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1.
Jim Nevelos PhD Aaron Johnson MD Christopher Heffernan James Macintyre David C. Markel MD Michael A. Mont MD 《Clinical orthopaedics and related research》2013,471(2):519-526
Background
Dislocation remains common after total hip arthroplasty. Efforts have been made to identify and minimize risk factors. One such factor, jump distance, or the distance the femoral head must travel before dislocating, has been poorly characterized with respect to three-dimensional kinematics.Questions/purposes
We therefore determined: (1) the three-dimensional stability of four different component designs; (2) whether the degree of abduction and anteversion affects the stability; (3) whether pelvic inclination angles affected stability; and (4) which combination of these three factors had the greatest stability.Methods
We created a positionable three-dimensional model of a THA. Acetabular components were modeled in various abduction and anteversion angles and in two different pelvic inclinations which simulate standing and chair-rising activities.Results
The posterior horizontal dislocation distance increased as inclination angle and femoral head size increased. The 48-mm resurfacing typically had lower jump distances and was at risk of posterior edge loading at 30° inclination. The highest jump distance for all positions and activities occurred with the dual-mobility bearing.Conclusion
These findings suggest that monoblock cups require extremely accurate positioning for low dislocation risk and that pelvic orientation may increase dislocation risks.Clinical Relevance
As a result of the dual-mobility designs having the greatest resistance to dislocation, these cups may be appropriate for patients who are at risk for dislocation in difficult primary situations and in revision hip arthroplasty procedures in which proper component orientation may be less likely to be achieved. 相似文献2.
Moritz M. Innmann Tobias Gotterbarm Jan Philippe Kretzer Christian Merle Volker Ewerbeck Stefan Weiss Peter R. Aldinger Marcus R. Streit 《International orthopaedics》2014,38(5):929-934
Purpose
Concerns have been raised in relation to metal-on-metal (MoM) articulations with catastrophic soft-tissue reactions due to metal debris. We reviewed how small head MoM articulations perform in primary uncemented total hip arthroplasty (THA) in young patients at a minimum of ten years.Methods
We retrospectively evaluated the clinical and radiographic results of the first 100 consecutive primary cementless THAs using the 28-mm Metasul MoM articulation in 91 patients younger than 50 years of age at the time of surgery.Results
After 13 years, survival for the endpoint revision due to any reason was 90.9 % and 98.9 % for revision due to aseptic implant loosening. The cumulative incidence of MoM related revisions was 1.2 %. Small proximal femoral osteolysis was found in 18 % of hips. No acetabular osteolysis or loosening was detected. Two hips showed signs of femoral neck impingement with severe damage to the neck.Conclusions
Early in the second decade, MoM-associated complications were rare using the 28-mm Metasul articulation, and aseptic loosening was not a major mode of failure in this cohort of young patients.Level of evidence
Therapeutic Level IV. 相似文献3.
4.
Eduardo García-Rey Ricardo Fernández-Fernández David Durán Rosario Madero 《Journal of orthopaedics and traumatology》2013,14(1):39-49
Background
The preoperative bone defect and the reconstruction of the center of rotation of the hip are critical in acetabular revision surgery. Uncemented oblong cups are employed in order to manage these issues. We analyzed the clinical results and rates of revision of two different uncemented oblong cups, the reconstruction of the center of rotation of the hip, as well as the rate of radiological loosening and possible risk factors.Materials and methods
Forty-five patients (46 hips) underwent acetabular revision surgery using two different uncemented oblong cups. We assessed the clinical results and the survival rate for revision and aseptic loosening. Intraoperative bone loss was classified according to Paprosky, and acetabular reconstruction was assessed according to Ranawat. The mean follow-up was 7.2 years (range 4–11 years).Results
There were four re-revisions (three due to aseptic loosening); the survival rate for re-revision due to aseptic loosening was 60.1 % at seven years. The mean distance between the center of the femoral head prosthesis and the approximate center of the femoral head improved from 21.5 to 10.2 mm. Thirteen cups showed radiological loosening; the survival rate for radiological loosening at seven years was 40.54 %. A smaller postoperative horizontal distance was correlated with cup loosening.Conclusions
Although optimal acetabular reconstruction can be achieved by using oblong uncemented cups in revision hip surgery, the clinical and radiological results are not encouraging. Excessive medialization of the cup may increase the rate of loosening. 相似文献5.
