal, Switzerland.
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Clauss M, Luem M, Ochsner PE, Ilchmann T. Fixation and loosening of the cemented Muller straight stem: a long-term clinical and radiological review. ACTA ACUST UNITED AC 2009; 91:1158-63. [PMID: 19721040 DOI: 10.1302/0301-620x.91b9.22023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The original forged Müller straight stem (CoNiCr) has shown excellent ten- to 15-year results. We undertook a long-term survival analysis with special emphasis on radiological changes within a 20-year period of follow-up. In all, 165 primary total hip replacements, undertaken between July 1984 and June 1987 were followed prospectively. Clinical follow-up included a standardised clinical examination, and radiological assessment was based on a standardised anteroposterior radiograph of the pelvis, which was studied for the presence of osteolysis, debonding and cortical atrophy. Survival of the stem with revision for any reason was 81% (95% confidence interval (CI), 76 to 86) at 20 years and for aseptic loosening 87% (95% CI, 82 to 90). At the 20-year follow-up, 15 of the surviving 36 stems showed no radiological changes. Debonding (p = 0.005), osteolysis (p = 0.003) and linear polyethylene wear (p = 0.016) were associated with aseptic loosening, whereas cortical atrophy was not associated with failure (p = 0.008). The 20-year results of the Müller straight stem are comparable to those of other successful cemented systems with similar follow-up. Radiological changes are frequently observed, but with a low incidence of progression, and rarely result in revision. Cortical atrophy appears to be an effect of ageing and not a sign of loosening of the femoral component.
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Affiliation(s)
- M Clauss
- Department of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, Liestal CH 4410, Switzerland.
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Clauss M, Ilchmann T, Zimmermann P, Schafroth MU, Lüem M, Ochsner PE. Classification of acetabular changes in osteoarthritis: a histological and radiological analysis of 122 consecutive drill biopsies routinely taken during THA. Surg Radiol Anat 2008; 30:547-56. [DOI: 10.1007/s00276-008-0363-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 04/30/2008] [Indexed: 10/22/2022]
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Ochs U, Ilchmann T, Ochs BG, Marx J, Brunnhuber K, Lüem M, Weise K. EBRA migration patterns of the Plasmacup with ceramic or polyethylene inserts: a randomised study. Z Orthop Unfall 2007; 145 Suppl 1:S20-S24. [PMID: 17939093 DOI: 10.1055/s-2007-965655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM In this prospective randomised study, the influence of different bearing materials on migration and wear was measured and their effect on the function of the artificial joint and the patient outcome was investigated. Mid-term results were recorded so that recommendations can be made on the use of certain bearings, which minimise wear and thus the danger of subsequent aseptic loosening. METHOD Sixty-six patients met the inclusion criteria and were willing to take part in the study. These patients were randomised to 2 groups. All of them had total hip arthroplasty with implantation of a cementless Bicontact stem and Plasmacup using a cementless press-fit technique. Thirty-five of these patients were given a ceramic-ceramic bearing and 31 patients a ceramic-polyethylene bearing (gamma sterilised/nitrogen environment). At the most recent follow-up, they underwent detailed clinical and radiological examination and evaluation by means of the Harris Hip Score, Hannover function questionnaire and single-film X-ray analysis (EBRA). RESULTS The overall follow-up rate was 65.2 % (43 of 66) and the mean follow-up period was 8.1 (7.1 - 9.2) years. The median Harris Hip Score at the time of follow-up was 90.1 (58.7 - 99.9) points. The average Hannover function score was 87.14 % (63.9 - 100). In 4 of 66 cases (6.1 %) there was a tendency for the Plasmacup to subsidence in the first postoperative months that was slight but detectable by EBRA; however, this stopped subsequently. This primary subsidence was independent of the chosen bearing material. No significant difference in the clinical and radiological parameters was found between the two groups. CONCLUSION The very good results with regard to the rate of loosening confirm the press-fit cup fixation concept. The study shows a similar medium-term result for the ceramic-ceramic and ceramic-polyethylene bearing so that use of both bearings can continue to be recommended. Only long-term studies with sufficiently large numbers of patients will be able to show whether significant differences can be detected between the two slide bearings with regard to wear and migration behaviour and so that a recommendation can be given to the surgeon.
