RESUMEN
Previously, radiostereometric analysis following hip revision performed using impacted morsellised allograft bone and a cemented Exeter stem has shown continuous subsidence of the stem for up to five years. It is not known whether the subsidence continues thereafter. In our study, 17 of 25 consecutive osteo-arthritic patients with aseptically loose stems who underwent first-time revision using impacted morsellised allograft bone and a cemented Exeter stem were followed by yearly radiostereometric examinations for nine years. The mean subsidence at six weeks was 1.1 mm (0.1 to 2.3), from six weeks to one year 1.3 mm (0 to 2.6), from one to five years 0.7 mm (0 to 2.0), and from five to nine years 0.7 mm (0.1 to 3.1). That from six weeks to nine years was 2.7 mm (0 to 6.4) (95% confidence interval 2.0 to 3.5). The Charnley pain score significantly improved after revision, and was maintained at nine years, but walking ability deteriorated slightly as follow-up extended. Of the eight patients who were not followed for nine years, two had early subsidence exceeding 11 mm. Our findings show that in osteo-arthritic patients who undergo revision for aseptic loosening of the stem using impacted morsellised allograft bone and a cemented Exeter stem, migration of the stem continues over nine years at a slower rate after the first year, but without clinical deterioration or radiological loosening.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Sustitutos de Huesos/uso terapéutico , Trasplante Óseo/métodos , Prótesis de Cadera , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación , Análisis de Falla de Equipo/métodos , Femenino , Estudios de Seguimiento , Migración de Cuerpo Extraño/etiología , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Falla de Prótesis , Reoperación/métodos , Resultado del TratamientoRESUMEN
The Exeter stem and impacted, morselized allograft bone and cement were used in the revisions of 18 consecutive femoral components (17 patients). The primary arthroplasty had been done because of osteoarthritis. All of the femoral components were revised for the first time because of aseptic loosening. The migration pattern of the Exeter stem after revision was studied using roentgen stereophotogrammetric analysis. At 2 years after surgery, all 18 femoral stems had migrated in the distal direction (average, 2.5 mm). In addition, seven of the stems had migrated in the medial direction (average, 1.3 mm), and two stems had migrated in the lateral direction (0.5 mm and 1 mm, respectively). Sixteen of the femoral stems also had migrated in the posterior direction (average, 2.9 mm), but none migrated in the anterior direction. The migration rate decreased gradually with time during the followup. Six femoral stems continued to migrate between 1.5 and 2 years after surgery. In patients with major femoral bone deficiency at the time of hip revision, the use of impacted morselized allograft bone and cement yielded an initial fixation similar to that obtained in conventionally cemented revisions. Pain had improved in all patients at the 2-year followup.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Cementos para Huesos , Trasplante Óseo , Prótesis de Cadera , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fotogrametría , Diseño de Prótesis , ReoperaciónRESUMEN
Our aim was to determine whether tantalum m arkers improved the accuracy and/or precision of methods for the measurement of migration in total hip replacement based on conventional measurements without mathematical correction of the data, and with Ein Bild Roentgen Analyse - Femoral Component Analysis (EBRA-FCA) which allows a computerised correction. Three observers independently analysed 13 series of roentgen-stereophotogrammetric-analysis (RSA)-compatible radiographs (88). Data were obtained from conventional measurements, EBRA-FCA and the RSA method and all the results were compared with the RSA data. Radiological evaluation was also used to quantify in how many radiographs the intraosseous position of the bone markers had been simulated. The results showed that tantalum markers improve reliability whereas they do not affect accuracy for conventional measurements and for EBRA-FCA. Because of the danger of third-body wear their implantation should be avoided unless they are an integral part of the method.