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Markus T. Hongisto Harri Pihlajamäki Seppo Niemi Maria Nuotio Pekka Kannus Ville M. Mattila 《International orthopaedics》2014,38(8):1685-1690
Purpose
For femoral neck fractures, recent scientific evidence supports cemented hemiarthroplasty (HA) over uncemented HA and suggests that total hip arthroplasty (THA) should be performed more frequently. We report the current surgical trends in treating femoral neck fractures in Finland.Methods
The study was conducted using the Finnish National Hospital Discharge Register and included all Finns at least 50 years of age who underwent surgery for femoral neck fractures from 1998 through 2011. Age- and sex-specific incidence rates and annual proportion of each treatment method were calculated.Results
During 1998–2011, a total of 49,514 operations for femoral neck fracture were performed in Finland. The proportion of uncemented HA increased from 8.1 % in 2005 to 22.2 % in 2011. During the same time, the proportion of cemented HA decreased from 63.9 to 52.5 %, internal fixation decreased from 23.2 to 16.1 % and THA increased from 4.9 to 9.2 %.Conclusions
Between 2005 and 2011, the proportion of uncemented HA for femoral neck fractures increased markedly in Finland, while cemented HA and internal fixation declined. During this time, the use of THA nearly doubled. The current evidence-based guidelines for treatment of femoral neck fractures were mainly followed, but the increase in uncemented HA procedures contradicts recent scientific evidence. 相似文献7.
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Jacob M. Elkins MD PhD John J. Callaghan MD Thomas D. Brown PhD 《Clinical orthopaedics and related research》2014,472(2):529-542
Background
Large-diameter femoral heads for metal-on-metal THA hold theoretical advantages of joint stability and low bearing surface wear. However, recent reports have indicated an unacceptably high rate of wear-associated failure with large-diameter bearings, possibly due in part to increased wear at the trunnion interface. Thus, the deleterious consequences of using large heads may outweigh their theoretical advantages.Questions/purposes
We investigated (1) to what extent femoral head size influenced stability in THA for several dislocation-prone motions; and the biomechanics of wear at the trunnion interface by considering the relationship between (2) wear potential and head size and (3) wear potential and other factors, including cup orientation, type of hip motion, and assembly/impaction load.Methods
Computational simulations were executed using a previously validated nonlinear contact finite element model. Stability was determined at 36 cup orientations for five distinct dislocation challenges. Wear at the trunnion interface was calculated for three separate cup orientations subjected to gait, stooping, and sit-to-stand motions. Seven head diameters were investigated: 32 to 56 mm, in 4-mm increments.Results
Stability improved with increased diameter, although diminishing benefit was seen for sizes of greater than 40 mm. By contrast, contact stress and computed wear at the trunnion interface all increased unabatedly with increasing head size. Increased impaction forces resulted in only small decreases in trunnion wear generation.Conclusions
These data suggest that the theoretical advantages of large-diameter femoral heads have a limit. Diameters of greater than 40 mm demonstrated only modest improvement in terms of joint stability yet incurred substantial increase in wear potential at the trunnion.Clinical Relevance
Our model has potential to help investigators and designers of hip implants to better understand the optimization of trunnion design for long-term durability. 相似文献10.
