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1.
Koh KH Moon YW Lim SJ Lee HI Shim JW Park YS 《Archives of orthopaedic and trauma surgery》2011,131(11):1591-1600
Introduction
Revision surgery in patients showing polyethylene wear and acetabular osteolysis without visible acetabular cup loosening involves the difficult decision of whether to revise only the liner or both the cup and the liner. The purpose of this study is to compare the outcomes of complete acetabular revision and isolated liner exchange in patients showing wear and osteolysis without loosening. 相似文献2.
Todd C. Moen MD Raju Ghate MD Noel Salaz BA Jason Ghodasra BA S. David Stulberg MD 《Clinical orthopaedics and related research》2011,469(2):382-386
Background
Aseptic osteolysis has been the single most important factor limiting the longevity of a THA. A great deal of attention has been focused on the development of implants and materials that minimize the development of osteolysis. The monoblock porous tantalum acetabular cup was designed to minimize osteolysis, but whether it does so is unclear. 相似文献3.
Nadim James Hallab Marco Caicedo Alison Finnegan Joshua J Jacobs 《Journal of orthopaedic surgery and research》2008,3(1):1-11
Introduction
Many kind of hydroxyapatite-coated cups were used, with favorable results in short term studies; it was supposed that its use could improve osteointegration of the cup, enhancing thus stability and survivorship. The purpose of this study is to analyze the long term behavior of the hemispheric HA coated, Dual Radius Osteonics cup and to discuss the way of failure through the exam of the revised components and of both periacetabular and osteolysis tissue.Materials and Methods
Between 1994 and 1997, at the Department of Orthopedic Sciences of the Insubria University, using the posterolateral approach, were implanted 276 Dual Radius Osteonics® in 256 patients, with mean age of 63 years.Results
At a mean follow-up of 10 years (range 8–12 years), 183 cups in 165 patients, were available for clinical and radiographical evaluation. 22 Cups among the 183 were revised (11%). The cause of revision was aseptic loosening in 17 cases, septic loosening in one case, periprosthetic fracture in another case, osteolysis and polyethylene wear in two cases and, finally, recurrent dislocations in the last one. In the remaining patients, mean HHS increased from a preoperative value of 50,15 to a postoperative value of 92,69. The mean polyethylene wear was 1,25 mm (min. 0,08, max. 3,9 mm), with a mean annual wear of 0,17 mm. The mean acetabular migration on the two axis was 1,6 mm and 1,8 mm. Peri-acetabular osteolysis were recorded in 89% of the implants (163 cases). The cumulative survivorship (revision as endpoint) at the time was 88,9%.Conclusion
Our study confirms the bad behavior of this type of cup probably related to the design, to the method of HA fixation. The observations carried out on the revised cup confirm these hypotheses but did not clarify if the third body wear could be a further problem. Another interesting aspect is the high incidence of osteolysis, which are often asymptomatic becoming a problem for the surgeon as the patient refuses the possibility of a revision. 相似文献4.
Purpose
The treatment strategy for pelvic osteolysis with a well-fixed acetabular component after total hip arthroplasty (THA) involves replacing the acetabular cup liner and femoral head, débriding osteolytic lesions, and grafting. 相似文献5.
Yasuharu Nakashima Taishi Sato Takuaki Yamamoto Goro Motomura Masanobu Ohishi Satoshi Hamai Mio Akiyama Masanobu Hirata Daisuke Hara Yukihide Iwamoto 《Journal of orthopaedic science》2013,18(6):962-968
Purpose
The purpose of this study was to report results at a minimum of 10 years for hydroxyapatite (HA) coating on the titanium arc-sprayed cementless total hip arthroplasty (THA) and to evaluate the impact of cross-linked polyethylene (XLPE) on implant longevity.Methods
A total of 131 consecutive primary THAs in 123 patients using an AMS acetabular cup and a PerFix HA stem were retrospectively reviewed. Conventional PE was used for 62 hips (CPE group) and cross-linked PE for 69 hips (XLPE group), with mean follow-up periods of 13 and 11.5 years, respectively. These patients were reviewed using the Japanese Orthopaedic Association (JOA) Hip Score and evaluated in terms of PE wear, osteolysis, and implant survival.Results
The JOA score improved from 42.6 to 83.9 points at the final follow-up. The mean wear rate of 0.12 mm/year in the CPE group was significantly greater than that of XLPE at 0.007 mm/year. In the CPE group, ten (16.1 %) and two (3.2 %) hips, respectively, underwent PE exchange due to severe wear and acetabular revision due to loosening associated with osteolysis. Three patients had revision in the XLPE group: one cup for aseptic loosening, one PE for recurrent dislocation, and one stem for neck fracture. No evident osteolysis was seen in the XLPE group. Kaplan–Meier survivorship with any revision as the end point shows that the 12-year survival rate was 97.7 % for cups, 93.8 % for PE liners, and 99.2 % for stems. Multivariate analysis revealed that the use of XLPE significantly reduced the risk of revision, with the odds ratio (OR) of 4.3.Conclusions
AMS and PerFix HA components in this series show excellent implant fixation; however, high rates of PE wear and subsequent osteolysis were limiting factors in long-term success. Low wear rates with XLPE suggest improved implant longevity. 相似文献6.