Asunto(s)
Análisis de Falla de Equipo , Prótesis de Cadera , Fotogrametría , Complicaciones Posoperatorias/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador , Tantalio , Simulación por Computador , Estudios de Seguimiento , Humanos , Cómputos Matemáticos , Valor Predictivo de las PruebasRESUMEN
We revised the hip (6 stems and 5 sockets) with impacted morselized allografts and cement in 6 patients. We followed prosthetic migration by roentgen radiostereometric analysis (RSA) every 7th day for 6 weeks after the first (index) examination performed on the first postoperative day before mobilization. Most of the migration occurred during the first 2 weeks. In most cases more than half of the distal stem migration was seen between the 1st and 14th days. In all cases, the stem and socket migrations slowed down gradually and several prosthetic components had become stable after 5 weeks. We conclude that it is essential to perform the index RSA examination on the 1st or 2nd day after surgery and to state when and how weight bearing should be permitted. Otherwise it will be difficult to compare prosthetic migration in various studies and define normative values for migration predicting survival.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Fotogrametría/métodos , Falla de Prótesis , Radiografía/métodos , Anciano , Cementos para Huesos/uso terapéutico , Análisis de Falla de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Valor Predictivo de las Pruebas , Valores de Referencia , Reoperación , Análisis de Supervivencia , Factores de Tiempo , Trasplante Homólogo , Soporte de PesoRESUMEN
In a consecutive series of hip revisions due to mechanical loosening, using impacted morselized allografts and cement, we followed 21 acetabular components by radiostereometric analysis (RSA) during 2 years. All but 1 acetabular component migrated in the proximal direction (median 2.1 (0.5-6.4) mm). 6 components migrated in the medial direction (median 0.8 (0.4-1.2) mm) and 6 in the lateral (median 0.8 (0.4-2.0) mm). 14 components migrated in the posterior direction (median 0.8 (0.3-2.3) mm) and 1 in the anterior 0.6 mm. The migration rate gradually decreased in all directions, but 7 acetabular components still migrated in at least 1 direction (median 0.3-0.6 mm) between 1.5 and 2 years postoperatively.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Trasplante Óseo , Prótesis de Cadera , Falla de Prótesis , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Trasplante HomólogoRESUMEN
We studied the interface gap around cemented femoral stems. Fresh pig femora were used. Bone cement mixed under vacuum or at atmospheric pressure was injected into the femoral canal and a cobalt chrome stem was then implanted. The femora were sectioned transversely from the minor trochanter and distally by using a high-pressure water cutter. Most of the interfaces had intimate contact. However, in all specimens, small gaps were found at the bone-cement and cement-stem interfaces. The gaps at the interfaces between the bone and cement and the cement and stem were measured, using a computerized video digital system. They occupied about 10% of the circumference at the bone-cement interface and about 15% of the circumference at the cement-stem interface, irrespective of the mixing procedures. Most gaps were less than 100 mu at the interfaces. In conclusion, cemented implants in the animal model showed that small gaps are found at the interfaces directly after implantation. These gaps may be weak points and initiate debonding when loading the prostheses.
Asunto(s)
Cementos para Huesos/uso terapéutico , Modelos Animales de Enfermedad , Composición de Medicamentos/métodos , Prótesis de Cadera , Polimetil Metacrilato/uso terapéutico , Animales , Presión Atmosférica , Cementos para Huesos/química , Evaluación Preclínica de Medicamentos , Humanos , Recién Nacido , Microscopía por Video , Oseointegración , Polimetil Metacrilato/química , Porosidad , Falla de Prótesis , Distribución Aleatoria , Método Simple Ciego , Porcinos , VacioRESUMEN
Several methods of measuring the migration of the femoral component after total hip replacement have been described, but they use different reference lines, and have differing accuracies, some unproven. Statistical comparison of different studies is rarely possible. We report a study of the EBRA-FCA method (femoral component analysis using Einzel-Bild-Röntgen-Analyse) to determine its accuracy using three independent assessments, including a direct comparison with the results of roentgen stereophotogrammetric analysis (RSA). The accuracy of EBRA-FCA was better than +/- 1.5 mm (95% percentile) with a Cronbach's coefficient alpha for interobserver reliability of 0.84; a very good result. The method had a specificity of 100% and a sensitivity of 78% compared with RSA for the detection of migration of over 1 mm. This is accurate enough to assess the stability of a prosthesis within a relatively limited period. The best reference line for downward migration is between the greater trochanter and the shoulder of the stem, as confirmed by two experimental analyses and a computer-assisted design.
