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1.
Seung-Jae Lim Hyung-Gon Ryu Hyeon-Jun Eun Chan-Woo Park Kyeu-Back Kwon Youn-Soo Park 《The Journal of arthroplasty》2018,33(7):2182-2186.e1
Background
The purpose of this study is to evaluate the minimum 5-year outcomes and bearing-specific complications in a single surgeon series of fourth-generation alumina ceramic-on-ceramic total hip arthroplasties (THAs).Methods
We retrospectively analyzed 667 patients (749 hips) who underwent primary THAs by a single surgeon using fourth-generation alumina ceramic bearings. There were 315 men and 352 women with a mean age of 54.2 years. The surgeon used cementless prostheses with an identical design and BIOLOX Delta ceramics in all hips, using a 36-mm head in 472 hips (63%) and a 32-mm head in 227. The mean follow-up duration was 6.5 years (range, 5 to 8 years).Results
The mean Harris hip score improved from 45.6 points preoperatively to 91.3 points at final follow-up. All but 1 acetabular cup and all femoral stems were well fixed. No radiographic evidence of osteolysis was identified at final follow-up. There were 2 (0.3%) ceramic liner fractures and no ceramic head fractures. A total of 48 hips (6.4%) exhibited audible noise (29 clickings and 19 squeakings), but no patient required revision. Other complications were 1 dislocation, 1 deep infection, 3 iliopsoas tendonitis, and 6 periprosthetic femoral fractures. Kaplan-Meier survivorship for revision for any reason was 98.6% (95% confidence interval, 97.7-99.5) at 6.5 years.Conclusion
Delta ceramic-on-ceramic THAs had a high rate of survivorship without radiographic evidence of osteolysis at 6.5-year follow-up. However, we found 0.3% ceramic liner fractures and 6.4% audible noises associated with the use of Delta ceramics. 相似文献2.
Background
There are limited studies to evaluate long-term clinical and radiographic outcomes of alumina delta ceramic-on-ceramic bearings in cementless total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiographic results, prevalence of osteolysis, squeaking, and fracture of ceramic material associated with the use of the alumina delta ceramic-on-alumina delta ceramic bearing in cementless THA in patients aged <50 years.Methods
We reviewed the cases of 277 patients (334 hips) who underwent a cementless THA using alumina delta ceramic-on-alumina delta ceramic when they were 50 years or younger at the time of surgery. Demographic data; Harris Hip Score; Western Ontario McMaster Universities Osteoarthritis Index; and University of California, Los Angeles activity score were recorded. Radiographic and computerized tomographic evaluations were used to evaluate implant fixation and osteolysis. Squeaking sound and ceramic fracture were documented. The mean follow-up was 7.8 years (range, 6-9).Results
The mean postoperative Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, University of California, Los Angeles activity score were 93 points, 15 points, and 8.6 points, respectively. Two patients had thigh pain (grade 7 points). All acetabular components and all but 2 femoral components were well fixed. Thirty-three hips (10%) exhibited clicking sound, and 2 hips (0.6%) exhibited squeaking sound. No hip had osteolysis or ceramic head or liner fracture.Conclusion
Our minimum 6-year follow-up results with the use of alumina delta ceramic-on-alumina delta ceramic bearings in patients aged <50 years suggest that cementless THA provides a high rate of survivorship without evidence of osteolysis or fracture of ceramic material. 相似文献3.