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Affiliation(s)
- U Ochs
- BG Trauma Centre, University of Tuebingen, Schnarrenbergstrasse 95, Tuebingen, Germany.
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Riede U, Lüem M, Ilchmann T, Eucker M, Ochsner PE. The M.E Müller straight stem prosthesis: 15 year follow-up. Survivorship and clinical results. Arch Orthop Trauma Surg 2007; 127:587-92. [PMID: 17572903 DOI: 10.1007/s00402-007-0342-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Indexed: 02/09/2023]
Abstract
The aim of the study was to document the long-term clinical and radiologic results as well as the 15 year survival of a single cemented straight stem. Our series consisted of consecutive patients with 161 straight stem prostheses implanted between 1984 and 1987 in 152 patients. Follow-up was performed prospectively at 1, 2, 5, 10 and 15 years post-operatively. Seven stems were revised due to aseptic loosening, the 15 years survival rate being 94%. There were 18 acetabular revisions. Pain and patient satisfaction declined slightly over the study period. We observed a more prominent health-related decline of functional results. This effect was mainly due to aging. Younger patients showed better clinical results, but also a higher revision rate.
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Affiliation(s)
- Ulf Riede
- Orthopaedic Department, Kantonsspital Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
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Ilchmann T, Reimold M, Müller-Schauenburg W. Estimation of the wear volume after total hip replacement. A simple access to geometrical concepts. Med Eng Phys 2007; 30:373-9. [PMID: 17569572 DOI: 10.1016/j.medengphy.2007.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 03/21/2007] [Accepted: 04/05/2007] [Indexed: 11/21/2022]
Abstract
Various formulas have been proposed to calculate the volume of prosthetic wear from the penetration depth of the head as assessed on plain radiographs, based on idealized, three-dimensional geometrical models of a prosthetic hip. However, for most published formulas no (or no simple) derivation is available and not all of them are correct. We describe a simple geometrical model that allows for transparent derivation of equations for various components of prosthetic wear volume and compare the calculated volumes with those obtained from published equations. These components are: (1) a right generalized cylinder resulting from a linear shift of a half spherical part of the prosthetic head into the hemispherical cup, (2) an additional wedge that is "cut" from the cup and (3) the wear from an optional additional cylindrical portion of the cup. We emphasize that calculation of a three-dimensional wear volume from linear penetration depth should be based on a geometrical concept that is transparent and simple enough for clinical research, such as the one presented. The incorrect formula of Kabo et al. should be completely abandoned.
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Affiliation(s)
- T Ilchmann
- Department of Orthopaedics, Kantonsspital, Rheinstrasse 26, Liestal, Switzerland.
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Clauss M, Ilchmann T, Zimmermann P, Ochsner PE. [Corrective osteotomy of post-traumatic malunions and pseudarthroses in the femur using a fork plate: a prospective analysis of 23 consecutive cases]. Unfallchirurg 2006; 110:205-12. [PMID: 17177042 DOI: 10.1007/s00113-006-1211-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The fork plate is a further development of the AO fixed-angle blade plate, which facilitates the seeding of the angle blade. In a prospective study we evaluated the applicability of the fork plate for the correction of post-traumatic malunions and pseudarthroses in the femur. MATERIAL AND METHODS Between 01/1993 and 12/2003 a consecutive series of 23 patients were operated due to post-traumatic malunion or pseudarthrosis of the femur with an average age of 46 years at the time of surgery. The operative procedure is analogous to the one using angle blade plates. The most important surgical step, the placement of the fork instead of the blade, is more precise thanks to stepwise control with the image intensifier. RESULTS All preexisting malunions and pseudarthroses were corrected with the fork plate as preoperatively planned. Complications not related to the implant were found in 13%, all of which resolved without sequelae. In 87% we found a bony union of the osteotomy after 3 months, and the three remaining femora healed within an additional 2-12 months without loss of the correction achieved. CONCLUSION In all of the cases analyzed, the fork plate proved to be of value for correction of femoral malunion and pseudarthrosis. In relation to the angle blade plate, the fork plate features a modified surgical technique with the same possible indications. As a consequence this modification provides a high level of therapeutic safety even with a small number of annual operations performed.