Background
Options to treat patients with wear or osteolysis include full revision, partial (tibial or femoral) revision, and isolated polyethylene exchange. It is unclear whether one choice is superior to the other. Polyethylene quality reportedly influences the survivorship of primary TKA, but similar reports are not described for revision TKA. 相似文献7.
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Kyu-Tae Hwang Young-Ho Kim Yee-Suk Kim Il-Yong Choi 《Archives of orthopaedic and trauma surgery》2012,132(12):1789-1796
Purpose
The long-term results of a bipolar hemiarthroplasty (BHA) for osteonecrosis (ON) of the femoral head have not been favorable. The causes have been attributed to cup migration and osteolysis or groin pain. The purpose of this study was to analyze the long-term outcomes and the survivorships of bipolar hemiarthroplasty applied to Ficat stage III ON.Materials and methods
Between 1985 and 1993, 49 patients (63 hips) underwent cementless BHA for Ficat stage III ON. Of these 49 patients, 43 patients (55 hips) of mean age 42.2?years were available for follow-up review at a mean duration of 20.3?years post operation. Anteroposterior hip serial (including extreme abduction/adduction) radiographs were used to evaluate osteolysis, migration, cartilage wear rate, and the ratio of outer/inner bearing motion (O/I ratio) at the latest follow-up.Results
The mean Harris hip score improved to 80.8 points at the latest follow-up. Survivorship at 24?years was 79 and 69?% with revision for any reason and development of acetabular osteolysis as the end point. Groin pain was present in 20 (36.4?%) of the 55 hips, and isolated groin pain was not a reason for revision. The patients had revision surgery performed, which showed that the cartilage wear rate was significantly high, and that the O/I ratio was significantly low (p?<?0.05).Conclusion
Survivorship determined in this study was more favorable than that of previous studies, and exceeded expectation. The BHA for Ficat stage III ON is not reliable option anymore, considering low survival rate and high osteolysis developmental rate. 相似文献10.
Philippe Hernigou Xavier Roussignol Jerome Delambre Alexandre Poignard Charles-Henri Flouzat-Lachaniette 《Clinical orthopaedics and related research》2015,473(12):3762-3769
Background
Dislocation is a common complication after total hip arthroplasty (THA). Although the etiology of dislocation is multifactorial, longer-term changes in muscle such as atrophy may influence the risk of prosthetic dislocation. Biological differences in wear products generated by different bearing surfaces may influence differences in the appearance of periarticular muscle after THA; however, such bearing-associated differences to our knowledge have not been studied in vivo, and few studies have evaluated bearing-associated differences in dislocation risk.Questions/purposes
(1) Is there a correlation between the postoperative risk of dislocation at revision and the bearing surfaces of the primary arthroplasty? (2) Is there a higher extent of fatty muscle atrophy on CT scan in hips with osteolysis (polyethylene hips) as compared with hips without osteolysis (ceramic-on-ceramic hips)? (3) Are these two abnormalities (bone osteolysis and fatty atrophy) associated with a decrease of mesenchymal stem cells (MSCs) in bone and in muscle?Methods
We retrospectively evaluated 240 patients (240 hips) who had a THA revision (98% of which, 235 of the 240, were isolated acetabular revisions) and a normal contralateral hip. All patients had received the same implants for the primary arthroplasty (32-mm head) except for bearing surfaces (80 hips with ceramic-on-ceramic, 160 with polyethylene). No differences were noted between the groups in terms of age, sex, body mass index, proportion of patients who had a dislocation after the index arthroplasty but before the revision, and proportion of the patients with stem loosening in addition to acetabular loosening. Indications for revision generally were cup loosening. The revisions in the hips with polyethylene bearings generally had more acetabular bone loss, but the position of the center of the cup and the orientation of the cup were similar after reconstruction in the two groups. Before revision, osteolysis, muscle atrophy, and fatty degeneration were evaluated on CT scan and compared with the contralateral side. Bone muscle progenitors were evaluated by bone marrow MSCs and satellite cells for muscle. At revision, all the hips received the same implants with the same head diameter (32 mm) and a standard liner. Revisions were performed between 1995 and 2005. The followup after revision was at a mean of 14 years (range, 10–20 years) for ceramic revision and 12 years (range, 10–20 years) for polyethylene hips, and there was no differential loss to followup between the groups.Results
