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Modular hip arthroplasty

Brian P Chalmers, Graham D Pallante, Michael J Taunton, Rafael J Sierra, Robert T Trousdale
BACKGROUND: Revision THA to treat recurrent instability can itself be complicated by recurrent instability, and when this occurs, this problem is difficult to treat. Some patients' THAs will continue to dislocate despite use of a constrained liner. One option in this difficult-to-treat group is conversion to a dual-mobility (DM) construct, but there are few data on this approach. QUESTIONS/PURPOSES: (1) What were the Harris hip scores in a small group of patients whose constrained liners were converted to DM constructs to treat recurrent dislocation? (2) What were the redislocation, rerevision, and DM construct retention rates in these patients? METHODS: We conducted a retrospective analysis of a longitudinally maintained institutional database maintained by individuals other than the treating surgeons to identify patients undergoing conversion of constrained liners to DM constructs in revision THA from 2011 to 2014...
February 2018: Clinical Orthopaedics and related Research
O Lorbach
IMPLANT DESIGNS: Within the last 50 years, implants for shoulder replacement have developed rapidly. Monobloc-stems in few sizes were changed to modular implant systems that allow for an individual adaption of the stem, as well as adaption of the humeral head component according to the specific anatomic situation of the patient. Moreover, stemless und short stem implants are available, which may highly simplify primary implantation, especially in posttraumatic cases as well as in revision cases with a need for removal or change of the implants...
March 6, 2018: Der Orthopäde
Craig J Della Valle, Tyler E Calkins, Joshua J Jacobs
There has been an increasing use of modularity at the head-neck junction in total hip arthroplasty to more closely mimic the native anatomy, allowing for optimal leg length and stability. Corrosion at this junction in metal-on-polyethylene bearings can lead to an adverse local tissue reaction (ALTR). This increasingly prevalent condition should be considered in the differential diagnosis of hip pain and difficulty ambulating. A recent symposium by the American Academy of Hip and Knee Surgeons described the diagnosis, etiology, management, and prevention of taper corrosion...
March 1, 2018: Journal of Arthroplasty
Maurizio Montalti, Francesco Castagnini, Federico Giardina, Enrico Tassinari, Federico Biondi, Aldo Toni
BACKGROUND: Total hip arthroplasty (THA) in severe developmental dysplasia of the hip (DDH) is a challenging procedure. The most used techniques involve anatomic cup positioning, augmentation femoral osteotomy. However, anatomic cup positioning is not always feasible in severe DDH and osteotomy nonunion may ensue. The purpose of the study was to assess the survivorship, the hip score results, the radiological parameters (fixation, loosening, component position) of a large cohort of patients with Crowe III and IV DDH, treated with high hip center and modular necks THAs...
February 2, 2018: Journal of Arthroplasty
Matthew P Abdel
Dislocation after revision total hip arthroplasty (THA) continues to be one of the most common and concerning complications after the procedure. As with every hip arthroplasty, it is essential to optimize component positioning, minimize impingement, and maintain the integrity of the abductor complex during the revision THAs. However, in several revision circumstances, additional strategies are required to mitigate the risk of dislocation, particularly those being revised for instability or those with cognitive or neuromuscular disorders...
February 27, 2018: Journal of Arthroplasty
Julien Wegrzyn, Jean-Paul Roux, Charlotte Loriau, Nicolas Bonin, Vincent Pibarot
PURPOSE: Using a cementless femoral stem in total hip arthroplasty (THA), optimal filling of the proximal femoral metaphyseal volume (PFMV) and restoration of the extramedullary proximal femoral (PF) parameters (i.e., femoral offset (FO), neck length (FNL), and head height (FHH)) constitute key goals for optimal hip biomechanics, functional outcome, and THA survivorship. However, almost 30% of mismatch between the PF anatomy and implant geometry of the most widely implanted non-modular cementless femoral stem has been demonstrated in a computed tomography scan (CT scan) study...
February 22, 2018: International Orthopaedics
Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu, Chao-Ming Chen, Wei-Ming Chen
BACKGROUND: Subsidence remains a common complication after revision hip arthroplasty which may lead to prolonged weight-bearing restrictions, leg-length discrepancies or considerable loss of function. We evaluated the effectiveness of cement augmentation in the proximal femoral metaphysis during a revision of femoral components to prevent post-operative stem subsidence. METHODS: Forty patients were enrolled. Follow-up averaged 67.7 months (range: 24-149). Twenty-seven patients had a Paprosky type II defect and 13 had a type IIIa defect...
