共查询到20条相似文献,搜索用时 31 毫秒
1.
Shinya Hayashi Takayuki Nishiyama Takaaki Fujishiro Shingo Hashimoto Noriyuki Kanzaki Kotaro Nishida Ryosuke Kuroda Masahiro Kurosaka 《International orthopaedics》2013,37(6):1063-1068
Purpose
Accurate orientation of acetabular and femoral components are important during THA. However, no study has assessed the use of the CT-based fluoro-matched navigation system during THA. Therefore, we have evaluated the accuracy of stem orientation by CT-based fluoro-matched navigation.Methods
The accuracy of stem orientation by CT-based fluoro-matched navigation was assessed by postoperative CT data. Furthermore, we compared the postoperative stem orientation with the intraoperative registration errors.Results
The average antetorsion error of the stem (navigation records − postoperative CT) was −0.5° ± 5.2°. The stem valgus error was 0.4° ± 2.7°. The accuracy of the navigation record for the orientation of the stem valgus was dependent on the intraoperative registration errors.Conclusions
The clinical accuracy of CT-based fluoro-matched navigation is adequate for stem alignment orientation, and the intraoperative verification of registration errors is valuable for checking the accuracy of stem orientation by navigation. 相似文献2.
Masanobu Hirata Yasuharu Nakashima Takashi Itokawa Masanobu Ohishi Taishi Sato Mio Akiyama Daisuke Hara Yukihide Iwamoto 《International orthopaedics》2014,38(7):1341-1346
Purpose
Stem version is not always equivalent to femoral neck version (native version) in cementless total hip arthroplasty (THA). We therefore examined the discrepancy of version between the native femoral neck and stem using pre- and postoperative computed tomography (CT), the level of the femur where the canal version most closely fit the stem version, and the factors influencing version discrepancy between the native femoral neck and stem.Methods
A total of 122 hips in 122 patients who underwent primary THA using a metaphyseal-fit stem through the postero-lateral approach were included. Pre- and postoperative CT images were utilized to measure native and stem version, and the version of the femoral canal at four levels relative to the lesser trochanter.Results
The mean native and stem versions were 28.1 ± 11.0° and 38.0 ± 11.2°, respectively, revealing increased stem version with a mean difference of 9.8° (p < 0.0001). A total of 84 hips (68.9 %) revealed an increase in version greater than 5°. Femoral canal version at the level of the lesser trochanter most closely approximated that of stem version. Among the factors analysed, both univariate and multivariate analysis showed that greater degrees of native version and anterior stem tilt significantly reduced the version discrepancy between the native femoral neck and stem version.Conclusions
Since a cementless stem has little version adjustability in the femoral canal, these findings are useful for surgeons in preoperative planning and to achieve proper component placement in THA. 相似文献3.
Wenzel Waldstein Christian Merle Tom Schmidt-Braekling Friedrich Boettner 《International orthopaedics》2014,38(7):1347-1352
Purpose
Limited data exist for the reconstructive potential of short bone-preserving stems in THA using a minimal invasive posterolateral approach. Our study aim was to assess the effect of stem design on the reconstruction of hip offset and leg length in MIS posterolateral THA.Methods
This retrospective consecutive single-surgeon study compares hip offset and leg length, as well as acetabular component positioning (cup anteversion; inclination) of 129 THAs with a cementless standard-length stem (Synergy®) and 143 THAs with a cementless short bone-preserving stem (Trilock®).Results
In reference to the contralateral side, the mean difference in hip offset was 0.9 mm (p = 0.067) for the standard stem and 0.1 mm (p = 0.793) for the short stem, respectively. Leg-length discrepancy was 0.7 mm (Synergy®) and 0.9 mm (Trilock®), respectively. A total of 233 (86 %) acetabular components fell within the target zone for anteversion and inclination.Conclusion
Accurate component positioning in MIS posterolateral approach THA is possible and is not influenced by the type of stem. 相似文献4.