Manish Noticewala Taylor S. Murtaugh Jonathan Danoff Gregory J. Cunn Roshan P. Shah Jeffrey Geller 《Journal of Clinical Orthopaedics and Trauma》2018,9(4):281-284
Background
Displaced femoral neck fractures (DFNF) in the elderly can be treated with hemiarthroplasty or total hip arthroplasty (THA). One concern with utilizing THA in this setting is post-operative dislocation. The purposes of this study were to determine the incidence of hip dislocation following THA for DFNF and to identify risk factors for dislocation.Methods
The charts of 66 posterior-approach THA cases performed for DFNF with mean post-operative follow-up of 4.4 years were retrospectively reviewed. Pre-operative patient demographic data and intra-operative clinical data were recorded including age, race, gender, height, weight, body mass index (BMI), femoral head diameter, acetabular cup diameter, use of an elevated liner, and cementing of femoral component. For patients with available post-operative pelvis radiographs, acetabular cup inclination and version angles were also calculated.Results
Four dislocation (4/66, 6%) events occurred at an average of 51 days after surgery. No specific risk factors for dislocation were identified but the use of a cemented femoral stem did approach significance (p = 0.06). 47% of the acetabular cups were located outside of the Lewinnek safe zone. Although the dislocation rate of THAs with acetabular cups outside of the safe zone was higher than the dislocation rate for THAs with cups in the safe zone (12.5% vs 0%), placement of acetabular cups outside of the safe zone was not a risk factor for dislocation.Conclusions
Posterior THA with proper cup positioning and meticulous soft tissue repair is an effective treatment option for DFNF with low dislocation risk. 相似文献11.
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Kensei Yoshimoto Yasuharu Nakashima Takuaki Yamamoto Jun-ichi Fukushi Goro Motomura Masanobu Ohishi Satoshi Hamai Yukihide Iwamoto 《International orthopaedics》2016,40(8):1625-1630
Purpose
Dislocation is a leading cause of failure after revision total hip arthroplasty (THA). This study was conducted to examine the risk factors for dislocation as well as their recurrence after revision THA.Methods
We retrospectively reviewed 178 revision THAs in 162 patients between 1998 and 2013. The mean patient age was 65.2 years at operation and the mean follow-up period was 6.7 years. Multivariate logistic regression was performed to identify risk factors for dislocation, and further comparison was made between patients with single and recurrent dislocations.Results
Sixteen hips in 15 patients (9.0 %) dislocated at a mean of 9.1 months (range, 0–83 months) after revision THA. Multivariate analysis identified advanced age (odds ratio [OR]?=?2.94/10 years) and osteonecrosis of the femoral head (OR?=?7.71) as the independent risk factors for any dislocations. Risk factors for recurrent dislocations, which were observed in eight hips (50 %), were later dislocations (≥4 months) and lower BMI.Conclusion
Dislocation is a serious problem after revision THA with multiple risk factors. Although our findings were limited to revision THAs done through posterolateral approach, recognition of these factors is helpful in patient education and surgical planning.14.
Ho-Rim Choi David Anderson Scott Foster Matthew Beal Jo Ann Lee Christopher Barr Henrik Malchau Joseph McCarthy Young-Min Kwon 《International orthopaedics》2013,37(10):1905-1910
Purpose
This study evaluates acetabular cup position in the setting of revision total hip arthroplasty (THA) with severe acetabular bone defects.Methods
With a definition of safe zone of abduction (30–50°) and anteversion (5–25°), acetabular cup position was measured by a digital image analysis program for 34 patients with Paprosky type III acetabular bone defects.Results
There were 24 cups (71 %) for abduction and 26 cups (76 %) for anteversion located in the safe zone. Nineteen cups (56 %) were within the safe zone for both abduction and anteversion. There was no dislocation, however one cup out of the safe zone resulted in early cup failure due to aseptic loosening.Conclusions
The acetabular cup positioning in patients with Paprosky type III defects was 'optimal' in half of the cases. The prevalence of optimal acetabular cup position was similar to those reported in primary THA, suggesting that the presence of a large acetabular bone defect may not be a significant risk factor for suboptimal acetabular cup positioning in the setting of revision THA. 相似文献15.