Young-Kyun Lee Ki-Chul Kim Woo-Lam Jo Yong-Chan Ha Javad Parvizi Kyung-Hoi Koo 《The Journal of arthroplasty》2017,32(4):1360-1362
Background
Malseating of ceramic liner appeared as a matter of concern in multibearing metal, although multibearing cup can be coupled with hard liners as well as polyethylene liner. In this metal shell, the inner taper angle should be 10° for the modularity, while standard metal shells for ceramic liner have an inner taper angle of 18°. However, there has been no study in the effect of taper angle to the risk of malseating. We evaluated whether the taper angle of metal shell might affect the malseating of ceramic liner, and dissociation force of ceramic liner from metal shell.Methods
Three surgeons manually inserted ceramic liners into two designs of metal shell with different tapers angles (10° and 18°). We compared malseating rates of ceramic liners and push-out strengths, which means dissociation force of the ceramic liner from the metal shell, between these two metal shell designs.Results
The malseating rates in 10° metal shell were higher than those in 18° metal shell (23.3% vs 0%, P < .05). The mean dissociation force (1148.8 ± 46.7 N) in 10° taper cup was higher than that (389.7 ± 108.3 N) in 18° taper cup (P < .01).Conclusion
Our results suggest that surgeon should be cautious about malseating of ceramic liner when using multi-bearing metal shell with inner taper angle of 10°.Clinical relevance
When surgeon use multi-bearing metal shell with inner taper angle of 10°, our results suggest that surgeon should be cautious about malseating of ceramic liner. 相似文献4.
Min Chen Zhengliang Luo Xiaofeng Ji Peng Cheng Guolin Tang Xifu Shang 《The Journal of arthroplasty》2017,32(1):131-138
Background
The direct anterior approach (DAA) for total hip arthroplasty (THA) is typically performed in the supine position using a specially designed operating room table, which makes this approach more accessible to orthopedic surgeons. We attempted to perform this procedure in the lateral decubitus position on an ordinary operation table to avoid dependence on a special operating room table. There is an obvious absence of literature regarding this subject.Methods
A total of 248 patients (295 hips) were recruited for primary THAs from July 1, 2014 to December 31, 2014. In total, 126 hips (42.7%) underwent THAs using the DAA in the lateral decubitus position. The technical feasibility and early results were evaluated.Results
The orientation of the acetabular component was 16.5° ± 4.9° anteversion and 43.3° ± 3.5° abduction. Intraoperative proximal femoral fracture occurred in one hip. The superficial wound complications occurred in 2 hips and the hematoma in one hip while in hospital. The lateral femoral cutaneous nerve injury was noted in 43 hips. The early dislocation occurred in 2 hips. Heterotopic ossification was Brooker class I in 5 hips and class II in 1 hip. No aseptic loosening, postoperative periprosthetic fracture, and deep infection occurred in our series.Conclusion
The DAA for THA in the lateral decubitus position may be a valuable alternative if the DAA in the supine position is difficult to implement owing to absence of a special operating room table. This technique also seems to provide satisfactory clinical and radiographic outcomes with an acceptable complication in our early follow-up. 相似文献5.
Emrah Kovalak Hanife Özdemir Cenk Ermutlu Abdullah Obut 《Acta orthopaedica et traumatologica turcica》2018,52(3):196-200
Objectives
The aim of this study was to evaluate how fatty atrophy (FA) of the hip abductors in operated and non-operated hips affected the functional outcome following arthroplasty.Methods
Forty-four hips of 22 patients (8 males and 14 females; mean age: 60?±?14.4 (range: 24–84)) who matched the inclusion criteria and willing to participate in the study were retrospectively evaluated. The mean follow-up was 13.8?±?2.3 (range: 10–18) months Magnetic resonance imaging (MRI) and Harris Hip Score (HHS) were used to evaluate muscle degeneration and functional outcome after unilateral THA through a posterolateral approach. The FA grade was evaluated using Goutallier grading system. Non-operated hips of subjects were used as the control. Age, duration after the operation, gluteal muscle FA, and the relationships with HHS were evaluated.Results
FA was more evident in the operated hip (p?<?0.05), and was more in the gluteus minimus than in the gluteus medius in both hips (p?<?0.05). Patients' age was not correlated with gluteal muscle FA in the operated hip (p?>?0.05), whereas there was a positive correlation with the contra-lateral hip (p?<?0.05). Duration after surgery did not affect gluteal muscle FA in the operated hip. Older age and FA of either the operated or healthy hip resulted in poorer HHS (p?<?0.05). HHS had the strongest correlations with patient age (p?<?0.001) and FA (p?=?0.026) of the gluteus minimus of contralateral hip.Conclusion
Following THA, there was marked FA in the operated hip compared to that in the contralateral hip. In these cases, degree of FA in the replaced hip did not correlate with patients' age. Fatty atrophy of the gluteus minimus precedes that of gluteus medius. FA of the contralateral gluteus minimus and patient age are strongly correlated with lower HHS. Level of evidence: Level IV, diagnostic study.Level of evidence
Level IV, diagnostic study. 相似文献6.
