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Stem selection in THA

Philip P Roessler, Cornelius Jacobs, Amelie C Krause, Matthias D Wimmer, P Johannes Wagenhäuser, Max Jaenisch, Frank A Schildberg, Dieter C Wirtz
BACKGROUND: Conventional radiography (CR) is the imaging method of choice in monitoring bone remodelling and other stability parameters after total hip arthroplasty (THA). Quantitative roentgen- or computed-tomography-based methods to determine bone density are prone to metal artifacts and often very costly, which is why they are not used as standard in a clinical setting. Since subjective assessment of bone remodelling in CR also has a certain susceptibility to errors, semi-quantitative methods have been developed to help approximate periprosthetic bone density development via CR to open up an additional tool for documentation of radiographic THA follow-up...
November 5, 2018: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
Kyung-Soon Park, Chee Ken Chan, Sung-Kyu Kim, Qing Song Li, Chae-Jin Im, Taek-Rim Yoon
BACKGROUND: Due to concern of potential metallosis caused by residual microscopic ceramic particles, metal-on-metal (MoM) bearing is deemed undesirable in revision total hip arthroplasty (THA) for ceramic bearing fracture. We determined whether MoM bearing is suitable to be used in revision THA for ceramic fractures and also evaluated whether this treatment increases serum iron levels compared with MoM bearing revision THA for polyethylene failure. METHODS: Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52...
November 8, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Maria C Inacio, Michelle Lorimer, David C Davidson, Richard N De Steiger, Peter L Lewis, Stephen E Graves
BACKGROUND: Despite wide adoption of hydroxyapatite (HA)-coated femoral stems in THA, no studies have found differences in the risk of revision surgery with its use or investigated the interaction of different prosthesis designs with stem coating. QUESTIONS/PURPOSES: The purpose of this study was to evaluate the risk of revision in THAs with HA-coated stems compared with non-HA-coated. To achieve this purpose, we asked: (1) What is the difference in risk of revision of THAs with HA-coated femoral stems compared with non-HA-coated using an aggregate analysis? (2) What is the difference in risk of revision of THAs with HA-coated femoral stems compared with non-HA-coated for five prosthesis types that used the same femoral and acetabular component combination but where the femoral stem had both a HA and non-HA coating option? METHODS: The Australian Orthopaedic Association National Joint Replacement Registry analyzed cementless primary THA registered between September 1, 1999, and December 31, 2014...
December 2018: Clinical Orthopaedics and related Research
Ali Parsa, Mohammad Azizbaig Mohajer, Maryam Mirzaie
BACKGROUND: Rigorous haemostatic control and careful rehabilitation are essential for haemophilic patients undergoing total hip arthroplasty (THA). AIM: to examine the current literature regarding THA in patients with haemophilia in order to determine clinical outcomes and complication rates. METHODS: We included 11 case reports/series and 9 original articles. There was a total of 206 patients who underwent 226 THAs. FINDINGS: The number of patients enrolled in the selected articles varied from 1 in case reports to 34 in the original articles...
September 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Joong-Myung Lee, Tae-Sup Kim, Tae-Ho Kim
Purpose: This study was performed to assess potential improvements in clinical outcomes when applying recent advanced hip arthroplasty surgical techniques and understand the potential relationship between bone mineral density (BMD) and surgical outcomes. Materials and Methods: Among 37 cases of periprosthetic femoral fractures after hip arthroplasty treated between March 2014 and September 2016, all included a follow-up of at least one year and were included in this study...
June 2018: Hip & Pelvis
David S Peitgen, Moritz M Innmann, Christian Merle, Tobias Gotterbarm, Babak Moradi, Marcus R Streit
Implant failure and periprosthetic fractures because of periprosthetic bone loss are a major concern in total hip arthroplasty (THA). Hardly any clinical data exist on the long-term evolution of bone mineral density (BMD) around uncemented femoral implants. The question to address is whether relevant bone loss continues into third decade around well-fixed uncemented femoral implants. BMD around stable uncemented straight titanium femoral implants was assessed in a longitudinal cohort study. We included 142 hips of 128 patients and measured the development of the periprosthetic BMD using dual-energy X-ray absorptiometry...