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Affiliation(s)
- M Clauss
- Abteilung für Orthopädie und Traumatologie, Kantonsspital, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
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Abstract
INTRODUCTION Various modes of fixation are proposed for the treatment of slips of the capital femoral epiphysis (SCFE). We describe our experience with the use and removal of a new, cannulated titanium screw (Asnis III, Stryker, Howmedica). PATIENTS AND METHODS Single cannulated titanium screws had been inserted in 101 hips of 65 patients in the 3-year period from 2001 to 2003. These pins were used for in situ fixation of minor chronic slips in 41 patients and for prophylactic fixation on the contralateral side in patients with open physis in 60 patients. RESULTS The insertion of these screws was achieved without any real problem. The mean surgical time was 25 min (13-46 min). Problems came up when we started to remove the pins. Hardware retrieval was attempted in 27 patients with 43 pins. The mean surgical time for removal was double the average time of insertion with 51 min (26-107 min). The hexagonal Allen sockets proved to be too weak to overcome the necessary torque for loosening the pin from bone and applying the reverse-cutting-force, necessary to extract the pin. Eleven patients needed extensive chiselling. Two adolescents sustained a subtrochanteric fracture 5 and 7 weeks after hardware removal. Seven pins could not be totally removed. CONCLUSION Due to the considerable disadvantages encountered in our series we conclude that Asnis III cannulated screws should be suspended from further use in SCFE.
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Affiliation(s)
- T Ilchmann
- Department of Orthopaedic Surgery, Pediatric Center Olgahospital, Stuttgart, Germany.
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Ilchmann T, Neher S, Maurer F, Weise K. Modes of failure of a threaded acetabular cup : a radiographic study with EBRA of 42 revised cups. Int Orthop 2006; 31:211-6. [PMID: 16761152 PMCID: PMC2267560 DOI: 10.1007/s00264-006-0155-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 04/01/2006] [Accepted: 04/03/2006] [Indexed: 10/24/2022]
Abstract
A radiographic study of a singular type of threaded cup, revised due to aseptic loosening, was performed with Einzel-Bild-Roentgen-Analyse (EBRA) to detect eventual risk factors and patterns of loosening. Fifty-three cups of 50 patients were revised. Forty-two cups could be measured with EBRA. No cup had obvious osteolysis, 33 cups demonstrated early migration, and all cups had migrated at the time of revision. Twenty-eight of the cups had a change of inclination and 21 of anteversion, respectively. The mean migration was 1.9 mm in the medial and 7.9 mm in the cranial direction; the mean wear rate was 0.2 mm/year. Cups with early migration had a higher migration rate. All male patients had early migration; medially placed cups had less migration than the other cups. Wear was not significantly affected by the migration of the implant. No cup had a complete radiolucent line, and the only radiographic sign for loosening was the change of position of the cup. Medial placement showed less migration in case of loosening. Regular radiographic follow-up is recommended for the examined implant, and the cup should not be used in the future.