More hips with polyethylene liners at the time of index arthroplasty dislocated after revision than did hips with ceramic liners (18% [29 of 160] compared with 1% [one of 80]; odds ratio, 17.5; 95% confidence interval, 2.3363–130.9100; p = 0.005). For the 80 hips with ceramic-on-ceramic, no osteolysis was detected before revision; there was no muscle fatty degeneration of the gluteus muscles on CT scan or histology. For the 160 hips with polyethylene liners, osteolytic lesions on the acetabulum and femur were observed in 100% of the hips. The increased atrophy of the gluteus muscles observed on CT scan correlated with the increase of osteolysis (r = 0.62; p = 0.012). The surgical limbs in the patients with polyethylene hips as compared with ceramic-on-ceramic hips demonstrated a greater reduction in cross-sectional area (respectively, 11.6% compared with 3%; odds ratio, 3.82; p < 0.001) and radiological density (41% [14.1/34.1] compared with 9%; odds ratio, 6.8; p = 0.006) of gluteus muscles when compared with the contralateral normal side. (41% compared with 9%; odds ratio, 6.8; p = 0.006).Conclusions
Ceramic bearing surfaces were associated with fewer dislocations after revision than polyethylene bearing surfaces. The reasons of the lower rate of dislocation with ceramic-on-ceramic bearings may be related to observed differences in the periarticular muscles (fat atrophy or not) with the two bearing surfaces.Level of Evidence
Level III, therapeutic study. 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.
Enrico Bonicoli Nicola Piolanti Lorenzo Andreani Paolo Parchi Michele Lisanti 《European orthopaedics and traumatology》2013,4(1):9-14
Background
Acetabular cup loosening is the primary reason of revision in total hip arthroplasty; this usually occurs as a result of implant fixation failure. There are a variety of surgical hardware and strategies available to address this problem that is one of the most challenging circumstances in hip surgery. The purpose of this prospective nonrandomized study is to present our preliminary results in the Ist Orthopaedic and Traumatology Unit of Pisa University with Regenerex? revision shell.Methods
Regenerex? revision shell is a porous titanium construct optimized for vascularized osteogenesis and designed to accept a cemented all-poly cup. If the bone defects were less than GIR IV or Paprosky type III, the Regenerex? revision shell was consecutively used, and at the end of December 2011, this shell was placed in 33 patients. In this study, we identified 28 cases with a minimum follow-up of 12 months; the mean interval from surgery to evaluation was 25 months; we performed clinical, functional, and radiologic evaluations.Results
The mean Harris hip score was >83 while the mean Western Ontario and McMaster Universities Osteoarthritis Index score was >75. In five cases, postoperative radiolucent lines were present. No signs of osteolysis were noted around the screws, and none of the 28 cups was thought to be loose.Conclusions
This preliminary report is to our knowledge the first one to be published about clinical and radiological results on Regenerex? revision shell. Our results are promising, but we need further investigations in order to obtain more data about this material in revision surgery. 相似文献13.
Jeong Joon Yoo Hyeong Jo Yoon Pil Whan Yoon Young-Kyun Lee Hee Joong Kim 《Archives of orthopaedic and trauma surgery》2013,133(3):413-419
Purpose
In an alumina-on-alumina total hip arthroplasty (THA), recommended with a small inclination angle <45°, the acetabular component (cup) may be positioned more medially to be covered almost completely by host bone. The purpose of this study was to identify the correlating factors and to evaluate the outcomes of medial placement of the cup in patients with alumina-on-alumina THAs.Methods
Using the propensity score matching with age, gender, body mass index, initial diagnosis, and the length of follow-up as variables, 38 hips with a medialized cup and 38 hips with a non-medialized one were identified from 389 hips in 347 who patients underwent primary alumina-on-alumina THA and followed up for more than 7 years. Clinical and radiological outcomes were compared between the two groups.Results
Preoperative acetabular medial wall thickness and the cup inclination angle were significantly smaller in the medialization group compared to the non-medialization group. Center edge angle, cup size, and coverage by host bone were not significantly different between the two groups. The hip center of rotation was significantly medialized in the medialization group. The Harris hip scores were not significantly different between the two groups. No component loosening or osteolysis was observed and no revision was required in either groups.Conclusions
Thin acetabular medial wall and a small inclination angle of the cup were the correlating factors of medial placement of the cup in patients who underwent an alumina-on-alumina THA. Medial placement did not lead to differences in the clinical or radiological outcomes. 相似文献14.