Massimo Mariconda Alessandro Silvestro Gelsomina Mansueto Domenico Marinò 《Archives of orthopaedic and trauma surgery》2010,130(1):61-64
Introduction
Catastrophic polyethylene failure is an uncommon complication of ceramic-on-polyethylene total hip arthroplasty (THA) because of the favourable tribological characteristics of these implants. We present a case of a 50-year-old woman who formerly underwent bilateral ceramic-on-polyethylene THA with expansion acetabular cups and eleven years later presented with unilateral THA dislocation, secondary to catastrophic polyethylene failure and metal shell fracture.Case presentation
The patient came to our hospital for worsening pain in her left hip and an acute incapacity to bear weight on her left lower limb. Twelve and eleven years earlier she had undergone bilateral ceramic-on-polyethylene THA with acetabular expansion components of identical size on both sides. Radiographically, the left femoral head appeared superiorly dislocated and severe polyethylene wear was detected. The inclination angles of the left and right cups were 60° and 44°, respectively. The patient underwent left acetabular revision, and complete polyethylene wear-through with fracture of a cranial lobe of the expansion metal shell was noted at surgery. One large osteolytic lesion in the roof of the acetabulum and diffuse periarticular metallosis were also present. These findings required the use of a Burch–Schneider reinforcement cage. Two years later the patient is functioning well and has full autonomy in her activities of daily living.Conclusion
The correct inclination of the acetabular component is necessary to prevent accelerated polyethylene wear in THA, even though favourable articular bearing surfaces have been used (e.g., ceramic-on-polyethylene coupling). Should the cup appear well fixed and fairly oriented on follow-up radiographies, the early detection of severe polyethylene wear may permit a revision of only the femoral head and acetabular liner. 相似文献16.
Philippe Hernigou Louis Ratte François Roubineau Jacques Pariat Guillaume Mirouse Isaac Guissou Jerome Allain Charles Henri Flouzat Lachaniette 《International orthopaedics》2013,37(7):1219-1223
Purpose
Total hip arthroplasty (THA) has been efficacious for treating hip fractures in healthy older patients. However, in those patients with fractures a widely variable prevalence of dislocation has been reported, partly because of varying durations of follow up for this specific end-point. The purpose of the present study was to determine the cumulative risk of dislocation in these patients with fractures and to investigate if retentive cups decrease the risk of dislocation.Methods
Between 2000 and 2005, 325 patients with neck fracture underwent primary THA using a retentive (325 hips) cup. The results of these 325 acetabular cups were compared to 180 THA without retentive cups performed for neck fractures in the same hospital between 1995 and 2000 by the same surgical team. The mean age of the 505 patients was 75 years (range 65–85). All patients were followed for a minimum of five years for radiographic evidence of implant failure. The patients were followed at routine intervals and were specifically queried about dislocation. The cumulative risk of dislocation and recurrent dislocation was calculated with use of the Kaplan–Meier method.Results
For patients without retentive cups, the cumulative risk of a first-time dislocation was 5 % at one month and 12 % at one year and then rose at a constant rate of approximately 1 % every year to 16 % at five years. For patients with retentive cups, the cumulative risk of a first-time dislocation was 1 % at one month, 2 % at one year and then did not changed at five years. There were no differences in the mortality rates or in loosening rates among the treatment groups. The rate of secondary surgery was highest in the group without retentive (10 % for recurrent dislocation) compared with 1 % in the group treated with retentive cups. In absence of retentive cups, multivariate analysis revealed that the relative risk of dislocation for female patients (as compared with male patients) was 2.1 and that the relative risk for patients who were 80 years old or more (as compared with those who were less than 80 years old) was 1.5. Two underlying diagnoses occurring during follow up—cognitively impaired patients or neurologic disease—were also associated with a significantly greater risk of dislocation in absence of retentive cup. For these patients the risk was also decreased with a retentive cup.Conclusion
With standard cups the incidence of dislocation is highest in the first year after arthroplasty and then continues at a relatively constant rate for the life of the arthroplasty. Patients at highest risk are old female patients and those with a diagnosis of neurologic disease. Retentive cups in these patients are an effective technique to prevent post-operative hip dislocation. 相似文献17.