Asunto(s)
Artrografía/métodos , Artroplastia de Reemplazo de Cadera , Cabeza Femoral/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera/normas , Acetábulo/diagnóstico por imagen , Fenómenos Biomecánicos , Articulación de la Cadera/cirugía , Humanos , Variaciones Dependientes del ObservadorRESUMEN
The functional results in terms of quality of life 10 to 20 years after cemented total hip arthroplasty due to primary arthrosis were evaluated in 187 patients with nonrevised hips by use of the Nottingham Health Profile questionnaire. Function was impaired compared with age- and sex-matched random control subjects.
Asunto(s)
Prótesis de Cadera/psicología , Calidad de Vida , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Estudios de Casos y Controles , Cementación , Femenino , Estudios de Seguimiento , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Muestreo , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Six vacuum mixing systems, Cemvac, Merck, Mitvac, Optivac, Osteobond, and Stryker, were tested using prechilled Palacos R bone cement to investigate the reduction of porosity compared to mixing at atmospheric pressure. In addition the Optivac, Osteobond, and Stryker were tested using Simplex P bone cement to find out if they were effective in reducing the porosity of a middle viscosity bone cement. All vacuum mixing systems reduced the number of macropores (> 1 mm) and micropores (0.1 mm < voids < 1 mm) and increased the density of both Palacos R and Simplex P. But only the Optivac, Stryker, and Merck systems reduced the area percentage of macropores with more than 50% compared to the control. When using Simplex P bone cement, all three mixing systems tested reduced the numbers and the area percentage of macropores compared to the control. The results show that vacuum mixing is effective in reducing the porosity in both a high viscosity cement such as Palacos R and a middle viscosity cement such as Simplex P. Not all systems tested were effective in reducing the number and size of large voids.
Asunto(s)
Cementos para Huesos , Absorciometría de Fotón , Estudios de Evaluación como Asunto , Ensayo de Materiales , Metilmetacrilato , Metilmetacrilatos , Porosidad , Polvos , VacioRESUMEN
We report the preliminary findings of the use of roentgen stereophotogrammetric analysis to evaluate the early migration of five femoral components after revision for mechanical loosening using impacted cancellous allograft and cement. All hips were examined at one week, four to six months and one year after surgery. All the components subsided by 0.4 to 4.9 mm during the first year. In four hips the prosthetic head was displaced 1.1 to 6.9 mm posteriorly. Fixation of the femoral components was less secure than after primary arthroplasty but the incidence and magnitude of early migration were similar to those after revision with cement alone.
Asunto(s)
Artroplastia/métodos , Cabeza Femoral/trasplante , Migración de Cuerpo Extraño/cirugía , Prótesis de Cadera/efectos adversos , Cadera/cirugía , Anciano , Cementos para Huesos , Femenino , Estudios de Seguimiento , Migración de Cuerpo Extraño/etiología , Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Radiografía , Reoperación , Trasplante Homólogo/métodosRESUMEN
Four different brands of bone cement (Palacos R, Simplex P, Sulfix, CMW 1) were tested for exothermic changes during polymerization at atmospheric pressure and under partial vacuum of 0.2 bar. Palacos R was also mixed at four pressure levels (1.0, 0.2, 0.12, and 0.05 bar). The peak temperature in the bone cement was 46 to 124 degrees C, depending on the measuring point. There was no difference in peak temperature or duration of temperature increase above 50 degrees C during the curing of cement whether mixed at atmospheric pressure or under partial vacuum at different pressure levels.
Asunto(s)
Cementos para Huesos/química , Materiales Biocompatibles , Calor , Temperatura , VacioRESUMEN
We followed 11 patients 3-15 years after a cemented mega total hip replacement for a proximal femoral bone tumor. 7/8 survivors had good function and only occasional pain. 1 hip had been revised because of deep infection and in 1 case the cup had been exchanged because of aseptic loosening. 2 patients had been operated on because of local recurrence of the tumor. At follow-up, 1 patient had radiographic signs of loosening of the stem after 7 years. There was in 8 cases a pronounced athropy of the femoral cortical bone, not correlated to loosening of the stem.