Hirofumi Oshima Sakae Tanaka Yoshio Takatori Takeyuki Tanaka Hisatoshi Ishikura Toru Moro 《The Journal of arthroplasty》2017,32(10):3065-3070
Background
We evaluated the clinical and radiographic outcomes, including femoral head penetration, of total hip arthroplasty performed using a specific polyethylene (PE) liner in small Asian patients at 10 years after the index surgery. In addition, we investigated whether femoral head penetration was affected by patient-related, implant-related, and surgical factors.Methods
Between August 2002 and June 2005, for cementless primary total hip arthroplasty, we used acetabular PE liners that were manufactured from GUR 1050 resin, machined from isostatic compression-molded bar stock, and sterilized with a gamma ray irradiation in argon gas. We assessed 82 hips in 78 patients who received these liners.Results
The mean Harris hip score improved from 41.0 preoperatively to 84.5 at 10 years postoperatively. Periprosthetic osteolysis was observed in 7 hips (9.8%). No acetabular component migration was detected, and no revision surgery was performed 10 years postoperatively. The mean steady-state wear rate was 0.031 mm/y, which was lower than the wear rate for other conventional PE liners of the previous studies. Among the patient-related, implant-related, and surgical factors, sex was significantly associated with the mean steady-state wear rate, with a higher rate in male patients than in female patients.Conclusion
PE acetabular liners used in small Asian patients show similar clinical outcomes and reduced wear compared with those of other liners. In addition, sex is significantly associated with the mean steady-state wear rate, and the steady-state wear rate is higher in male patients than in female patients. 相似文献7.
Jared S. Bookman Ian D. Kaye Kevin K. Chen Fredrick F. Jaffe Ran Schwarzkopf 《The Journal of arthroplasty》2017,32(8):2587-2589
Background
Short-term and intermediate-term wear rates for highly cross-linked polyethylene (HCLPE) liners in total hip arthroplasty (THA) are significantly lower than published rates for traditional polyethylene liners. The aim of this study was to report the longest-to-date follow-up of a specific HCLPE liner.Methods
A series of 35 THAs using a specific HCLPE liner were reviewed. Anteroposterior radiographs were reviewed for femoral head penetration, the presence of femoral and/or acetabular osteolysis, long-term survival, total wear, and wear rates in all patients.Results
The average patient age at time of surgery was 70 years with an average follow-up of 10 years (118 months; range, 7.2-13.4 years). The mean wear rate in our cohort was 0.07 mm/y. Total wear was 0.71 mm over the study period. No hips showed evidence of osteolysis in any zones. Survivorship at latest follow-up was 100% with all-cause revision as an end point.Conclusion
The wear rate of HCLPE liners continues to be lower than published wear rates for traditional polyethylene and continues to reaffirm the acceptably low wear rates using HCLPE acetabular liner in primary THA. 相似文献8.