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Abstract
BACKGROUND Reconstruction of the bone stock and fixation of the implant remain challenging problems in revision surgery. In this retrospective study, we wanted to gain information on initial stability and wear after revision with the Burch-Schneider ring. PATIENTS AND METHODS Between 1994 and 1998, we performed 70 reconstructions of the acetabulum with a Burch-Schneider ring in revision arthroplasty. 63 patients could be followed up clinically and radiographically. 40 cups were suitable for EBRA measurements whereas migration and wear could not be assessed by this method in 23 cases due to lack of comparability of pelvic radiographs. The mean follow-up time was 4.7 years. RESULTS 2 cups were re-revised and 14 cups had breakage or changes of position of the screws. 30 cups showed detectable migration and 18 cups detectable wear. The mean migration was 2.8 mm and the mean wear rate was 0.12 mm/year. 16 cups had detectable migration after 1 year; 11 of these 16 continued to migrate and 9 of them had screw breakage. Both re-revisions showed early migration. Early migration correlated with later screw breakage and the overall migration correlated with wear. The only risk factor found for early migration was the wear rate. INTERPRETATION The Burch-Schneider ring is an established and reliable implant for cup revision with good clinical results, but it seems to be difficult to maintain intraoperative stability. The implants with continuous migration may lead to late clinical failure and require further observation. Wear may contribute to migration and resorption of the bone graft.
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Affiliation(s)
- Thomas Ilchmann
- Department of Orthopedics, Kantonsspital Liestal, Switzerland.
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Abstract
BACKGROUND In an experimental set up information is to be gained on the error of measurement for subsidence assessment of the stem after hip replacement. METHODS Subsidence was measured with a pencil and ruler for four different reference lines and with the computerized EBRA-FCA method. Hip flexion, rotation and abduction were simulated in a standardized way. In a second experimental set up, subsidence was simulated in defined steps. RESULTS In the tilt study, the maximum error of measurement was 7 mm with standard methods and 1.7 mm with the EBRA-FCA method. In the subsidence study, there was a maximum error of measurement of 1.9 mm with the standard methods. With EBRA-FCA, the maximum error of measurement was 0.2 mm when taking all radiographs into account. CONCLUSIONS The main error of subsidence measurement is caused by tilt of the femur for standard methods and partly can be reduced by EBRA-FCA. EBRA-FCA is more reliable than standard methods but might underestimate the actual subsidence in a clinical situation.
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Affiliation(s)
- Thomas Ilchmann
- Department of Orthopedics, Kantonsspital, Liestal, Switzerland.
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Abstract
EBRA (Ein Bild Roentgen Analyse) is a computer-aided algorithm to assess migration of endoprosthetic components. Stem subsidence is measured in comparable radiographs, as defined by the software. Recent studies showed an improved accuracy of EBRA-FCA as compared to standard methods. For the BiCONTACT cementless femoral component, a prospective follow-up study of 250 cases has provided excellent results, with a survival rate of 97.1% after 11 years. For this migration study 93 hips with a complete radiographic follow-up (> 10 x-rays) over 120 months were included. Seventy-one stems were be measured; in 22 stems the measurement was impossible due to heterotopic ossification. Thirty-two hips (45.1%) showed initial subsidence within the first 24 months but no later, and 11 hips (15.5%) had a late onset of subsidence. In nine hips (12.7%) continuous sinking could be found. Nineteen hips (26.8%) had irregular patterns of migration. In 31.0% the overall migration was between 0.5-1mm after 120 months. Six stems (8.5%) had an absolute amount of subsidence exceeding 2mm after 120 months (one more than 3 mm). The mean subsidence was 0.2mm after three months and six months, 0.3mm after 12 months and reached 0.5mm after 10 years. EBRA-FCA is a practicable method to assess migration of the femoral component. There seems to be initial subsidence for about one half of the stems but further movements are rare, which might be a sign for osseo-integration. The radiographic findings correspond to the excellent clinical performance of this stem in long-term follow-up. (Hip International 2005; 15: 85-91).
