Total hip arthroplasty for tuberculous coxarthrosis

Forty-four total hip prostheses were implanted in thirty-eight patients who had tuberculous arthritis of the hip. The interval between active disease and total hip arthroplasty ranged from three months to forty-five years. The length of follow-up averaged 45.6 months (range, twenty-four to eighty-five months). Cultures of material and specimens of tissue that were taken intraoperatively were positive in four hips. The mean functional rating of the hip was 62 points preoperatively and 85 points at final follow-up. Thirty-one patients had a good result; one had to have a revision because of loosening of a component. Six patients had reactivation of the disease that was controlled satisfactorily by chemotherapy alone or in combination with débridement of sinus tracts without removal of the prosthesis. There was a major difference in the percentage of recurrences in patients who had inactive disease for less than ten years (six of fifteen patients) compared with those who had inactive disease for more than ten years (no patients). Total hip arthroplasty appears to be a safe procedure for patients who have quiescent tuberculosis as well as for patients who have active tuberculosis of the hip when there is no gross evidence of active infection.     

Hip arthroplasty in coxarthrosis secondary to Paget's disease

A total of 5 hip arthroplasties implanted between 1997 and 2000 in 5 patients affected with coxarthrosis secondary to Paget's disease were reviewed. The quality of the pagetic bone (sclerotic and very vascularized) resulted in a slightly longer amount of time required for surgery because of the difficulty preparing prosthetic placement and intra- and postoperative blood loss exceeding the norm. Complications were not observed. Clinical results were good in 100% of cases. Radiographically, 2 stems were assembled in varus.     

Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis

We studied the perioperative blood loss in 100 total hip arthroplasties performed for rapidly destructive coxarthrosis and compared it with the blood loss in 100 total hip arthroplasties for regular coxarthrosis. The treatment protocol was identical in both groups. Total blood loss was calculated as the compensated blood loss (volume transfused during and immediately after surgery) and the non-compensated blood loss using Nadler and Mercuriali formula. The mean blood loss calculated in milliliters of red blood cells (100% haematocrit) was 578 ml in regular coxarthrosis and 945 ml in rapidly destructive coxarthrosis. The blood loss after total hip arthroplasty is greater when surgery is performed for rapidly destructive coxarthrosis than for regular coxarthrosis (P < 0.001).     

Periarticular heterotopic ossification after total hip arthroplasty for primary coxarthrosis

Periarticular heterotopic ossification (PHO) is a common roentgenographic finding, occurring in more than two-thirds of patients after total hip arthroplasty (THA) for coxarthrosis. In the present study, 56 patients treated with bilateral THA were analyzed to determine the correlation between heterotopic ossification on the two sides. A strong correlation was found between the grade of PHO on the two sides: patients who developed severe PHO after the first THA invariably developed considerable PHO after surgery on the other side. The incidence and grade of PHO were higher in men than in women.     

Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis

Heterotopic bone formation was investigated in 392 Charnley low-friction total hip arthroplasties. A multivariate linear regression analysis was used to account for the influence of co-variables: sex, age at surgery, postoperative treatment with antiinflammatory drugs during at least the first 2 weeks, and previous ipsilateral hip surgery. A total of 232 hips had been treated for primary coxarthrosis, and 114 and 46 hips for secondary coxarthrosis due to congenital dislocation and fracture-dislocation of the hip, respectively. None of the hips with primary coxarthrosis previously had ipsilateral hip surgery, whereas 41 hips (36%) in patients with congenital dislocation of the hip and 28 hips (61%) in patients with fracture-dislocation of the hip had one or more ipsilateral surgical procedures prior to the arthroplasty. The sex ratio varied between the groups, with a male:female hip ratio of 1:1, 1:10, and 3:1 for the three groups, respectively. The risk of developing grades 2 or 3 heterotopic ossification after total hip arthroplasty were significantly higher in men, patients without postoperative treatment with antiinflammatory drugs, and patients above age 60. In contrast, the analysis documented that previous ipsilateral hip surgery and type of coxarthrosis did not influence lesion development, supporting the theory that a systemic, rather than local factor, is responsible for the development of heterotopic bone formation after total hip arthroplasty.     

Overweight predisposes to coxarthrosis. Body-mass index studied in 239 males with hip arthroplasty

In a case-control study, body-mass index (BMI) at aged 20, 30, 40, and 50 years was studied in 239 men who had just received a hip prosthesis because of coxarthrosis and in 302 controls randomly selected from the general population. Information about weight, occupational physical load, sports activities, smoking, and many other factors was self-reported in a questionnaire. Men with a BMI greater than the mean BMI + 1 SD had an increased relative risk of developing severe coxarthrosis as compared with men with a BMI less than the mean BMI -1 SD. Those slightly obese at the aged 40 years had a relative risk of 2.5 for later surgery of the hip.     