Masanori Tsubosaka Shinya Hayashi Shingo Hashimoto Koji Takayama Ryosuke Kuroda Tomoyuki Matsumoto 《Journal of orthopaedic science》2018,23(4):671-675
Background
The Summit cementless stem has been used as a device to occupy the proximal medullary canal space in total hip arthroplasty (THA). The purpose of this study was to evaluate the mid-term clinical and radiographic results of the Summit stem and the differences in the results as a function of medullary cavity shape.Methods
This study analyzed the 90 consecutive patients who underwent THA by using the Summit cementless stem. The minimum clinical and radiographic follow-up period for the patients was 5 years (mean, 5.5 years; range, 5.0–7.1 years). The radiographic and Harris hip scores (HHS) were evaluated across the three Dorr type classifications of femoral bone.Results
The postoperative HHSs were significantly higher than the preoperative HHS scores (p < 0.05). No significant differences in preoperative and postoperative HHSs were found among the three Dorr types. Stress shielding was observed in 58 hips. Spot welds and cortical hypertrophy were observed in various zones in 53 and 11 hips, respectively. No significant difference in the number of occurrences of cortical hypertrophy was found among the three Dorr types. However, the number of occurrences of severe stress shielding in Dorr type C was higher than that in Dorr type B. The number of occurrences of spot welds in Dorr type C was lower than that in both Dorr types A and B.Conclusions
Mid-term clinical results were good regardless of the medullary cavity shape. However, severe stress shielding in Dorr type C was more frequently than that in Dorr type B. Therefore, attention should be paid to the types of medullary cavity shapes for Summit stem use. 相似文献9.
Jonathan G. Haw Andrew K. Battenberg Der-Chen T. Huang Thomas P. Schmalzried 《The Journal of arthroplasty》2017,32(4):1381-1386
Background
Cross-linked polyethylene (XLPE) has demonstrated significantly reduced wear and osteolysis into the second decade for total hip arthroplasty. There is a relative paucity of data with ≥36-mm bearings. Issues include potential effects of reduced liner thickness and component position on wear, osteolysis, and mechanical failure of the bearing.Methods
Radiographs of 48 primary total hip arthroplasties with ≥36-mm modular XLPE bearings were analyzed at a minimum 5 years postoperative on serial radiographs using a validated, edge-detection-based algorithm. Subgroups were examined to assess the effect of bearing diameter, liner thickness, acetabular abduction angle, and acetabular anteversion on XLPE wear.Results
There was no significant difference in volumetric wear when subgroups were stratified by component factors: liner thickness (<6.5 mm vs ≥6.5 mm) 40.69 mm3/y vs 24.47 mm3/y, respectively (P = .315); acetabular component abduction angle (<45° vs ≥45°): 38.68 mm3/y vs 27.8 mm3/y, respectively (P = .522); acetabular anteversion (<20° vs ≥20°): 41.32 mm3/y vs 31.79 mm3/y, respectively (P = .521). There were no dislocations, mechanical failures, or revisions. There were 7 hips with volumetric wear rates ≥80 mm3/y; 1 had possible osteolysis.Conclusion
Larger-diameter XLPE wear was not measurably affected by liner thickness, acetabular abduction angle, or acetabular anteversion. However, there is a trend for increasing volumetric wear with increasing bearing size. Wear outliers do occur, and continued follow-up of larger-diameter XLPE bearings is warranted. 相似文献10.
Stephen A. Jones 《The Journal of arthroplasty》2018,33(5):1331-1336
Background
Dislocation remains one of the most common complications after total hip arthroplasty. Constrained acetabular liners were developed to address the problem of recurrent instability. They have been in clinical use since the mid 1980s and function by capturing the femoral head.Method
The aim of this review is to highlight the mechanism of action, development, and advances in constrained liner design, together with an emphasis on the modes of failure and the authors' opinion on the current indications for the use of these implants.Results
A systematic review of the literature summarizes the current body of published evidence on the results of constrained liners. Overall, at best level III evidence is available. In the 38 studies included, this study considered a total of 2852 constrained liners with a mean follow-up 4.3 years (range 0.8-20 years), which had a mean dislocation and/or constrained failure rate of 11.4% (95% confidence interval 10.3-12.6).Conclusion
Constrained acetabular liners remain an important option in the armamentarium of the revision hip surgeon. At this point in time with current designs and published results, they should remain a salvage device. The implantation of a constrained liner should be considered when all other factors related to the total hip arthroplasty have been optimized, especially component malposition. 相似文献11.