Asunto(s)
Neoplasias Femorales/cirugía , Fémur/patología , Prótesis de Cadera/efectos adversos , Adulto , Anciano , Atrofia/etiología , Cementos para Huesos , Femenino , Fémur/diagnóstico por imagen , Estudios de Seguimiento , Prótesis de Cadera/métodos , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Falla de Prótesis , Radiografía , ReoperaciónRESUMEN
A 53-year-old man presented with femoral metastasis from a renal carcinoma. Four months after bone curettage and fixation and nephrectomy, a large recurrence of the metastasis was resected en bloc with the proximal femur and a megaprosthesis inserted. Six years later he is well and physically active.
Asunto(s)
Carcinoma de Células Renales/secundario , Carcinoma de Células Renales/cirugía , Neoplasias Femorales/secundario , Neoplasias Femorales/cirugía , Prótesis de Cadera , Neoplasias Renales/patología , Carcinoma de Células Renales/diagnóstico por imagen , Neoplasias Femorales/diagnóstico por imagen , Cuello Femoral , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/cirugía , Radiografía , Reoperación , Factores de TiempoRESUMEN
Four to 12 years after primary treatment of femoral neck fracture with hemiarthroplasty in a group of Finnish patients and secondary total hip arthroplasty as a salvage procedure for healing complication after primary osteosynthesis in a group of Swedish patients, function was classified and the Nottingham Health Profile questionnaire was applied. The two groups were comparable with regard to age, sex, and social status. The patients with secondary total hip arthroplasty used walking aids to a lesser extent than the patients with hemiarthroplasty and experienced less problems in several aspects of life. Walking ability was considered unchanged, compared to prefracture, to a larger extent in the secondary total hip arthroplasty group. Thus, secondary total hip arthroplasty in patients with healing complication following primary osteosynthesis gives better long-term functional capacity than that obtained with a primary hemiarthroplasty.
Asunto(s)
Actividades Cotidianas , Actitud Frente a la Salud , Fracturas del Cuello Femoral/psicología , Fracturas del Cuello Femoral/cirugía , Prótesis de Cadera , Anciano , Bastones/estadística & datos numéricos , Femenino , Fracturas del Cuello Femoral/complicaciones , Estudios de Seguimiento , Fijación Interna de Fracturas , Curación de Fractura , Indicadores de Salud , Prótesis de Cadera/métodos , Prótesis de Cadera/psicología , Humanos , Masculino , Reoperación , Terapia Recuperativa , Factores de Tiempo , Andadores/estadística & datos numéricosRESUMEN
From 1970 to 1980 cemented metal-on-plastic total hip replacement was performed on 799 hips with primary osteoarthritis using one surgical technique. At the 10- to 20-year follow-up there had been 97 revisions for mechanical loosening. Univariate survivorship analysis showed that an increased risk of revision was associated with male gender, young age at primary THR, the Brunswik and Lubinus snap-fit prostheses with large femoral heads (as compared with the Charnley prosthesis), and varying experience of the surgeon. Multivariate statistical analysis showed a three-fold increased risk of revision for men (p < 0.0001), an increase in relative risk of 1.8 per 10 years younger at surgery (p < 0.0001), a fivefold increase in risk for the Brunswik prosthesis (p < 0.0001) and a twofold increase for the Lubinus prosthesis (p = 0.0067). Inexperience of the surgeon, however, was not validated as a risk factor. The study shows that the true risk factors for revision can be identified accurately by combining univariate survivorship and multivariate statistical analyses.