October 2018: Calcified Tissue International
Tim A E J Boymans, Ide C Heyligers, Bernd Grimm
INTRODUCTION: The growing use of cementless stems is associated with an increase in implant-related complications. This global survey study investigates which parameters orthopaedic surgeons currently consider for either cemented or cementless stem fixation in primary total hip arthroplasty (THA). METHODS: A survey regarding current practice patterns was distributed among hip arthroplasty specialists. Key questions concerned: (i) frequency of using cemented/cementless stems; (ii) frequency of using parameters which influence a choice between both; (iii) usage of specific cut-off values for parameters...
May 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Carla Timmer, Davey M J M Gerhardt, Enrico de Visser, Marinus de Kleuver, Job L C van Susante
INTRODUCTION: This study reports on the incidence of intraoperative calcar fractures with the cementless Spotorno (CLS) stem, and the potential role of a learning curve and implant positioning is investigated. METHODS: After introduction of the CLS stem, 800 consecutive cementless total hip arthroplasties (THA) were analyzed. The incidence of calcar fracture in the first 400 THA was compared with the second 400 THA, in order to study a potential learning curve effect...
May 7, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Michael Tanzer, Stephen E Graves, Andrea Peng, Andrew J Shimmin
BACKGROUND: There is ongoing debate concerning the best method of femoral fixation in older patients receiving primary THA. Clinical studies have shown high survivorship for cemented and cementless femoral stems. Arthroplasty registry studies, however, have universally shown that cementless stems are associated with a higher rate of revision in this patient population. It is unclear if the difference in revision rate is a reflection of the range of implants being used for these procedures rather than the mode of fixation...
July 2018: Clinical Orthopaedics and related Research
Weon-Yoo Kim, Myung-Sup Ko, Se-Won Lee, Kwang-Sub Kim
Purpose: This study characterizes the short-term outcomes of ceramic coated metal-on-metal (MoM) large head total hip arthroplasty (THA) in prospectively selected patients aged 70 to 75 years. Materials and Methods: Eighteen patients (18 hips) between the ages of 70 and 75-years old with THA using ceramic-coated MoM large heads between June 2014 and December 2014 were evaluated. We prospectively selected patients younger than 70 years for bipolar hemiarthroplasty and older than 75 years for conventional THA...
March 2018: Hip & Pelvis
Loes Janssen, Karolina A P Wijnands, Dennis Janssen, Michiel W H E Janssen, Jan W Morrenhof
BACKGROUND: Some studies have revealed an increased risk of early aseptic loosening of cementless stems in THA when inserted through an anterior or anterolateral approach compared with a posterior approach, whereas approach does not appear to be a risk factor in others. Stem design, whether "anatomic" (that is, stems with a curved lateral profile or an obtuse angle at the proximal-lateral portion of the stem) or "shoulder" (that is, straight with a proximal shoulder), may also be associated with a differential risk of aseptic loosening in cementless THA depending on the surgical approach used, but if so, this risk is not well characterized...
June 2018: Clinical Orthopaedics and related Research
Matti Seppänen, Inari Laaksonen, Pekka Pulkkinen, Antti Eskelinen, Ari-Pekka Puhto, Jukka Kettunen, Jarkko Leskinen, Mikko Manninen, Keijo Mäkelä
BACKGROUND: Large-diameter head metal-on-metal (MoM) THA has largely been abandoned as a result of higher than anticipated revision rates. However, the majority of these implants are still in situ. Although earlier reports from the Finnish Arthroplasty Register noted similar short-term survivorship between large-diameter head MoM THA and conventional cemented THA, longer term survivorship of this population is unclear. Although reported revision rates for this implant group have been high, the majority of these implants have not been revised and followup is important to improve long-term management...
June 2018: Clinical Orthopaedics and related Research
Yasushi Wako, Junichi Nakamura, Michiaki Miura, Yuya Kawarai, Masahiko Sugano, Kento Nawata
BACKGROUND: The purpose of this study is to clarify interobserver and intraobserver reliabilities of the three-dimensional (3D) templating of total hip arthroplasty (THA). METHODS: We selected preoperative computed tomography from 60 hips in 46 patients (14 men and 32 women) who underwent primary THA. To evaluate interobserver and intraobserver reliability, 6 orthopedic surgeons performed 3D templating twice over a 4-week interval. We investigated intraclass correlation coefficients (ICCs) and percent agreement of component size and alignment, comparing morphological differences in the hip...