Prevalence of primary coxarthrosis in siblings of patients with primary coxarthrosis

The prevalence of primary coxarthrosis was investigated in 289 siblings of 184 patients treated by total hip replacement. Age and sex-matched persons from the city files of Malm?, Sweden, were selected as controls. The prevalence of presenting symptoms (initiating a hip roentgen examination) of primary coxarthrosis in the siblings was 8%, compared to 3.8% in the controls (p less than 0.05). The type and localization of primary coxarthrosis was evenly distributed between the two groups. Conversely, the prevalence of gonarthrosis did not differ between the two groups. The prevalence of primary coxarthrosis in the siblings suggests the influence of a hereditary factor in the etiology of primary coxarthrosis.     

Microfractures in coxarthrosis

We examined the subchondral bone architecture of the femoral head in relation to trabecular microfracture. Three groups of femoral head specimens were studied. Twenty-eight specimens taken during hip replacement had grade III or IV arthrosis (70 × 8 years). From autopsy, 40 femoral heads were obtained, 18 in a group greater than 50 years of age (72 × 10 years) and 22 in a group less than 50 years of age (25 × 11 years). None of these 40 heads had worse than grade II arthrosis. Coronal slices of the femoral heads were macerated and examined under a dissecting microscope to count trabecular microfractures. For bone histomorphometry, blocks were taken from the subchondral principal compressive and tensile trabeculae. The bone volume, trabecular thickness, and marrow space were quantified. In the subchondral principal compressive region, the arthrotic group had more bone volume, thicker trabeculae, similar trabecular space, and trabecular microfractures when compared with the group greater than 50 years old. In the tensile region, there were no differences except for decreased trabecular microfracture number in the arthrotic group. With the thinnest trabeculae in the compressive region occurring in the greater than 50 years old group, the trabeculae of the younger age group have thinned with age, but with the onset of arthrosis, the thinning is overtaken by pathologic thickening of trabeculae.     

Microfractures in coxarthrosis

We examined the subchondral bone architecture of the femoral head in relation to trabecular microfracture. Three groups of femoral head specimens were studied. Twenty-eight specimens taken during hip replacement had grade III or IV arthrosis (70 +/- 8 years). From autopsy, 40 femoral heads were obtained, 18 in a group greater than 50 years of age (72 +/- 10 years) and 22 in a group less than 50 years of age (25 +/- 11 years). None of these 40 heads had worse than grade II arthrosis. Coronal slices of the femoral heads were macerated and examined under a dissecting microscope to count trabecular microfractures. For bone histomorphometry, blocks were taken from the subchondral principal compressive and tensile trabeculae. The bone volume, trabecular thickness, and marrow space were quantified. In the subchondral principal compressive region, the arthrotic group had more bone volume, thicker trabeculae, similar trabecular space, and trabecular microfractures when compared with the group greater than 50 years old. In the tensile region, there were no differences except for decreased trabecular microfracture number in the arthrotic group. With the thinnest trabeculae in the compressive region occurring in the greater than 50 years old group, the trabeculae of the younger age group have thinned with age, but with the onset of arthrosis, the thinning is overtaken by pathologic thickening of trabeculae.     

The overall mortality rate in patients with total hip arthroplasty, with special reference to coxarthrosis

The mortality rate was calculated in 1385 patients with total hip arthroplasties compared with the population at risk in the period from 1968 to 1981. In elderly women with coxarthrosis, after the age of 70, the mortality rate decreased after the first postoperative year. There was no such effect in men. In women, there were no changes in mortality rate in those who had had revision operations, whereas in men operated on for coxarthrosis who were over the age of 70, there was an increased mortality rate after the first postoperative year following revision. Patients operated on for complications after hip fracture and/or rheumatoid arthritis had an increased mortality rate after the first postoperative year, including both women and men below age 70.     

非骨水泥臼杯加自体股骨头植骨全髋关节置换术治疗髋臼发育不良伴骨性关节炎

目的：评价非骨水泥臼杯加自体股骨头植骨的全髋关节置换术治疗髋臼发育不良继发骨性关节炎的结果。方法：回顾性分析20例(21髋)患者行全髋关节置换术治疗髋臼发育不良继发骨性关节炎。女性18例,男性2例,平均年龄50岁,采用非骨水泥臼杯加自体股骨头植骨螺钉固定重建髋臼侧。臼杯置于真性髋臼水平,所有病例由于髋臼缺损而需要行自体股骨头植骨。平均植骨块覆盖的臼杯比例为31％(10％～45％)。8髋植骨块覆盖小于25％,13髋位于25％-50％之间。平均随访时间4．7年(1．5—8年)。采用改良Harris评分对结果进行评估。术前及随访时进行摄片观察。结果所有植骨块均获得愈合。无植骨块塌陷和髋假体松动。改良Harris评分由术前平均46分增加到89分。术前除1例双髋发育不良外,下肢不等长均超过2cm,术后只有2例仍有双下肢不等长超过1cm。3髋的植骨块外侧非支撑臼杯部分出现轻微的骨吸收。3髋发现有BrookerⅠ度异位骨化,1髋Ⅱ度异位骨化。结论：使用非骨水泥臼杯加自体股骨头植骨重建髋臼侧的全髋关节置换术治疗髋发育不良继发骨性关节炎可获得良好结果。该方法在植骨块支撑臼杯不超过50％的情况下,髋臼固定可靠,可保留髋臼的骨量。