Bernstein M Desy NM Petit A Zukor DJ Huk OL Antoniou J 《International orthopaedics》2012,36(9):1807-1812
Purpose
Long-term studies are required to support the use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) given the concern about systemic metal ion release and reports of adverse local soft tissue reactions. The purpose of this study was to report the seven to 13-year clinical, radiographic, and metal ion results in patients following MoM THA.Methods
We studied 163 prostheses after second-generation MoM THA between July 1997 and November 2003. Cobalt and chromium metal ions were collected using whole and analysed by inductively-coupled plasma-mass spectrometry.Results
The mean follow-up was 8.87 years (range, 7–13 years). Four hips (2.5 %) were revised. The Kaplan-Meier survivorship was 91.3 % for revision for all causes, and 97.5 % when excluding the hips revised for a manufacturer’s defect. Median whole blood cobalt levels peaked at a value of 2.87 μg/L at four years (p < 0.0001 vs. pre-operative) and subsequently decreased to 2.0 μg/L after nine years (p = 0.002 vs. four years). Median chromium levels maximally increased up to 0.75 μg/L after five years (p < 0.0001 vs. pre-operative) and tended to decrease thereafter to values of 0.56 μg/L after seven years.Conclusions
This seven to 13-year follow-up study indicates that the clinical and radiological results following MoM THA are satisfactory with low revision rates. Cobalt and chromium ion levels peaked at four and five years, respectively, and gradually decreased thereafter. 相似文献5.
Patrice Mertl MD Antoine Combes MD Frédérique Leiber-Wackenheim MD Michel Henri Fessy MD Julien Girard MD PhD Henri Migaud MD 《HSS journal》2012,8(3):251-256
Background
Dual mobility (DM) cups of mobile polyethylene were introduced to prevent total hip arthroplasty (THA) dislocation, but no large series with this design to treat recurrent instability have been reported.Purpose
Our retrospective investigation ascertained the efficiency of DM cups in correction of recurrent dislocation and assessed any adverse effects.Methods
One hundred eighty THAs with recurrent instability were revised to DM cups in 180 patients (mean age, 67.4 ± 11.7 years; range, 19 to 92 years). Thirty-one patients (17.2%) underwent at least one earlier THA revision, and 15 (10.3%) incurred non-union of the greater trochanter. Of the initial group in 2009, 145 patients had completed evaluations which included assessment of the Harris Hip Score and a radiographic assessment at a mean follow-up of 7.7 ± 2.2 years (range, 4 to 14 years). The rate of survival was calculated considering any reason for revision as failure.Results
At follow-up, Harris hip score was 83.9 ± 16.1 (range, 21 to 100). Dislocation of the large articulation occurred in seven hips (4.8%), and only two recurred (1.4%) (one requiring additional revision). In addition, two intra-prosthetic dislocations of the small articulation (1.4%) were observed and needed revision surgery. The large number of earlier surgeries and non-union of the greater trochanter were related to recurrent instability. Two cups (1.4%) showed signs of definite loosening; six (4.1%) presented signs of possible loosening. Twenty-nine hips manifested femoral or acetabular osteolysis (20%), but only three were severe. Eight-year survival rate considering revision for any reason was 92.6% (95% CI, 85.5–96.4%).Conclusions
This series indicates that DM cups are a viable option to treat recurrent THA instability. Their design provides a low risk of recurrent instability without increasing mechanical complications. 相似文献6.
Myung Chul Yoo Yoon Je Cho Kang Il Kim Kee Hyung Rhyu Young Soo Chun Sung Wook Chun Hoon Oh Eun Yeol Kim 《Clinics in Orthopedic Surgery》2009,1(1):19-26
Background
We performed a retrospective study to evaluate the results of acetabular circumferential medial wall osteotomy, a procedure designed to provide secure fixation of a cementless hemispherical acetabular cup for the sequelae of septic arthritis of the hip.Methods
We assessed 38 total hip arthroplasties (THAs) with circumferential acetabular medial wall osteotomies performed on patients with sequelae of septic arthritis of the hip between 1993 and 2000, who were followed up for ≥ 3 years. The average follow-up period was 8.3 years (range, 3 to 12 years). The indication for this technique was poor acetabular cup coverage of ≤ 70% on preoperative templating. In all cases, cementless hemispherical acetabular cups were fixed to the true acetabulum. Additional procedures included soft tissue release in 16 hips and femoral derotational and shortening osteotomies in 12 hips. We evaluated both clinical and radiological results.Results
The Harris hip scores improved from 57 points preoperatively to 91 points postoperatively. Radiological analysis revealed no aseptic loosening or radiolucent lines around the acetabular cup. Stable bony fixation of the acetabular cup in the true acetabulum was seen in all cases. Acetabular osteolysis was demonstrated in 12 hips. Revision surgery was performed in 6 hips, but there were no complications related to acetabular circumferential medial wall osteotomy.Conclusions
Circumferential acetabular medial wall osteotomy can provide appropriate positioning and sufficient coverage of the acetabular cup and thus preserve the medial wall thickness in cementless THA without the need for additional bone grafting for the sequelae of septic arthritis of the hip. 相似文献7.
