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Revision hip replacement

Harman Khatkar, Harry Hothi, Danielle de Villiers, Christian Lausmann, Daniel Kendoff, Thorsten Gehrke, John Skinner, Alister Hart
PURPOSE: Ceramic coatings have been used in metal-on-polyethylene (MOP) hips to reduce the risk of wear and also infection; the clinical efficacy of this remains unclear. This retrieval study sought to better understand the performance of coated bearing surfaces. METHODS: Forty-three coated MOP components were analysed post-retrieval for evidence of coating loss and gross polyethylene wear. Coating loss was graded using a visual semi-quantitative protocol. Evidence of gross polyethylene wear was determined by radiographic analysis and visual inspection of the retrieved implants...
October 25, 2016: International Orthopaedics
Nicholas Arlas, Harry Jergesen
Factors endemic in safety-net hospitals may breed poor outcomes in hip and knee arthroplasty. This review highlights these challenges and discusses strategies to reduce operative risk and promote better surgical outcomes. Sub-optimally managed medical co-morbidities, poverty, and substance abuse are examples of challenges common in safety-net hospital populations and are associated with poor surgical outcomes. Patient management strategies that positively affect surgical outcomes may be nonexistent, underfunded, or underused...
2016: Journal of Health Care for the Poor and Underserved
Michael G Ficklin, Michael P Kowaleski, Kevin A R Kunkel, Jonathan T Suber
A two-year-old, 44 kg dog with a right Helica cementless total hip replacement (THR) was radiographically diagnosed with implant loosening eight months after the index total hip replacement procedure. Subsequent synoviocentesis and synovial fluid culture revealed a methicillin-resistant coagulase-negative Staphylococcus spp infection of the right THR. A one-stage revision using a hybrid BFX cementless acetabular cup and CFX cemented femoral stem was performed. Vancomycin and micro-silver antimicrobial powder impregnated cement were used in the revision...
October 20, 2016: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
Matti Seppänen, Mikko Karvonen, Petri Virolainen, Ville Remes, Pekka Pulkkinen, Antti Eskelinen, Antti Liukas, Keijo T Mäkelä
Background and purpose - In a previous registry report, short-term implant survival of hip resurfacing arthroplasty (HRA) in Finland was found to be comparable to that of total hip arthroplasty (THA). Since then, it has become evident that adverse reactions to metal debris (ARMDs) may also be associated with HRA, not only with large-diameter head metal-on-metal THA. The aim of the study was to assess medium- to long-term survivorship of HRA based on the Finnish Arthroplasty Register (FAR). Patients and methods - 5,068 HRAs performed during the period 2001-2013 in Finland were included...
October 19, 2016: Acta Orthopaedica
Michael J Zelefsky, Marisa A Kollmeier, Elan Gorshein, Xin Pei, Marina Torres, Sean McBride, Laura Happersett, Gil'ad N Cohen, Yoshiya Yamada
BACKGROUND AND PURPOSE: To evaluate the incidence and predictors of hip toxicity postradiotherapy for localized prostate cancer. METHODS AND MATERIALS: 4067 prostate cancer patients were treated with external beam radiotherapy (EBRT; n=2569; 63%) or brachytherapy with or without supplemental EBRT (n=1508; 27%). 43% (n=1738) were treated with neo-adjuvant and concurrent ADT and 57% (n=2329) with radiotherapy alone. Hip toxicity was defined as moderate or severe pain upon ambulation with or without the need for hip-revision surgery...
October 15, 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Zaheed Damani, Gail MacKean, Eric Bohm, Brie DeMone, Brock Wright, Tom Noseworthy, Jayna Holroyd-Leduc, Deborah A Marshall
BACKGROUND: Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba...
October 18, 2016: Health Research Policy and Systems
B Fink, R Lass
Background: Total hip arthroplasty (THA) is one of the most common and successful surgical procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patient's satisfaction and pain. Despite the clinical success of primary THA with 10-year survival rates as high as 96 % (Swedish Hip Arthroplasty Register, 2011), the prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1...