Bo Liu Yu-Hang Gao Lu Ding Shu-Qiang Li Jian-Guo Liu Xin Qi 《The Journal of arthroplasty》2018,33(3):915-918
Background
We evaluated acetabular cup coverage (CC) and rim contact (RC) to evaluate the bone stock above the acetabulum for guiding acetabular component placement using the high hip center technique in patients with Crowe type III developmental dysplasia of the hip.Methods
Using hip computed tomography and image processing software, pelvises were reconstructed digitally in 20 hips with Crowe type III developmental dysplasia of the hip. Mimicked cup was placed with anteversion angles of 0° (group I), 5° (group II), and 10° (group III) respectively. In each group, the cup was placed at the anatomical hip center at first, and then the cup was moved up to 40 mm vertically about the native rotation center with an increment of 2.5 mm at each step. CC and RC were calculated and documented with each movement.Results
CC was 65.87%, 67.77%, and 68.98% for group I, group II, and group III at the native rotation center, and increased progressively to 86.45%, 85.85%, and 84.71% at 25 mm above. RC was 49.17%, 50.25%, and 51.92% for group I, group II, and group III at the native rotation center, and increased progressively to 86.87%, 86.39%, and 84.94% at 22.5 mm above. CC and RC were positively correlated, despite the different anteversion angles (r = 0.687 at 0°, 0.683 at 5°, and 0.645 at 10°; P < .001).Conclusion
Computed tomography analysis and computer stimulation demonstrate that it is feasible to use high hip center technique in Crowe type III hips. 相似文献12.
Huiwu Li Yao Yuan Jiawei Xu Yongyun Chang Kerong Dai Zhenan Zhu 《The Journal of arthroplasty》2018,33(3):794-799
Background
A number of methods for reduction in high hip dislocation in total hip arthroplasty (THA) are time-consuming and laborious, and require great surgical skills. This study aimed to introduce a new reduction technique to achieve rapid, safe, and easy reduction in high hip dislocation.Methods
We retrospectively reviewed 74 THA patients (82 hips; 44 women, 30 men) with severe hip dysplasia who underwent direct leverage using a Hohmann retractor into the anatomical acetabulum without femoral shortening osteotomy between September 2007 and January 2014. Forty-nine hips were classified as Crowe III and 33 hips were classified as Crowe IV. The mean follow-up period was 5.1 years (range 2-8).Results
Mean Harris Hip Score increased from 42.1 (range 24-71) before surgery to 89.9 (range 76-100) at final follow-up examination. The legs were lengthened by a mean of 3.0 cm (range 1.1-5.5) and 2.5 cm (range 1.1-3.5) in Crowe III hips and 3.6 cm (range 1.9-5.5) in Crowe IV hips postoperatively. The average leg-length discrepancy at the final follow-up examination was 0.4 cm (standard deviation 0.5 cm). One greater trochanteric fracture occurred during the hip reduction process. One patient developed femoral nerve palsies and recovered completely at 3 weeks postoperatively.Conclusion
Direct leverage using the Hohmann retractor for the reduction in high hip dislocation in THA without femoral shortening osteotomy is simple, safe, and effective. 相似文献13.