Akos Zahar Kornel Papik Jozsef Lakatos Michael B. Cross 《International orthopaedics》2014,38(5):947-951
Purpose
Managing a deficient acetabulum in patients with developmental dysplasia of the hip (DDH) can be challenging. The purpose of the study was to determine the mid-term results of total hip arthroplasty (THA) using a bulk structural autograft for reconstruction of the acetabular roof in patients with DDH.Methods
Between 1982 and 1999, 112 patients underwent THA with acetabular roof-plasty using a bulk structural autograft for secondary osteoarthritis related to DDH. A total of 106 patients (115 hips) met inclusion criteria and were followed for an average of 11.6 years (seven to 24 years). The mean age was 52.5 years at the index operation. Clinical and radiological evaluations were performed according to the methods of Merle d’Aubigné and Postel, Johnston et al. and DeLee and Charnley.Results
The overall Merle d’Aubigné hip score significantly improved (3.7 vs 10.4, p < 0.01). The limb length discrepancy decreased from 30 to 6 mm (p < 0.01). The average distance that the hip centre was distalised was 22.3 mm (0–56 mm). However, radiolucent lines were observed in 27 % of patients at final follow-up, and the overall rate of revision for aseptic loosening was 16 %. Further, Kaplan-Meier survivorship curves predicted a rapid increase in the failure rate at 15 years.Conclusions
The mid-term functional outcome of THA with an acetabular roof-plasty using a bulk autograft is satisfactory; however, the long-term results are questionable. 相似文献8.
Yasuharu Nakashima Masanobu Hirata Mio Akiyama Takashi Itokawa Takuaki Yamamoto Goro Motomura Masanobu Ohishi Satoshi Hamai Yukihide Iwamoto 《International orthopaedics》2014,38(1):27-32
Purpose
The combined anteversion (CA) technique is a method in which the cup is placed according to the stem anteversion in total hip arthroplasty (THA). We examined whether the CA technique reduced the dislocation rate, and the distribution of CA with the manual placement of the cup.Methods
We retrospectively reviewed 634 hips in 579 patients with primary cementless THA. In 230 hips using the CA technique [CA(+)], a CA of 50 ± 10° was the aim. In the remaining 404 hips [CA(−)], the cup was first placed targeting 20° of anteversion. The post-operative CA was measured using the computed tomography (CT) images in 111 hips.Results
One hip (0.4 %) had a dislocation in the CA(+) group, whereas ten hips (2.5 %) had a dislocation in the CA(−) group. A multivariate analysis showed that primary diagnosis, head size and CA technique significantly influenced the dislocation rate. Patients in the CA(−) group were 5.8 times more likely to have a dislocation compared to the CA(+) group. In the 111 hips with CT images, 81 hips (73.0 %) achieved the intended CA.Conclusions
Although the manual placement of the cup resulted in 27 % of outliers from the intended CA, the CA technique significantly reduced the dislocation after primary THA. 相似文献9.
10.
Cristiano Hossri Ribeiro Nilson Roberto Severino Patricia Maria Moraes de Barros Fucs 《International orthopaedics》2014,38(8):1627-1631
Purpose
This study aimed to verify if the navigation system used in high tibial osteotomy (HTO) adds precision to the procedure regarding mechanical axis correction and prevention of tibial slope increases.Methods
In this historically controlled study, patients with medial osteoarthrosis and genuvarum underwent HTO between 2004 and 2012; the first 20 were operated with the conventional technique, using pre-planning correction by the Dugdale method and 18 further patients were operated with the navigation system introduced in our hospital.Results
The two groups were similar for pre-operative mechanical axis (mean 8.10 ± 3.14 for the control and 6.60 ± 2.50 for the navigated group), pre-operative tibial slope (mean 8.95 ± 3.47 versus 8.17 ± 3.11, respectively) and Lyshom score (40.85 ± 15.46 and 44.83 ± 16.86). After surgery, the control group presented mean mechanical axis of 3.35 ± 3.27, tibial slope of 13.75 ± 3.75 and Lyshom score of 87.60 ± 11.12. The navigated group showed a postoperative mechanical axis mean of 3.06 ± 1.70, tibial slope of 10.11 ± 0.18 and Lyshom score of 91.94 ± 11.61.Conclusions
The navigation system allowed a significantly better control of tibial slope. Patients operated with the navigation system had significantly better Lysholm scores. 相似文献11.