October 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Peter Cnudde, Ola Rolfson, Szilard Nemes, Johan Kärrholm, Clas Rehnberg, Cecilia Rogmark, John Timperley, Göran Garellick
BACKGROUND: Sweden offers a unique opportunity to researchers to construct comprehensive databases that encompass a wide variety of healthcare related data. Statistics Sweden and the National Board of Health and Welfare collect individual level data for all Swedish residents that ranges from medical diagnoses to socioeconomic information. In addition to the information collected by governmental agencies the medical profession has initiated nationwide Quality Registers that collect data on specific diagnoses and interventions...
October 4, 2016: BMC Musculoskeletal Disorders
Lane Koenig, Qian Zhang, Matthew S Austin, Berna Demiralp, Thomas K Fehring, Chaoling Feng, Richard C Mather, Jennifer T Nguyen, Asha Saavoss, Bryan D Springer, Adolph J Yates
BACKGROUND: Demand for total hip arthroplasty (THA) is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery. QUESTIONS/PURPOSES: We asked: (1) What is the expected effect of THA on patients' employment and earnings? (2) How does accounting for these effects influence the cost-effectiveness of THA relative to nonsurgical treatment? METHODS: Taking a societal perspective, we used a Markov model to assess the overall cost-effectiveness of THA compared with nonsurgical treatment...
October 3, 2016: Clinical Orthopaedics and related Research
C Morin, C Ursu, C Delecourt
INTRODUCTION: The everyday life of a non-ambulatory adolescent or young adult with cerebral palsy can be severely impaired by a painful or stiff hip. The usual surgical solutions such as proximal femoral resection (PFR) are not entirely satisfactory for pain relief, and are mutilating. HYPOTHESIS: A retrospective study assessed the impact of total hip replacement (THR) on such impairment, on the hypothesis that it is more effective than PFR in relieving pain, without aggravating disability...
September 30, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Dia Eldean Giebaly, Haider Twaij, Mazin Ibrahim, Fares S Haddad
INTRODUCTION: Total hip replacement is a successful procedure with long survival records compared to other joint arthroplasties. Cemented implants have been available for many years, however the complications associated with loosening and, ultimately, failure over time has led to the development of cementless stems and implants.The ideal prosthesis should recreate a biomechanically normal hip joint, allow pain-free function and last the patient's life span without requiring revision. Optimal results with uncemented femoral stems rely on obtaining initial stability, osseointegration, biological fixation, and uniform stress transfer to the proximal bone...
September 29, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
S Singh, S Reddy, Raj Shrivastva
This study compared the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) data for total hip replacements (THRs) and total knee replacements (TKRs) from Hospital A [with laminar airflow (LAF)] and Hospital B (without LAF). These hospitals were originally managed by two different trusts that subsequently merged. Consequently, the theatres in Hospital A have always had LAF and those in Hospital B had only conventional ventilation systems. As this merger happened before the establishment of the NJR, it puts us in a unique position, enabling direct comparison of the revision rates for infected hip and knee replacements between the two hospitals that follow similar infection protocols...
September 29, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Nemandra A Sandiford, Donald S Garbuz, Bassam A Masri, Clive P Duncan
BACKGROUND: The ideal femoral component for revision THA is undecided. Cylindrical nonmodular stems have been associated with stress shielding, whereas junctional fractures have been reported with tapered fluted modular titanium stems. We have used a tapered fluted nonmodular titanium femoral component (Wagner Self-locking [SL] femoral stem) to mitigate this risk. This component has been used extensively in Europe by its designer surgeons, but to our knowledge, it has not been studied in North America...
September 26, 2016: Clinical Orthopaedics and related Research
Eemeli Jämsen, Vesa-Petteri Kouri, Mari Ainola, Stuart B Goodman, Dan C Nordström, Kari K Eklund, Jukka Pajarinen
Aseptic loosening and osteolysis of joint replacements are driven by macrophage-mediated inflammatory reactions to implant-derived wear debris, but many aspects of these events remain poorly characterized. To better understand the relationships among inflammatory and chemotactic mediators, macrophage phenotype and polarizing cytokines, osteoclast activity, and Toll-like receptors (TLRs) in the pathogenesis of aseptic loosening, we determined how the relative expressions of these factors in the peri-implant tissues correlate to each other and to the life span of the implants using Pearson correlation...