John J. Callaghan MD Eric R. Reynolds Nicholas T. Ting BA Devon D. Goetz MD John C. Clohisy MD William J. Maloney MD 《Clinical orthopaedics and related research》2011,469(1):154-159
Background
Liner exchange and bone grafting are commonly performed for wear and osteolysis around well-fixed modular acetabular components that otherwise would require structural allografting and revision THA. However, liner exchange in the face of substantial lysis around TKA has been performed rarely with reports of failure rates of up to 25% at 3 year followup. 相似文献15.
Jun-Dong Chang In-Sung Kim Sharad Prabhakar Sameer A. Mansukhani Sang-Soo Lee Je-Hyun Yoo 《The Journal of arthroplasty》2017,32(5):1576-1580
Background
The purpose of the study was to evaluate the implant positions and clinical results of revision total hip arthroplasty (THA) using an imageless navigation with the concept of combined anteversion.Methods
A total of 40 cementless revision THAs (24 men and 16 women) using an imageless navigation with the concept of combined anteversion were retrospectively evaluated. The concept of combined anteversion was applied in cup positioning based on Widmer's equation (cup anteversion + 0.7 × stem anteversion). The mean follow-up period was 80.7 months. Postoperatively, the inclination of the cup was evaluated on standard anteroposterior view of the radiograph, and the anteversion of the cup and femoral stem was evaluated using computed tomography scan. A cup inclination of 40° ± 10° and combined anteversion of the cup and femoral stem of 37° ± 10° based on Widmer's equation were regarded as the “safe zone.”Results
The average anteversion of the revised femoral stems was 15.3° ± 2.9° (range, 9.5°-21.5°), whereas that of the remained femoral stems was 17.4° ± 9.7° (range, 4.2°-29.8°). The inclination, anteversion of the cup, and combined anteversion after revision THA were 42.3° ± 3.1° (range, 32.1°-48.2°), 25.0° ± 2.9° (range, 16.9°-29.5°), and 36.1° ± 3.4° (range, 27.2°-42.9°), respectively. Therefore, the position of the implants, relative to the safe zone, showed no outliers after the revision surgery. Neither dislocation nor osteolysis was observed after the surgery.Conclusion
Favorable results of this study indicate that imageless navigation helps the surgeon in placing the components of revision THA in the safe zone. This study also shows that when this safe zone is consistently obtained, then no postoperative dislocations were observed in these patients over the 6-year follow-up period. 相似文献16.
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Panagiotis Korovessis Thomas Repantis Andreas Zafiropoulos 《Archives of orthopaedic and trauma surgery》2011,131(5):603-611
Background and purpose
The Zweymüller-Plus system (SL-Plus stem, Bicon-Plus threaded cup) for primary total hip arthroplasty (THA) was introduced in 1993, as a successor of the Alloclassic THA with a few modifications in the conical stem shape and a new biconical threaded cup with a spherical shape. The medium-term performance of this system is not well established. To better understand the potential impact these design changes have had on (1) survivorship, (2) implant stability and (3) periprosthetic osteolysis, we studied patients who underwent THA using the SL-Plus stem and Bicon-Plus. 相似文献19.
Katsufumi Uchiyama Naonobu Takahira Kensuke Fukushima Takeaki Yamamoto Mitsutoshi Moriya Moritoshi Itoman 《Journal of orthopaedic science》2010,15(6):764-771
Background
In revision total hip replacement (THR), cages and rings are commonly used for the reconstruction of bone defects that are due to mechanical loosening of the acetabular cup and migration of the femoral head prosthesis. The purpose of this study was to evaluate the radiological results of the use of Ganz reinforcement rings with bone allografts in acetabular revision THR. 相似文献20.
Kar H. Teoh Robert D.J. Whitham David M. Golding Jenny F. Wong Paul Y.F. Lee Aled R. Evans 《The Journal of arthroplasty》2018,33(2):460-463