M. van Heumen P. J. C. Heesterbeek B. A. Swierstra G. G. Van Hellemondt J. H. M. Goosen 《Journal of orthopaedics and traumatology》2015,16(1):15-20
Background
A dual mobility cup has the theoretic potential to improve stability in primary total hip arthroplasty (THA) and mid-term cohort results are favorable. We hypothesized that use of a new-generation dual mobility cup in revision arthroplasty prevents dislocation in patients with a history of recurrent dislocation of the THA.Materials and methods
We performed a retrospective cohort study of patients receiving an isolated acetabular revision with a dual mobility cup for recurrent dislocation of the prosthesis with a minimum follow-up of 1 year. Kaplan–Meier survival analyses were performed with dislocation as a primary endpoint and re-revision for any reason as a secondary endpoint.Results
Forty-nine consecutive patients (50 hips) were included; none of the patients was lost to follow-up. The median follow-up was 29 months (range 12–66 months). Two patients died from unrelated causes. Survival after 56 months was 100 % based on dislocation and 93 % (95 % CI 79–98 %) based on re-revision for any reason. Radiologic analysis revealed no osteolysis or radiolucent lines around the acetabular component during the follow-up period.Conclusion
The dual mobility cup is an efficient solution for instability of THA with a favorable implant survival at 56 months.Level of evidence
Level 4, retrospective case series. 相似文献12.
Purpose
Total hip arthroplasty (THA) is an effective procedure for developmental dysplasia of the hip (DDH); however, it is sometimes difficult to complete for severe cases because of femoral head dislocation, dysplasia of the acetabulum and the femur, disparity in limb length, soft tissue contraction, and muscular atrophy. We aimed at exploring the efficiency of the techniques of release and balance of soft tissues and reconstruction of true socket THA for patients with severe DDH.Methods
From January 2000 to January 2009, 46 adult patients with severe DDH (50 hips) were included in this study. According to the classification system, there were 26 type III and 24 type IV. Among them there were 32 women and 14 men, aged from 38 to 77 years. THA was performed via a lateral approach. All acetabular sockets were reconstructed at the original anatomical location following a meticulous technique of soft tissue release and balance around the hip to restore limb length, to strengthen the abductor and improve its function.Results
All patients had restoration of limb length (range, 2.5–5.5 cm; 30 limbs of more than 4 cm) without injury to the sciatic nerve. One postoperative dislocation occurred due to slight enlargement of the angle of abduction of the acetabulum. The follow-up ranged from 2.2 to 11.5 years (median 6.4 years) in 46 patients, and the Harris score increased from 40.2 preoperatively to 86.5 (P = 0.027). All hips were pain free with good function at the latest follow-up.Conclusion
The meticulous techniques of soft tissue release and balance can be recommended to ensure anatomical reconstruction of the true acetabular socket and to improve abductor function during arthroplasty for DDH. 相似文献13.
Patel S Thakrar RR Bhamra J Hossain F Tengrootenhuysen M Haddad FS 《Annals of the Royal College of Surgeons of England》2011,93(6):465-469
INTRODUCTION
The purpose of this study was to determine if hip resurfacing arthroplasty (HRA) and cementless total hip arthroplasty (THA) were comparable in correcting leg length and hip offset in patients with primary osteoarthritis.METHODS
A retrospective analysis was performed of 80 patients who underwent either HRA or cementless THA for primary osteoarthritis (40 in each group) between 2006 and 2008. Standardised anteroposterior radiographs taken pre-operatively and at one year following surgery were used to calculate the total offset and leg length in both hips.RESULTS
At one year following surgery, no leg length discrepancy was identified in either group. A difference of 0.39cm (p=0.046) remained between the mean total offset of the operated hip and the contralateral non-operated hip in the HRA group. No difference in offset was observed between the two hips after surgery in the THA group (p=0.875).CONCLUSIONS
Leg length is restored by HRA and THA. A difference remains in offset after HRA although we attribute this to intentional medialisation of the acetabular cup. 相似文献14.