September 26, 2016: Journal of Biomedical Materials Research. Part A
Sajad Arabnejad, Burnett Johnston, Michael Tanzer, Damiano Pasini
Current hip replacement femoral implants are made of fully solid materials which all have stiffness considerably higher than that of bone. This mechanical mismatch can cause significant bone resorption secondary to stress shielding, which can lead to serious complications such as peri-prosthetic fracture during or after revision surgery. In this work, a high strength fully porous material with tunable mechanical properties is introduced for use in hip replacement design. The implant macro geometry is based off of a short stem taper-wedge implant compatible with minimally invasive hip replacement surgery...
September 24, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Ingrid Milošev, Vesna Levašič, Janja Vidmar, Simon Kovač, Rihard Trebše
BACKGROUND: Due to degradation and metal dissolution during articulation of metal joint replacements the chemical periprosthetic environment may change. The aim was to establish whether metal replacements cause the local changes in pH and elevated metal concentrations. METHODS: pH was measured on samples from 167 patients: native hip and knee osteoarthritic joints, joints with hip and knee replacements revised for aseptic or septic reasons. pH of synovial fluid and periprosthetic tissue was measured perioperatively using a microelectrode and pH indicator papers for removed metal components...
September 23, 2016: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
J Schmolders, S Koob, P Schepers, S Gravius, D C Wirtz, C Burger, P H Pennekamp, A C Strauss
Introduction/Background: With extended life expectancy, the number of primary joint arthroplasties has also increased. Revision surgery is also more often necessary, due to aseptic or septic loosening of the prosthesis or periprosthetic fracture. Large bone defects often occur in these patients and several non-modular, conventional implants are available to handle this difficult situation. Custom made implants offer an individually designed and defect-adapted shape with perfect covering of the lesion, but may delay the operation...
September 15, 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
M F Hoffmann, S Lotzien, T A Schildhauer
BACKGROUND: The number of patients with total hip replacement (THR) is likely to grow. Periprosthetic femoral fractures occur in 0.1-4.5 % of patients with THR. Treatment of periprosthetic fractures in the vicinity of well-fixed implants has focused on lateral plating. The purpose of this study was to evaluate polyaxial locking plate treatment of periprosthetic fractures with THR in regard to fracture type, surgical procedure, complications, and outcome. METHODS: Between 2007 and 2013, 109 patients underwent surgical treatment for periprosthetic femur fractures with 66 fractures in the vicinity to a THR...
September 6, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Albrecht Encke, Sylvia Haas, Ina Kopp
BACKGROUND: Venous thromboembolism (VTE) is the third most common cardiovascular condition, after myocardial infarction and stroke. Prophylactic measures in accordance with current guidelines can significantly reduce the risk of VTE and the associated morbidity and mortality. Until now, the German interdisciplinary, evidence- and consensus-based (S3) clinical practice guideline on VTE prophylaxis was based on a complete review of all pertinent literature available in MEDLINE up to January 2008...
August 8, 2016: Deutsches Ärzteblatt International
Masaru Nakamura, Tateaki Shimakawa, Shunji Nakano, Takashi Chikawa, Shinji Yoshioka, Masahiro Kashima, Shunichi Toki, Hidehisa Horiguchi, Koichi Sairyo
BACKGROUND: Adverse tissue reaction to metal debris (ARMD) as a secondary complication of Metal-on-metal total hip replacement (MoM THR) has been of concern. We have been performing cementless MoM THR using an Asian-type anatomic medullary locking (AML) stem. The purpose of this study is to examine the incident rate of ARMD, and the implant survival rate. METHODS: The study included 187 patients (211 hip joints) who underwent MoM THR between February 2007 and November 2009 at our hospital and who were followed up for a minimum of 6 years...
August 28, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
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