Takaaki Fujishiro Takafumi Hiranaka Shingo Hashimoto Shinya Hayashi Masahiro Kurosaka Taiki Kanno Takeshi Masuda 《International orthopaedics》2016,40(4):697-702
Purpose
The purpose of the present study was to: (1) investigate the variation of both acetabular and femoral component version in a large series of consecutive primary THA patients, and (2) to better define the associations of acetabular and femoral component alignment and clinical factors with subsequent hip dislocation in those patients.Methods
We analyzed CT scans of 1,555 consecutive primary THAs and measured version of the components. We also documented the frequency and direction of subsequent dislocation as well as femoral head size, posterior tissue repair, any history of previous hip surgery, and gender.Results
The dislocation rate after THA was 3.22 %. The dislocation risk was 1.9 times higher if cup anteversion was not between 10° and 30°. Compared to hips that did not dislocate, those that experienced anterior dislocation had a significantly greater combined anteversion; those that dislocated posteriorly had a significantly smaller combined anteversion. Hips with previous rotational acetabular osteotomy or head size smaller than 28 mm correlated with an increased dislocation rate.Conclusion
The dislocation risk could be higher if cup anteversion was not between 10° and 30°. Greater combined anteversion could be a risk factor of anterior dislocation, and posterior dislocation could be more common in smaller combined anteversion.18.
Aaron J. Johnson MD MS LaQuawn Loving MS Lizeth Herrera BS Ronald E. Delanois MD Aiguo Wang PhD Michael A. Mont MD 《Clinical orthopaedics and related research》2014,472(2):624-629
Background
Dislocation remains the leading cause of revision THA. One approach to decreasing prosthetic dislocation risk has been the use of larger femoral head component sizes. The upper limit of head size in metal-on-polyethylene hip arthroplasty has historically been limited because of concerns about increased wear on thin polyethylene components. It is not known to what degree this concern should apply to more wear-resistant polyethylene components.Questions/purposes
We therefore determined (1) in vitro wear rates of polyethylene liners of varying thicknesses, (2) whether there were differences in the microscopic wear characteristics as a function of polyethylene thickness, and (3) whether thin polyethylene components resulted in early catastrophic failures.Methods
We used a hip wear simulator to compare the wear performance of 12 highly crosslinked polyethylene acetabular inserts. The internal diameter of all components was 36 mm, and there were three samples tested of each thickness (1.9, 3.9, 5.9, or 7.9 mm). Testing was conducted for 2.4 million cycles. Gravimetric mass loss was converted to volumetric loss, which was subsequently converted to theoretical linear penetration rates.Results
Wear rates decreased with increasing polyethylene thickness. Mean ± SD wear rates for the 1.9-, 3.9-, 5.9-, and 7.9-mm groups were 5.0 ± 0.5, 3.2 ± 0.3, 2.5 ± 1.1, and 2.2 ± 1.3 mm3/million cycles, respectively (p < 0.016). Calculated penetration rates were 0.015, 0.012, 0.011, and 0.010 mm/million cycles, respectively (p < 0.016). There were no catastrophic failures in any group.Conclusions
Thinner polyethylene components demonstrated higher wear rates, although even the highest wear rate observed in the thinnest polyethylene specimen was lower than that commonly reported for noncrosslinked polyethylene components. While encouraging, these findings should be validated in vivo before clinical recommendations can be made. 相似文献19.
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Sachiyuki Tsukada Motohiro Wakui Munenori Matsueda 《Archives of orthopaedic and trauma surgery》2013,133(6):861-868