RESUMEN
A high radiographic inclination angle (RI) contributes to accelerated wear and has been associated with dislocation after total hip arthroplasty (THA). With freehand positioning of the acetabular component there is a lack of accuracy, with a trend towards a high radiographic inclination angle. The aim of this study was to investigate whether the use of a digital protractor to measure the operative inclination angle (OI) could improve the positioning of the acetabular component in relation to a 'safe zone'. We measured the radiographic inclination angles of 200 consecutive uncemented primary THAs. In the first 100 the component was introduced freehand and in the second 100 a digital protractor was used to measure the operative inclination angle. The mean difference between the operative and the radiographic inclination angles (∆RI-OI) in the second cohort was 12.3° (3.8° to 19.8°). There was a strong correlation between the circumference of the hip and ∆RI-OI. The number of RI outliers was significantly reduced in the protractor group (p = 0.002). Adjusting the OI, using a digital protractor and taking into account the circumference of the patient's hip, improves the RI significantly (p < 0.001) and does not require additional operating time.
Asunto(s)
Acetábulo/anatomía & histología , Acetábulo/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera , Articulación de la Cadera/anatomía & histología , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera , Acetábulo/cirugía , Anciano , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Pesos y Medidas Corporales , Precisión de la Medición Dimensional , Femenino , Cadera/anatomía & histología , Articulación de la Cadera/cirugía , Humanos , Masculino , Conceptos Matemáticos , Persona de Mediana Edad , Estudios Prospectivos , RadiografíaRESUMEN
The orientation of the acetabular component can influence both the short- and long-term outcomes of total hip replacement (THR). We performed a prospective, randomised, controlled trial of two groups, comprising of 40 patients each, in order to compare freehand introduction of the component with introduction using the transverse acetabular ligament (TAL) as a reference for anteversion. Anteversion and inclination were measured on pelvic radiographs. With respect to anteversion, in the freehand group 22.5% of the components were outside the safe zone versus 0% in the transverse acetabular ligament group (p = 0.002). The mean angle of anteversion in the freehand group was 21° (2° to 35°) which was significantly higher compared with 17° (2° to 25°) in the TAL group (p = 0.004). There was a significant difference comparing the variations of both groups (p = 0.008). With respect to inclination, in the freehand group 37.5% of the components were outside the safe zone versus 20% in the TAL group (p = 0.14). There was no significant difference regarding the accuracy or variation of the angle of inclination when comparing the two groups. The transverse acetabular ligament may be used to obtain the appropriate anteversion when introducing the acetabular component during THR, but not acetabular component inclination.
Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Ligamentos Articulares/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Rango del Movimiento Articular , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
UNLABELLED: Poor air quality in schools has been associated with adverse health effects. Indoor air quality can be improved by increasing ventilation. The objective of this study was to compare the effectiveness of different interventions to improve ventilation behavior in primary schools. We used indoor CO(2) concentrations as an indicator. In 81 classes of 20 Dutch primary schools, we applied three different interventions: (i) a class-specific ventilation advice; (ii) the advice combined with a CO(2) warning device and (iii) the advice combined with a teaching package. The effectiveness of the interventions was tested directly after intervention and 6 weeks after intervention by measuring the CO(2) concentrations and comparison with a control group (iv). Before intervention, the CO(2) concentration exceeded 1000 ppm for 64% of the school day. The class-specific ventilation advice without further support appeared an ineffective tool to improve ventilation behavior. The advice in combination with a CO(2) warning device or the teaching package proved effective tools and resulted in lower indoor CO(2) concentrations when compared with the control group. Ventilation was significantly improved, but CO(2) concentrations still exceeded 1000 ppm for more than 40% of the school day. Hence, until ventilation facilities are upgraded, the CO(2) warning device and the teaching package are useful low-cost tools. PRACTICAL IMPLICATIONS: To improve ventilation behavior and indoor air quality in schools, CO(2) warning device and teaching package combined with a class-specific ventilation advice, are effective tools, while giving the ventilation advice solely, is not effective. Although ventilation is significantly improved through behavioral change, the ventilation rate is still insufficient to maintain good air quality during the full school day. Therefore, the improvement of the ventilation facilities is recommended. Hence, until ventilation facilities in schools are upgraded, the CO(2) warning device and the teaching package are useful low-cost tools to improve current indoor air quality.