Michael A. Gaudiani Peter B. White Narges Ghazi Amar S. Ranawat Chitranjan S. Ranawat 《The Journal of arthroplasty》2018,33(2):590-594
Background
Bearing surface wear and osteolysis are major factors limiting the durability of total hip arthroplasty (THA). Second generation annealed highly cross-linked polyethylene (HXLPE) and ceramics were introduced to THA for their excellent wear rates. However, there is little data comparing the wear rates of metal and ceramic heads on second generation HXLPE.Methods
Sixty patients who received a noncemented THA with a 32- or 36-mm delta ceramic head were matched with 60 THAs with a 32- or 36-mm metal head based on gender, head size, follow-up, and University of California, Los Angeles activity score. Linear and volumetric wear rates were measured.Results
At mean 6-year follow-up, the mean linear wear rates were 0.012 mm/y (standard deviation [SD] 0.045; 95% confidence interval [CI] 0.001-0.024) and 0.018 mm/y (SD 0.025; 95% CI 0.012-0.025) for the ceramic and metal groups, respectively (P = .724). The mean volumetric wear rates for the ceramic and metal head groups were 11.9 (SD 43.0; 95% CI 0.7-23.0) and 17.3 (SD 23.9; 95% CI 11.1-23.4), respectively. No significant differences were detectable in either the mean linear or volumetric wear rates (P = .380 and P = .398, respectively).Conclusion
Second generation HXLPE had low wear rates and we were unable to detect a significant difference in wear rates with 32- or 36-mm metal and ceramic heads. We believe that this is due to the excellent tribological properties of second generation HXLPE. We continue to use ceramic as standard of care because of issues of trunnionosis with metal heads. 相似文献14.
Jean Y. Lazennec Frederic Thauront Christopher B. Robbins Aidin E. Pour 《The Journal of arthroplasty》2017,32(11):3550-3556
Background
Although most hip dislocations occur in either standing or sitting position, the safe zone for implant position is defined for the supine position. Our goal was to determine preoperative and postoperative pelvis and hip orientations and whether the safe zone defined in supine position can be used to assess standing radiographs.Methods
Preoperative and postoperative three-dimensional EOS images were assessed in 66 total hip arthroplasty patients. None of the patients had dislocation within the follow-up period (12-36 months). The acetabular anteversion (both anterior pelvic plane [APP] and patient functional plane) and the femoral anteversion were measured. The sacral slope, pelvic version, pelvic inclination, and pelvic incidence were also measured.Results
Acetabular anteversion increased postoperatively in both APP and patient functional plane (P <.001). Femoral neck anteversion decreased postoperatively (P =.0942). Sacral slope was 42.4° (?25.9° to 24°) preoperatively compared with 40.3° (?4.1° to 64.2°) postoperatively (P =.013). Pelvic version changed from 15.2° (?10.4° to 43.8°) to 17.2° (?6° to 46.7°; P = 0.008). Pelvic inclination was 1.12° (?25.9° to 24°) before total hip arthroplasty and ?1.2° (?40.7° to 23.4°) postoperatively (P =.005).Conclusion
The acetabular and femoral implant orientations in standing position reside out of the safe zone in most patients. The APP is not vertical in standing position in most patients due to anterior or posterior pelvic tilt. The proposed safe zone in supine position may not be a useful measure in the assessment of standing radiographs of patients with significant anterior or posterior pelvic tilt.Level of Evidence
Level IV, therapeutic case series study. 相似文献15.
Xin Y. Mei Ibrahim S. Alshaygy Oleg A. Safir Allan E. Gross Paul R. Kuzyk 《The Journal of arthroplasty》2018,33(7):2050-2056
Background
Controversy remains over the surgical management of large osteochondral lesions of the femoral head in young, active patients. The purpose of this study is to assess midterm clinical and radiographic outcomes after fresh osteochondral allograft transplantation (OAT) for large femoral head lesions at minimum 2-year follow-up.Methods
A retrospective review of prospectively collected data was performed for 22 patients under the age of 50 years with defined femoral head osteochondral lesions who underwent fresh OAT between 2008 and 2015. Patients were assessed clinically using the modified Harris Hip Score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and Kellgren & Lawrence Grade for osteoarthritis severity. Complications and reoperation were assessed by chart review. Kaplan-Meier survivorship analyses with 95% confidence intervals were performed for the end point of conversion to total hip arthroplasty.Results
At a mean follow-up of 68.8 months (26-113), the mean mHHS improved significantly (P < .001) from 48.9 (19-84) to 77.4 (35-98). Sixteen of 22 patients (72.7%) had an mHHS ≥70 at the latest follow-up. Arthritic progression, as indicated by an increase in the Kellgren & Lawrence Grade, occurred in 4 of 22 hips (18.2%). Five patients (22.7%) underwent conversion to total hip arthroplasty. Graft survivorship was 86.4 ± 7.3% at 2 years, 78.5 ± 10.0% at 5 years, and 67.3 ± 13.5% at 9 years.Conclusion
Fresh OAT may be a viable treatment option for osteochondral defects of the femoral head in young, active patients with minimal preexisting joint deformity. 相似文献16.