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Affiliation(s)
- C Eingartner
- BG Trauma Center, University of Tuebingen, Tuebingen - Germany
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Eingartner C, Volkmann R, Ilchmann T, Weise K, Weller S. A modular system for cemented and cementless implantation of femoral stem prostheses. Surg Technol Int 2003; 7:353-61. [PMID: 12722002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
A femoral stem [BiContact, Aesculap, Germany) has been developed which is suitable for both cemented
and uncemented implantation. Thus a highly standardized procedure and a standard implant for any
iritraoperative finding is available. While the cemented stems have a smooth surface, the cementless
implants are proximally coated with a microporous titanium plasmaspray [Plasmapore]. The strategy based on
the intraoperative choice of the surgeon to use either cemented or cementless implants after bone preparation
turned out to be very successful in our institution. A consecutive series of 250 cases with cemented implantation
and 250 cases with uncemented implantation was analyzed in a prospective follow-up study, Pollow-up time
averaged 7 years for cemented and 6.5 years for uncemented THRs. The follow-up rate was 88.7% in cases treated
with cemented stems and 93.1% in cases treated with uncemented stems. The rate of aseptic loosening was 1.2%
for the cemented version and 0.4-% for the uncemented stem. Radiological loosening could be observed in
another 1.2% of the cemented stems and was not to be found in the uncemented cases. Our data suggest an
excellent midterm stability of both the cemented and the uncemented version of the BiContact hip system. The
long-term results for both the cemented and uncemented prostheses of our series are still to be evaluated.
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Abstract
We measured in vivo polyethylene wear of acetabular cups in 74 patients (83 hips) with Charnley total hip arthroplasties (THA), revised because of aseptic loosening of either the acetabular or femoral component. We analyzed conventional pelvic radiographs of 42 THAs before revision due to loose acetabular components alone and 41 THAs before revision due to loose femoral components alone. The THAs were revised after 10 to 26 years. The mean wear-rate in hips with a loose acetabular components was 0.3 mm/y, whereas in hips with a loose femoral components, it was 0.1 mm/y (P=.0001). The mean total linear wear, as measured on the last available radiographs before revision, was 3.4 mm and 1.5 mm, respectively (P=.0001). A significant difference in linear wear between hips with loose cups and loose stems was seen 1 year after surgery: 0.4 mm/y versus 0.3 mm/y, respectively (P=.05).
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Affiliation(s)
- Uldis Kesteris
- Department of Orthopedics, Lund University Hospital, Lund, Sweden.
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Abstract
Soft-tissue defects following calcaneal fractures can be covered in a relatively easy and safe procedure. We have modified the familiar distally based sural artery flap by lifting a part of the gastrocnemius muscle. With an inferior pedicle, this musulocutaneous flap can be rotated onto the defect on the sole of the foot and on the heel. Five patients with open fractures of the calcaneus or wound necrosis after osteosynthesis were treated with this procedure. Two defects were covered uneventfully, two flaps were prepared, the rotation being done in a secondary procedure. One patient demanded further revisions, and the flap was partially lost, but the remaining defect was covered after open treatment. This new musculocutaneous sural artery flap can be used for covering even an extensive defect after calcaneal fractures and seems to be a reliable procedure. Morbidity at the donor site is low, and in the case of failure, the free flap remains an alternative.
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Affiliation(s)
- J E Mueller
- BG Trauma Center, University of Tübingen, Germany.
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Abstract
A total of 51 patients with bilateral simultaneous Charnley total hip arthroplasties were studied for wear behavior. The mean observation time was 14.7 years. Fourteen hips had been revised during follow-up. The mean wear rate was 0.071 mm/y for left hips and 0.081 mm/y for right hips. There were considerable side differences for individual patients and little agreement between the wear measurements of left and right hips. Linear wear was increased in men, in patients with high body weight. Linear wear after hip arthroplasty is not side related.