February 7, 2018: Journal of the Chinese Medical Association: JCMA
Pablo S Corona, Matias Vicente, Mireia Lalanza, Carles Amat, Luis Carrera
BACKGROUND: Bone loss is a common problem in periprosthetic joint infection (PJI) scenarios. Modular megaprosthesis (MP) could offer a limb salvage solution in such situations. Concerns about risk of infection relapse, reinfection and implant longevity exist regarding MP use in cases of chronic PJI, rather than standard implants. We therefore sought to analyze our results with MP use in chronic PJI cases. METHODS: We performed a retrospective analysis of 29 MP patients...
January 24, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Shang Piao, Yong-Gang Zhou, Yin-Qiao Du, Hai-Yang Ma, Jing-Yang Sun, Zhi-Sen Gao, Ya-Wen Peng, Wen-Ming Wu
OBJECTIVE: To investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty. METHODS: From January 2008 to January 2016, 21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range, 29 to 73 years old). There were 13 cases caused by aseptic loosening, 4 cases by infection, 2 cases by nonunion of sub-tuberosity osteotomy, 1 case for repeated dislocation, 1 case for traumatic great trochanter fracture...
April 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Andreas Toepfer, Norbert Harrasser, Isabel Petzschner, Florian Pohlig, Ulrich Lenze, Ludger Gerdesmeyer, Ruediger von Eisenhart-Rothe, Heinrich Mühlhofer, Christian Suren
BACKGROUND: Several surgical options for the reconstruction of massive bone defects have been described and include biologic methods with autografts and allografts, and the use of tumor endoprostheses (total femoral replacement, TFR). Several types of modular TFR are available, but nevertheless unpredictable outcomes and high complication rates have been described from most authors. The present study aims to compare results after TFR performed with modular total femur prosthesis MML (Fa...
January 16, 2018: European Journal of Medical Research
Takao Kaneko, Norihiko Kono, Yuta Mochizuki, Hiroyasu Ikegami, Yoshiro Musha
INTRODUCTION: This study asked whether differences in coronal alignment after total knee arthroplasty (TKA) affect the load distribution on the tibial plateau. The aim of this study was to investigate the correlation between coronal alignment and the load distribution on the tibial plateau after TKA, using three-dimensional multi-detector-row-computed tomography (3D-MDCT). MATERIALS AND METHODS: In this study, we performed 84 cementless TKA with porous tantalum modular tibial component (PTMT) and divided into three groups based on post-operative hip-knee-ankle (HKA) angle: varus alignment group (n = 22), (176° ≧) neutral alignment group (n = 45), (180° ± 3°), and valgus alignment group (n = 17) (184° ≦)...
January 10, 2018: Archives of Orthopaedic and Trauma Surgery
Ronny Grunert, Stefan Schleifenbaum, Robert Möbius, Michael Kopper, Christian Rotsch, Welf-Guntram Drossel, Niels Hammer, Torsten Prietzel
Background: The modularity in total hip arthroplasty (THA) allows orthopaedic surgeons for an exact reconstruction of hip biomechanical parameters especially in revision and tumor arthroplasty. Modular structured femoral stems using taper junctions showed increased implant breakage in the recent past. Presentation of the hypothesis: We hypothesize that a novel modular stem-neck-interface leads to less implant breakage compared to conventional femoral stems. Testing of the hypothesis: For this purpose, a novel modular femoral stem for THA was to design and manufacture...
2018: Patient Safety in Surgery
Ewout S Veltman, Dirk Jan F Moojen, Rob Ghh Nelissen, Rudolf W Poolman
BACKGROUND: To prevent postoperative infection the use of systemic antibiotic prophylaxis is common ground. Type of antibiotic used and duration of prophylaxis are subject to debate. In case of suspected early periprosthetic infection a debridement, antibiotics and implant retention (DAIR) procedure is treatment of first choice. This study evaluated the antibiotic prophylaxis and DAIR treatment protocols nationwide as well as reporting of these DAIR procedures to the national joint registry...