Taiki Kusano Taisuke Seki Yoshitoshi Higuchi Yasuhiko Takegami Yusuke Osawa Naoki Ishiguro 《The Journal of arthroplasty》2018,33(6):1764-1769
Background
Few studies have reported risk factors for stress shielding. We sought to evaluate clinical and radiographic outcomes of a proximally hydroxyapatite-coated straight tapered titanium femoral component stem during a minimum 5-year follow-up and identify factors associated with high-degree stress shielding.Methods
A total of 156 total hip arthroplasties (n = 124; 98 women and 26 men; mean age, 56.5 years) with a minimum follow-up period of 5 years were included in the study. Clinical and radiologic measurements at follow-up (range, 5-16.3 years; mean, 10.2 years) were analyzed.Results
The mean preoperative Harris Hip Score (HHS) was 56.6, and the mean HHS at the latest follow-up was considerably improved at 86.8. Stress shielding at the latest follow-up was low degree in 136 (87%) hips and high degree in 20 (13%) hips. On average, high-degree stress shielding occurred 9.9 years (5-14 years) after surgery. The results of Cox proportional hazard analysis showed that a canal bone ratio ≥ 0.49 was an independent risk factor for high-degree stress shielding (P = .0075; hazard ratio, 3.981). HHS at the latest follow-up was significantly lower in high-degree stress shielding than in low-degree stress shielding (80.7 and 87.7, respectively; P = .0030).Conclusion
Preoperative canal bone ratio ≥ 0.49 is independently associated with high-degree stress shielding. In addition, the number of cases with high-degree stress shielding significantly increased over time during a mean 10-year follow-up. 相似文献17.
Kensuke Yoshino Tadashi Tsukeoka Yoshikazu Tsuneizumi Tae Hyun Lee Junichi Nakamura Masahiko Suzuki Seiji Ohtori 《The Journal of arthroplasty》2017,32(11):3495-3501
Background
Bone deficiency in revision total hip arthroplasty is a surgical challenge. The Murata-Chiba cup supporter (MC support ring) is an acetabular component supporter for a cementless porous-coated cup. The purpose of this study is to examine the clinical and radiographic outcomes of reconstruction of acetabular bone deficiency using iliac autografts supported by an MC support ring in a revision setting with minimum 15-year follow-up.Methods
Fifty-nine consecutive revision total hip arthroplasties (57 patients) using the MC support ring were followed for a minimum of 15 years. Nine hips had American Academy of Orthopaedic Surgeons type II deficiency and 24 had type III defects of the acetabulum. Clinical outcomes were evaluated using the Harris hip score. Radiographic evaluation included assessment for loosening and bone graft incorporation. Kaplan-Meier survival analysis was performed.Results
At a minimum 15-year follow-up (mean, 17.6 years), 32 patients (33 hips) were alive, 17 patients (18 hips) were deceased, and 8 patients (8 hips) were lost to follow-up. The mean Harris hip score improved from 44.3 to 77.2 at final follow-up. Four hips required reoperation due to deep infection (2 hips) and liner dissociation (2 hips), but no acetabular components were revised for aseptic loosening. Incorporation of the bone graft occurred in all cases. One unrevised patient had radiographic failure. Survivorship at 15 years with re-revision or radiographic failure as the end point was 90.6% (95% confidence interval, 83.0%-98.8%).Conclusion
The reconstruction of acetabular bone deficiency using autografts supported by an MC support ring provided satisfactory clinical and radiological results at 17.6 years postoperatively. 相似文献18.