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Affiliation(s)
- A Joshi
- Centre for Hip Surgery, Wrightington Hospital, Wigan, Lancashire, England
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Joshi AB, Markovic L, Ilchmann T. Polyethylene wear and calcar osteolysis. Am J Orthop (Belle Mead NJ) 1999; 28:45-8. [PMID: 10048358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
We have examined retrospectively the correlation between linear wear of the polyethylene socket and calcar height loss (osteolysis) in 266 patients with 410 total hip arthroplasties who were followed up for a minimum of 10 years. A positive correlation existed between wear and osteolysis. The correlation was stronger in patients with osteoarthrosis. Simultaneous bilateral hip arthroplasty showed no difference in the relationship between polyethylene wear and calcar height loss when comparing the right and left hip. There was poor correlation between calcar height loss and wear in patients with rheumatoid arthritis. Our findings support the theory that femoral osteolysis in the total hip arthroplasty is related to the amount of liberated particles generated by the wear of components. The poor correlation found in cases with rheumatoid arthritis could be related to suppression of the immune response in these patients.
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Affiliation(s)
- A B Joshi
- Centre For Hip Surgery, Wrightington Hospital, Lancashire, England
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Ilchmann T, Ochsner PE, Wingstrand H, Jonsson K. Non-operative treatment versus tension-band osteosynthesis in three- and four-part proximal humeral fractures. A retrospective study of 34 fractures from two different trauma centers. Int Orthop 1998; 22:316-20. [PMID: 9914936 PMCID: PMC3619582 DOI: 10.1007/s002640050268] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Thirty-four patients with three- and four-part proximal humeral fractures from two different trauma centres were studied retrospectively. Sixteen were treated without osteosynthesis and compared with 18 patients treated with tension-band fixation. Fracture classification and clinical examination were made by the same persons in both groups. Most of the three-part fractures healed with good pain relief and good function in daily life but often with a loss of motion. Four-part fractures often led to pain, loss of motion and of function. Conservative treatment seemed superior to tension-band fixation for three-part fractures. Four-part fractures healed with better function and range of motion after tension-band fixation.
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Affiliation(s)
- T Ilchmann
- Department of Orthopaedics and Radiology, University of Lund, Sweden
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Ilchmann T, Markovic L, Joshi A, Hardinge K, Murphy J, Wingstrand H. Migration and wear of long-term successful Charnley total hip replacements. ACTA ACUST UNITED AC 1998. [DOI: 10.1302/0301-620x.80b3.0800377] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analysed in-vivo migration and wear over a long period of all-polyethylene acetabular cups which had not been affected by mechanical loosening. The selection criteria of regular radiological follow-up, good clinical outcome (Charnley score of 5 or 6), continued walking without crutches and no radiological signs of loosening of the acetabular cups were fulfilled by 25 Charnley total hip arthroplasties. Mean migration, measured by the Nunn method, was 0.6 mm in the medial and 0.2 mm in the cranial direction. The mean yearly rate of wear was 0.05 mm and 0.04 mm, with six and two cups having no detectable wear, as measured by the Livermore and Charnley-Cupic methods, respectively. The maximal detected wear was 3.7 mm. There were no changes in the rate of wear with time. Computerised Ein Bild Röntgen Analyse (single-image radiological analysis) measurements of 20 hips indicated plastic deformation of the cups. We conclude that long-term successful cups do not migrate and have a very low rate of wear which was not affected by ageing of the polyethylene. There was no evidence that polyethylene wear alone caused mechanical loosening of the cup but high rates of wear seem to have an adverse prognostic value in terms of the long-term survival of the prosthesis.