2018: Journal of Bone and Joint Infection
Keisuke Akiyama, Takaaki Shibuya
PURPOSE: The influence of physiologic femoral bowing on range of motion (ROM) after total hip arthroplasty (THA) remains unknown. The purpose of this study was to investigate the morphology of the femur in patients who underwent THA, and to analyze the influence of femoral bowing on ROM due to implant impingement after THA. METHODS: The ROM was calculated from 100 hips in 90 patients who underwent THA using computed tomography data with a 3D dynamic analysis software...
December 23, 2017: International Orthopaedics
Maximilian F Kasparek, Lisa Renner, Martin Faschingbauer, Wenzel Waldstein, Michael Weber, Friedrich Boettner
INTRODUCTION: Although metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacings (HR) have similar bearing surfaces and comparable wear rates, metal ion levels and risk of failure are higher for MoM-THA. The mechanism behind the increased metal ion levels in large head MoM-THA is not completely understood. The current study aims to identify predictive factors for increased metal ion levels in unilateral and bilateral large head MoM-THA. MATERIALS AND METHODS: 99 Birmingham modular MoM-THA in 87 patients with metal ion levels at least 36 months after index procedure were analyzed...
December 19, 2017: Archives of Orthopaedic and Trauma Surgery
Andrew J Bryan, Matthew P Abdel, Thomas L Sanders, Steven F Fitzgerald, Arlen D Hanssen, Daniel J Berry
BACKGROUND: There are conflicting data on the results of irrigation and debridement with component retention in patients with acute periprosthetic hip infections. The goals of this study were to examine contemporary results of irrigation and debridement with component retention for acute infection after primary hip arthroplasty and to identify host, organism, antibiotic, or implant factors that predict success or failure. METHODS: Ninety hips (57 total hip arthroplasties and 33 hemiarthroplasties) were diagnosed with acute periprosthetic hip infection (using strict criteria) and were treated with irrigation and debridement and component retention between 2000 and 2012...
December 6, 2017: Journal of Bone and Joint Surgery. American Volume
Adam I Edelstein, Duy L Phan, Scott M Sporer
We report a case of bead shedding from a cylindrical extensively porous-coated cementless femoral component with concomitant taper corrosion at the modular head-neck junction of a metal-on-polyethylene total hip prosthesis. The patient presented with chronic thigh pain 4 years after primary total hip arthroplasty, and radiographs revealed significant osteolysis and metallic debris around the femoral stem. Intraoperatively, the patient had a grossly loose femoral component with debonding of sintered beads from the femoral stem, as well as evidence of taper corrosion...
December 2017: Arthroplasty Today
Colin D Canham, Pavel I Muradov, Jordan B Simpson, Stephen J Incavo
This report describes a case of mechanically assisted crevice corrosion and secondary adverse local tissue reaction in a patient following a total hip arthroplasty, utilizing a modular neck (bi-modular) femoral component. Radiographic evaluation demonstrated a well-positioned, stable, cementless arthroplasty. Upon further evaluation, the patient had elevated serum cobalt and chromium levels, and magnetic resonance imaging demonstrated a periprosthetic pseudotumor. Corrosion of both the neck-stem and head-neck junctions was suspected...
December 2017: Arthroplasty Today
Tomonori Tetsunaga, Kazuo Fujiwara, Hirosuke Endo, Tomoko Tetsunaga, Naofumi Shiota, Toru Sato, Toshifumi Ozaki
Background: We investigated whether the calcar femorale, a cortical septum in the region of the lesser trochanter of the femur, correlates with results of femoral stem implantation in patients with osteoarthritis of the hip secondary to developmental dysplasia using computed tomography. Methods: This retrospective study included 277 hips (41 males and 236 females; age, 37 to 92 years) of patients who had presented to Okayama Medical Center with hip pain. Of these, a total of 219 hips (31 males and 188 females) had previously undergone total hip arthroplasty...
December 2017: Clinics in Orthopedic Surgery
C Carulli, M Zago, A R Rizzo, M Innocenti
Haemophilia is an inherited haemorrhagic disease characterized by the lack of coagulative factors associated nowadays mostly to musculoskeletal complications, particularly severe secondary arthritis in specific joints. Recurrent traumatic or spontaneous joint bleeding, induce severe arthropathy at a young age that can be treated only by joint replacement. Total knee or hip arthroplasty in young subjects may fail earlier due to wear or infections and in the haemophilic population, this means bone loss, pseudo tumours and the need of revision or even limb salvage surgery...
October 2017: Journal of Biological Regulators and Homeostatic Agents
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