Asunto(s)
Contaminación del Aire Interior/análisis , Contaminación del Aire Interior/prevención & control , Monitoreo del Ambiente , Arquitectura y Construcción de Instituciones de Salud , Instituciones Académicas , Ventilación/métodos , Adolescente , Contaminantes Atmosféricos/análisis , Dióxido de Carbono/análisis , Niño , Humanos , Espectrometría de Masas , Control de Calidad , Medición de Riesgo , Ventilación/instrumentaciónRESUMEN
We report the initial results of an ongoing randomised, prospective study on migration of the Exeter and Elite Plus femoral stems after impaction allografting, as measured by radiostereometry. Clinically, the impaction technique gave good results for both stems. The mean subsidence in the first year was 1.30 mm and 0.20 mm for the Exeter and the Elite Plus stems, respectively. In the second year, the Exeter stem continued to subside further by a mean of 0.42 mm, while the Elite Plus stem did not do so. Subsidence of the Exeter stem correlated with deficiency of bone stock as graded on the Gustilo and Pasternak scale. This correlation was not found for the Elite Plus stem. None of the other parameters which were studied predisposed to subsidence. There was no significant association between the amount of subsidence and the radiological appearance of the graft for either stem. Our findings do not support the theory that radial compression, due to subsidence of the Exeter stem, is the essential stimulus for remodelling in impaction allografting.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Migración de Cuerpo Extraño/diagnóstico por imagen , Prótesis de Cadera/efectos adversos , Falla de Prótesis , Adulto , Anciano , Anciano de 80 o más Años , Pesos y Medidas Corporales/métodos , Remodelación Ósea , Trasplante Óseo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , RadiografíaRESUMEN
Monolayers of LLC-PK1 cells, a cell line with features typical of proximal tubular epithelial cells, were treated at the apical and basolateral side with S-(1,2,3,4,4-pentachlorobutadienyl)glutathione (PCBD-GSH) and N-acetyl-S-(1,2,3,4,4-pentachlorobutadienyl)-L-cysteine (PCBD-NAC). Apical treatment with PCBD-GSH (greater than 20 microM) resulted in cytotoxicity, which could be inhibited by acivicin and aminooxyacetic acid (AOAA), inhibitors of gamma-glutamyltranspeptidase (gamma GT) and beta-lyase respectively. In contrast apical treatment with PCBD-NAC was only toxic at high concentrations (greater than 850 microM), and this effect could hardly be inhibited by AOAA. Basolateral treatment of confluent LLC-PK1 monolayers, grown on porous membranes, with PCBD-GSH gave a much smaller response than apical treatment, consistent with the fact that gamma GT is predominantly present at the apical side. Basolateral treatment even with high concentrations of PCBD-NAC (1.1 mM) did not show an increase in cytotoxicity when compared to the effect after apical treatment. These results suggest the absence of an organic anion transporter, by which these conjugates in vivo are transported into the cells from the basolateral side. This supposition was substantiated in a study of transcellular transport of the model ions tetraethyl ammonium (TEA) and para-aminohippurate (PAH), in LLC-PK1 monolayers, grown as indicated above. No active PAH transport could be demonstrated, whereas an active TEA transport was present. The absence of an organic anion transporter limits the usefulness of LLC-PK1 cells for the study of nephrotoxicity of compounds, like PCBD-NAc, needing this transport to enter the cells. However, the finding of an active basolateral organic cation transporter, together with the presence of gamma GT, dipeptidase and beta-lyase, makes this system especially interesting for testing all compounds that use this transporter or these enzymes in order to elicit toxicity.