RESUMEN
We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery. Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% +/- 8% with revision because of aseptic loosening as the end point and 82% +/- 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Cementación , Luxación de la Cadera/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Luxación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Radiografía , Recuperación de la Función , Reoperación , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: In total hip arthroplasty, techniques for cementing the femoral component have changed over time. The purpose of the present study was to determine whether a cementing technique that includes use of a distal cement plug and retrograde filling of the femoral canal affects the fixation of the femoral component at a minimum of twenty years after the operation. METHODS: Between 1976 and 1978, the senior one of us (R.C.J.) performed 357 total hip arthroplasties with use of a Charnley flatback polished femoral stem and a contemporary cementing technique (insertion of a distal cement plug and retrograde filling of the femoral canal with cement) in 320 patients. The results after a minimum follow-up of twenty years were compared with those after 330 total hip arthroplasties performed, between 1970 and 1972, with the same femoral stem by the same surgeon with use of a hand-packing technique of cementing in 262 patients. The clinical and radiographic evaluation as well as the duration of follow-up were identical in the two groups. RESULTS: In the group managed with the contemporary cementing technique, six (1.8%) of the 336 hips that had not been lost to follow-up or revised because of infection or dislocation were revised because of aseptic loosening of the femoral component. Of the ninety-one hips in the eighty-two patients who were alive at a minimum of twenty years, five (5%) had a revision because of aseptic loosening of the femoral component. Only one hip was revised during the fifteen-to-twenty-year follow-up interval. (The revision was performed because of a fracture of the femoral component.) The rate of failure when radiographic signs of loosening were included was 4.8% (sixteen of 336 femoral components that had not been revised because of infection or dislocation) for the group managed with the contemporary cementing technique compared with 6.3% (twenty of 319 hips) in the group managed with the hand-packing technique; the difference was not significant (p = 0.40). Adequate filling of the femoral canal with cement was found to be associated with improved survival of the femoral component (p = 0.03). CONCLUSIONS: While no significant difference between the two cementing techniques could be identified, the ability to deliver adequate cement around the femoral component was more predictable with the contemporary cementing technique. In addition, the prevalence of loosening of the femoral component was low with use of either technique, a tribute to the Charnley flatback polished femoral component design.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/epidemiología , Satisfacción del Paciente , Falla de Prótesis , Reoperación/estadística & datos numéricos , Estadísticas no Paramétricas , Análisis de SupervivenciaRESUMEN
The infectious yeast Candida albicans progresses through two developmental programs which involve differential gene expression, the bud-hypha transition and high-frequency phenotypic switching. To understand how differentially expressed genes are regulated in this organism, the promoters of phase-specific genes must be functionally characterized, and a bioluminescent reporter system would facilitate such characterization. However, C. albicans has adopted a nontraditional codon strategy that involves a tRNA with a CAG anticodon to decode the codon CUG as serine rather than leucine. Since the luciferase gene of the sea pansy Renilla reinformis contains no CUGs, we have used it to develop a highly sensitive bioluminescent reporter system for C. albicans. When fused to the galactose-inducible promoter of GAL1, luciferase activity is inducible; when fused to the constitutive EF1 alpha 2 promoter, luciferase activity is constitutive; and when fused to the promoter of the white-phase-specific gene WH11 or the opaque-phase-specific gene OP4, luciferase activity is phase specific. The Renilla luciferase system can, therefore, be used as a bioluminescent reporter to analyze the strength and developmental regulation of C. albicans promoters.