Tsung-Yuan Tsai Dimitris Dimitriou Guoan Li Young-Min Kwon 《International orthopaedics》2014,38(8):1577-1583
Purpose
Component orientations and positions in total hip arthroplasty (THA) are important parameters in restoring hip function. However, measurements using plain radiographs and 2D computed tomography (CT) slices are affected by patient position during imaging. This study used 3D CT to determine whether contemporary THA restores native hip geometry.Methods
Fourteen patients with unilateral THA underwent CT scan for 3D hip reconstruction. Hip models of the nonoperated side were mirrored with the implanted side to quantify the differences in hip geometry between sides.Results
The study demonstrated that combined hip anteversion (sum of acetabular and femoral anteversion) and vertical hip offset significantly increased by 25.3° ± 29.3° (range, −25.7° to 55.9°, p = 0.003) and 4.1 ± 4.7 mm (range, −7.1 to 9.8 mm, p = 0.009) in THAs.Conclusions
These data suggest that hip anatomy is not fully restored following THA compared with the contralateral native hip. 相似文献15.
16.
17.
Sulaiman Al-Moussa MD FRCSC Paul Moroz MD FRCSC Paul E. Beaulé MD FRCSC 《HSS journal》2012,8(3):235-239
Background
Although pelvic osteotomy in children has been effective in re-establishing containment of the hip joint, its impact on hip joint development with respect to acetabular coverage is ill defined.Purpose
The purpose of this study is to determine the prevalence of acetabular overcoverage in patients who had pelvic osteotomy during childhood and its impact on patient function.Patients and Methods
Between 1980 and 2008, all patients who had a pelvic osteotomy done at our institution for non-neuropathic hip dysplasia (DDH) or secondary to Legg–Calvé–Perthes disease (LCP) prior to skeletal maturity were reviewed. A clinical assessment and the WOMAC, UCLA Activity Score, Marx activity score, and SF-36 quality-of-life questionnaires were completed. A standardized AP pelvic X-ray was performed to determine the acetabular coverage, signs of retroversion, and degenerative changes.Results
Twenty-eight patients (32 hips) were identified, of which 14 (9 DDH, 5 LCP) agreed to participate. Impingement sign was positive in eight patients (six DDH, two LCP). Crossover and ischial spine signs were each present in ten hips. Tonnis grades were: 0 in 1 hip, 1 in 10 hips, 2 in 2 hips, and 3 in 1 hip. The mean Tonnis angle was 11.6 ± 8.6°. The mean CE angle was 24.0 ± 15.9° with six hips having a CE angle <20° and one hip with a CE angle >40°. There was no correlation between crossover sign or ischial sign and Tonnis grade (p = 0.739), hip pain (p = 0.520), or impingement sign (p = 1.00).Conclusions
Acetabular overcoverage is common in patients who underwent pelvic osteotomy during childhood. No correlation was identified between retroversion and hip pain in our patient cohort. 相似文献18.
19.
Nael Hawi Daniel Oliver Kendoff Udo Hessling Carl Haasper Thorsten Gehrke Mustafa Citak 《International orthopaedics》2014,38(8):1603-1608
Purpose
The goal of this study was to analyse the efficacy of blood autotransfusion using a continuous autologous transfusion system in revisions of total hip arthroplasty (THA). We looked at whether administration of allogeneic blood units was reduced in these cases and if there is a difference between cemented and non-cemented revisions.Methods
Between January 2011 and December 2011, patients being treated with revision THA were included (n = 411). The following parameters were analysed: patient age, gender, weight (kg), height (cm), body mass index (BMI, kg/m2), surgical diagnosis, treatment and American Society of Anesthesiologists (ASA) classification score. The difference between pre- and post-operative haemoglobin (Hb, g/dl), amount of peri-operative blood loss (ml), amount of retransfused washed shed blood and amount of allogeneic and/or autologous transfusion (ml) were recorded.Results
In both the cemented and non-cemented revision THA groups, there was no significant difference between pre- and post-operative Hb with or without using an autotransfusion system. In 92 of 186 cemented cases using an autologous transfusion system (49.5 %) and 38 of 117 non-cemented cases using an autologous transfusion system (32.5 %), allogeneic blood transfusion (ABT) was required. Cemented procedures using an autologous transfusion system got significantly more ABTs than non-cemented procedures using an autologous transfusion system (p = 0.0042, odds ratio = 2.035).Conclusions
Use of an autologous transfusion system did not reduce the amount of ABT in revision THA in the patient cohort reported here. In our opinion, general blood management is required before and during surgery to reduce administration of ABT. 相似文献20.
McArthur B Cross M Geatrakas C Mayman D Ghelman B 《Clinical orthopaedics and related research》2012,470(10):2810-2818