Keisuke Akiyama Katsuya Nakata Makoto Kitada Mitsuyoshi Yamamura Hajime Owaki Takeshi Fuji 《The Journal of arthroplasty》2018,33(2):415-422
Background
Internal rotation of the hip and lateral patellar tilt increases after total hip arthroplasty (THA). However, it remains unknown whether these parameters change with time after the index THA.Methods
A total of 91 patients undergoing 2-stage bilateral primary THAs between January 2008 and May 2014 were included to assess the association of chronological changes in internal rotation of the hip or lateral patellar tilt with anthropometric and perioperative parameter and changes in alignment after the index THA. Chronological changes were assessed as changes between postoperative computed tomography on the index surgery and the preoperative computed tomography on the contralateral THA. Internal rotation of the hip was defined as the angle between the posterior intercondylar line and a line passing through the posterior inferior iliac spines. Lateral patellar tilt was defined as the angle between the posterior intercondylar line and a line joining the medial and lateral edges of the patella.Results
Internal rotation of the hip and lateral patellar tilt changed until 2 years after the index surgery by a mean of ?2° (range ?17.3° to 17.7°) and ?2° (range ?18.2° to 5.3°), respectively. Adductor tenotomy was associated with increasing internal rotation of the hip with time (adjusted R2 0.076); leg lengthening and larger preoperative femorotibial angle were associated with decreasing lateral patellar tilt with time (adjusted R2 0.159).Conclusion
Both internal rotation of the hip at rest and lateral patellar tilt decreased by approximately 2° until 2 years after surgery and there was a large variation in chronological change. 相似文献19.
Ting-Xian Ling Jin-Long Li Kai Zhou Qiang Xiao Fu-Xing Pei Zong-Ke Zhou 《The Journal of arthroplasty》2018,33(2):453-459
Background
Given the lack of studies of acetabular defect reconstruction in primary total hip arthroplasty (THA) using tantalum augments, this study aims to evaluate clinical and radiographic results for treatment with tantalum augments to reconstruct acetabular defects in primary THA.Methods
We retrospectively reviewed 19 patients (19 hips) with acetabular defects who underwent primary THA using tantalum augments, with a minimum follow-up of 2 years. Clinical, radiographic, and surgical data were retrospectively evaluated.Results
Mean follow-up was 5.1 years (range 2.5-7.6). Harris Hip Score improved from 35.8 (range 19-56) preoperatively to 85.3 (63-98) at last follow-up (P < .01). Oxford Hip Score, University of California Los Angeles activity scale, and Short Form-12 score also improved significantly from presurgery to last follow-up. Mean operation time and blood loss were 124.7 minutes and 530 mL, respectively. Mean hip center position was 2.97 cm (range 2.35-3.58) horizontally and 2.06 cm (1.29-2.92) vertically, and mean acetabular inclination was 38.9° (range 27°-47°) at last follow-up. These parameters were not significantly different from those recorded immediately postoperatively (P > .05). There was no aseptic loosening, cup and augment migration, screw breakage, or presence of hip infection at last follow-up. All hips were radiographically stable.Conclusion
Porous tantalum augments combined with titanium shells lead to satisfactory clinical and radiographic outcomes for the reconstruction of acetabular defect in primary THA at a mean 5.1 years of follow-up. This approach confers anatomical cup placement, simple operation, and a high rate of stable fixation. 相似文献20.
Melissa C. Soderquist Ryan Scully Anthony S. Unger 《The Journal of arthroplasty》2017,32(9):2748-2754