February 2018: Journal of Arthroplasty
Rene Burchard, Sabrina Braas, Christian Soost, Jan Adriaan Graw, Jan Schmitt
BACKGROUND: The main objective of every new development in total hip arthroplasty (THA) is the longest possible survival of the implant. Periprosthetic stress shielding is a scientifically proven phenomenon which leads to inadvertent bone loss. So far, many studies have analysed whether implanting different hip stem prostheses result in significant preservation of bone stock. The aim of this preclinical study was to investigate design-depended differences of the stress shielding effect after implantation of a selection of short-stem THA-prostheses that are currently available...
August 7, 2017: BMC Musculoskeletal Disorders
Iori Takigami, Yoshiki Ito, Kazu Matsumoto, Nobuo Terabayashi, Takaki Miyagawa, Haruhiko Akiyama
BACKGROUND: Cementless fixation of the femoral stem has been shown to be durable and predictable in total hip arthroplasty (THA), primarily as a result ofrecent improvements in prosthesis geometry and porous surface. Although patients with osteoporotic bone have been considered poor candidates for the use of a cementless femoral component, some recent studies have indicated satisfactory results. However, the indications and selection criteria of cementless stems based on the morphology of the femoral canal have not been established...
April 2017: Bulletin of the Hospital for Joint Diseases
James D Chang, Erin E Foster, Ashley G Wallace, Sung Joon Kim
Vancomycin resistance is conferred upon vancomycin-resistant enterococci (VRE) through the replacement of peptidoglycan (PG) stem terminal d-Ala-d-Ala with d-Ala-d-Lac. The d-Ala-d-Lac incorporation can affect both the fitness and virulence of VRE. Here we comprehensively investigate the changes to PG composition in vancomycin-resistant Enterococcus faecalis following the growth in presence of vancomycin using liquid chromatography-mass spectrometry. Using high-resolution mass spectrometry, 104 unique muropeptides fragments were identified and the relative abundance of each fragment was accurately quantified by integrating the ion current of a selected ion using extracted-ion chromatogram...
April 13, 2017: Scientific Reports
Bernd Fink, Michael Schlumberger, Damian Oremek
BACKGROUND: The treatment of periprosthetic infections of hip arthroplasties typically involves use of either a single- or two-stage (with implantation of a temporary spacer) revision surgery. In patients with severe acetabular bone deficiencies, either already present or after component removal, spacers cannot be safely implanted. In such hips where it is impossible to use spacers and yet a two-stage revision of the prosthetic stem is recommended, we have combined a two-stage revision of the stem with a single revision of the cup...
August 2017: Clinical Orthopaedics and related Research
Richard E Hughes, Aditi Batra, Brian R Hallstrom
PURPOSE OF REVIEW: National and regional arthroplasty registries have proliferated since the Swedish Knee Arthroplasty Register was started in 1975. Registry reports typically present implant-specific estimates of revision risk and patient- and technique-related factors that can inform clinical decision-making about implants and techniques. However, annual registry reports are long and it is difficult for clinicians to extract comparable revision risk data. Since implants may appear in multiple registry reports, it is even more difficult to gather relevant data for clinical decision-making about implant selection...
June 2017: Current Reviews in Musculoskeletal Medicine
R Hart, V Stipcak, M Janecek, P Visna
Mini-incision procedures reduce perioperative blood loss, postoperative pain, time of the postoperative recovery, length of the surgical scar, and hospitalisation time. Implant malposition and poor stability are potential risks for compromising long-term results. Between September 2000 and February 2002 (18 months), 120 cemented primary total hip arthroplasties for primary osteoarthritis were performed at the authors institutions. In 60 of these cases selected at random, a posterolateral mini-incision up to 10 cm was used...
April 2005: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
F Randelli, P Randelli, O Visentin, M Monteleone, G Brianza, G Randelli
Total hip arthroplasty (THA) in congenital high grade hip dislocation often represents a problematic issue. Reviewing their selected cases and literature data, authors focus on some key points for this demanding surgery. Most important steps are acetabular positioning and surgical approach (exposure and release). We used two different cups, the Zweymuller and the Wagner cup, with good primary stability. A Conus stem (Wagner) or an Alloclassic stem (in less displastic femoral shape) were used. We always performed this surgery as a one step procedure...
April 2002: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
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