Asunto(s)
Prótesis de Cadera/normas , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Osteoartritis/cirugía , Falla de Prótesis , Reoperación , Factores de TiempoRESUMEN
Palacos R bone cement was mixed in a commercial vacuum mixing system (MITAB), and in an experimental system allowing evacuating air from the powder before mixing and collecting the cement under partial vacuum. The effect on the porosity of mixing at different pressure levels was tested. The effect of evacuating air from the powder before mixing was also analyzed. The numbers and sizes of the voids in the cement samples were measured in radiographs and under the microscope. Also, the density of the cement was measured. Vacuum mixed samples had a substantial reduction of voids, as well as an increase in density compared to mixing at atmospheric pressure. After vacuum mixing and collection, a further reduction of the porosity and increased density were seen; all the large voids within the cement were eliminated at 0.05 bar absolute pressure.
Asunto(s)
Cementos para Huesos , Ensayo de Materiales , Humanos , Porosidad , VacioRESUMEN
Roentgen stereophotogrammetric analysis (RSA) was used to evaluate the migration in 17 cemented acetabular components after revision operations for mechanical loosening. All of the hips were examined four months and one year after surgery; ten of the hips were also examined after two years. In 15 of the 17 components, definite migration (0.5-2.7 mm) was identified, whereas two acetabular components showed no significant migration (< 0.25 mm). In 13 hips, the migration was seen within four months after surgery. There was a tendency for larger migration in revisions for severe bone destruction. These findings indicate that prosthetic fixation in revision operations is relatively poor. In cases with severe bone loss, cement fixations is extremely poor.
Asunto(s)
Acetábulo/diagnóstico por imagen , Migración de Cuerpo Extraño/diagnóstico por imagen , Prótesis de Cadera , Adulto , Anciano , Cementos para Huesos , Resorción Ósea/complicaciones , Femenino , Migración de Cuerpo Extraño/etiología , Humanos , Masculino , Persona de Mediana Edad , Fotogrametría , Falla de Prótesis , Radiografía , ReoperaciónRESUMEN
Nineteen patients with juvenile chronic arthritis underwent 29 resurfacing hip arthroplasties. In 22 the original all-plastic Wagner acetabular component was used and in 7 the metal-backed Wagner-Tillmann component. After a mean of 11 (range 8-13) years 19 of the Wagner acetabular components had been revised and another 2 showed radiographic loosening. After a mean of 7 (range 5-9) years no metal-backed acetabular cup had been revised and only 1 was definitely loose.
Asunto(s)
Artritis Juvenil/cirugía , Prótesis de Cadera , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Adolescente , Adulto , Artritis Juvenil/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Falla de Prótesis , Radiografía , Propiedades de SuperficieRESUMEN
Roentgen stereophotogrammetric analysis was used to measure the migration of 24 cemented femoral components implanted during revision for mechanical loosening. All hips were examined one week, four months and one year after surgery; 14 hips were also examined after two years. Twenty-one components subsided 0.2 to 5.5 mm during the observation period; in 17 of these, subsidence occurred within four months of surgery. In 16 hips the prosthetic head was displaced 0.7 to 11.2 mm posteriorly. The fixation of the femoral components was less secure than after primary arthroplasty, especially in cases of femoral canal enlargement, when a standard-sized rather than a thick-stemmed prosthesis had been used, and in cases of inadequate cement filling.
Asunto(s)
Cementos para Huesos/uso terapéutico , Fémur/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera , Anciano , Femenino , Estudios de Seguimiento , Prótesis de Cadera/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Fotogrametría , Diseño de Prótesis , Falla de Prótesis , Radiografía , Reoperación/estadística & datos numéricos , Factores de TiempoRESUMEN
Four different methods of radiologic evaluation of the acetabular component migration following total hip arthroplasty have been compared with roentgen stereophotogrammetry, a proven highly accurate method for studying early migration. In the Sutherland and Wetherell method the implant's position is measured with a pencil and a ruler from an ordinary pelvis radiograph. New reference lines of the Wetherell method are thought to be more accurate. The Sulzer and EBRA methods are computerized. In the Sulzer method prominent bone markers are digitized and used as reference points. In the EBRA method a system of tangents on prominent pelvis structure is digitized and used to detect radiographs with similar projection. The implant's position is calculated as the mean position of similar radiographs. The Sutherland, Wetherell, and Sulzer methods had almost the same accuracy, whereas the EBRA method was more accurate and could be used for pro- and retrospective studies in a large number of patients.