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Affiliation(s)
- T. Ilchmann
- Department of Orthopaedics, Lund University Hospital, S-221 85 Lund, Sweden
| | - L. Markovic
- Centre for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK
| | - A. Joshi
- Centre for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK
| | - K. Hardinge
- Centre for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK
| | - J. Murphy
- Centre for Hip Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK
| | - H. Wingstrand
- Department of Orthopaedics, Lund University Hospital, S-221 85 Lund, Sweden
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Ilchmann T, Markovic L, Joshi A, Hardinge K, Murphy J, Wingstrand H. Migration and wear of long-term successful Charnley total hip replacements. J Bone Joint Surg Br 1998; 80:377-81. [PMID: 9619922 DOI: 10.1302/0301-620x.80b3.8455] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analysed in-vivo migration and wear over a long period of all-polyethylene acetabular cups which had not been affected by mechanical loosening. The selection criteria of regular radiological follow-up, good clinical outcome (Charnley score of 5 or 6), continued walking without crutches and no radiological signs of loosening of the acetabular cups were fulfilled by 25 Charnley total hip arthroplasties. Mean migration, measured by the Nunn method, was 0.6 mm in the medial and 0.2 mm in the cranial direction. The mean yearly rate of wear was 0.05 mm and 0.04 mm, with six and two cups having no detectable wear, as measured by the Livermore and Charnley-Cupic methods, respectively. The maximal detected wear was 3.7 mm. There were no changes in the rate of wear with time. Computerised Ein Bild Röntgen Analyse (single-image radiological analysis) measurements of 20 hips indicated plastic deformation of the cups. We conclude that long-term successful cups do not migrate and have a very low rate of wear which was not affected by ageing of the polyethylene. There was no evidence that polyethylene wear alone caused mechanical loosening of the cup but high rates of wear seem to have an adverse prognostic value in terms of the long-term survival of the prosthesis.
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Affiliation(s)
- T Ilchmann
- Department of Orthopaedics, Lund University Hospital, Sweden
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Abstract
EBRA (Ein Bild Röntgen Analyse) is a new computerized method measuring migration and wear of the acetabular cup, suggested to improve measurement accuracy. We evaluated possible errors of measurement and compared EBRA with standard methods. 1. We did repeated measurements on a single radiograph using the same reference lines. The reliability of the input procedure with standard measurements was significantly better than repeated digitization with EBRA. 2. In a more clinical test, a group of 10 patients was studied. 5 radiographs were taken of the same patient on the same day. EBRA improved the reliability of repeated radiographic examination significantly for migration measurements in the vertical direction. 3. To assess the inter- and intraobserver variations, repeated measurements were performed on the clinical series of pelvic radiographs of 10 patients. EBRA was significantly better than standard methods. With EBRA, errors of wear and migration measurements could be reduced, as compared to standard methods. The major improvement with EBRA was found for migration measurements in the vertical direction.
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Affiliation(s)
- T Ilchmann
- Department of Orthopedics, Lund University Hospital, Sweden
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Abstract
Methods are needed for accurate measurement of acetabular cup migration and wear after hip replacement. The EBRA (Ein Bild Röntgen Analyse) method was recently introduced as computerized method for radiographic assessment of acetabular cup migration. In this study, various standard methods for measuring migration were evaluated and compared to radiostereometry (RSA), which has proved to be highly accurate. A subroutine for wear measurement was developed and added to the EBRA method. Of the standard methods, Nunn's method was the best for migration measurement and Livermore's the best for wear measurement. Measurements with EBRA were better than the standard methods. Pelvic tilt seemed to be the main source of error in measurements. The effect of pelvic tilt was evaluated experimentally. EBRA detected and excluded tilted radiographs, the errors of measurement being smaller with EBRA than with standard methods. The precision of the input procedure, repeated radiographic examination, the intra- and interobserver errors were assessed. Apart from the digital input of the data, EBRA was better than the standard methods. Normal values concerning acetabular cup migration and wear should be obtained from long-term surviving hip replacements, without radiographic signs of loosening. No method of measurement detected evidence of changes in the wear-rate and in migration over time. EBRA showed cold-flow in some cups, but did not provide additional information in the long-term. Nunn's method for migration measurements and Livermore's method for wear are recommended in clinical practice. EBRA is more accurate and should be used for studies of new implant designs that have passed the preclinical and, preferably, radiostereometric analysis. RSA is unsurpassed and is recommended for early clinical follow-up in a limited number of patients.
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Affiliation(s)
- T Ilchmann
- Department of Orthopedics, Lund University Hospital, Sweden
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