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1.
Clinical experience with ceramics in total hip replacement 总被引:5,自引:0,他引:5
Oonishi H Wakitani S Murata N Saito M Imoto K Kim S Matsuura M 《Clinical orthopaedics and related research》2000,(379):77-84
As part of a search for better articulation in total hip prostheses, the decrease in the thickness of the socket in different total hip prostheses was measured in vivo. The wear rates of (1) RCH 1000 (molecular weight, 10(6)) socket gamma-irradiated with 100 Mrad articulating with a crude COP (stainless steel containing 20% cobalt and 0.01% phosphorous) metal femoral head; (2) RCH 1000 socket nonirradiated articulating with a crude COP femoral head; (3) RCH 1000 socket irradiated with 100 Mrad articulating with an alumina femoral head; (4) ultra high molecular weight polyethylene (molecular weight, 5-6 x 10(6)) socket articulating with an alumina femoral head; and (5) ultrahigh molecular weight polyethylene socket articulating with a stainless steel femoral head (T-28) were 0.06, 0.30, 0.06, 0.1 and 0.25 mm/year, respectively, in the authors' clinical cases. Alumina femoral heads were effective in decreasing wear of the polyethylene socket. However, the wear rates of gamma-irradiated sockets articulating with alumina and with metal femoral heads wear very low and were not different from each other. Regarding the relationship between wear rate and the thickness of the ultra high molecular weight polyethylene socket articulating with a 28 mm alumina femoral head, on radiographs, average wear rates of socket thicknesses of 7, 8, 9, 10 and 11 mm were 0.14, 0.15, 0.12, 0.06, and 0.08 mm/year, respectively. On measuring retrieved prostheses, average wear rates of 7, 8, 9 and 11 mm thickness sockets were 0.2, 0.19, 0.14, and 0.1 mm/year, respectively. The wear of sockets has been proven to be minimal in alumina femoral heads articulating with ultrahigh molecular weight polyethylene sockets thicker than 10 mm. 相似文献
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Metal-on-metal total hip replacement 总被引:5,自引:0,他引:5
Metal-on-metal bearings have wear rates that are 20 to 100 times lower than metal-on-conventional polyethylene. The amount of wear generally is the same order of magnitude for the head and the cup. There is an initial run-in period of higher wear followed by lower, steady-state wear. Wear rate is a function of the interplay of material(s), macrogeometry, microgeometry, and the resultant type and amount of lubrication. The wear resistance and clinical performance of a metal-on-metal bearing are more sensitive to macrogeometry and lubrication than a metal-on-polyethylene bearing. Metal wear particles are nanometers in linear dimension. They are much smaller and more numerous than the submicron polyethylene wear particles, but the volume of periprosthetic inflammatory tissue is less. Osteolysis seems to be relatively rare. Little is known about the systemic distribution of metal particles and ions. The significance of systemic distribution also is not known. The levels of serum and urine Co and Cr ions are elevated in patients with metal-on-metal bearings, but the long-term, steady-state levels are not much higher than those from corrosion of modular femoral components. Because of the elevated levels of Co and Cr ions, there is a greater risk of delayed type hypersensitivity. There also is concern about the potential for malignant degeneration secondary to prolonged exposure to these elements. The available data are insufficient to address this concern. Rigorous long-term studies are needed. It will take decades of close clinical observation to determine if the benefits of metal-on-metal bearings outweigh the associated risks. 相似文献
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Ceramics in total hip replacement 总被引:5,自引:0,他引:5
Hannouche D Hamadouche M Nizard R Bizot P Meunier A Sedel L 《Clinical orthopaedics and related research》2005,(430):62-71
Alumina-on-alumina total hip arthroplasty has been used for 32 years in Europe. The theoretical advantages of this combination are represented by its remarkable sliding characteristics, its very low wear debris generation, and its improved fracture toughness. These advantages are achieved if the material is processed properly with high density, high purity and small grains. We summarize the results obtained with the alumina-on-alumina combination concerning in vitro and in vivo wear behavior with special emphasis on wear debris characterization and quantification and histologic tissue examinations. Alumina-on-alumina seems to be one of the best choices in young and active patients provided that sound socket fixation is maintained in the long term. 相似文献
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Andrew JG Palan J Kurup HV Gibson P Murray DW Beard DJ 《The Journal of bone and joint surgery. British volume》2008,90(4):424-429
A prospective, multi-centre study was carried out on 1421 total hip replacements between January 1999 and July 2007 to examine if obesity has an effect on clinical outcomes. The patients were categorised into three groups: non-obese (body mass index (BMI) < 30 kg/m(2)), obese (BMI 30 to 40 kg/m(2)) and morbidly obese (BMI > 40 kg/m(2)). The primary outcome measure was the change in Oxford hip score at five years. Secondary outcome measures included dislocation and revision rates, increased haemorrhage, deep infection, deep-vein thrombosis and pulmonary embolism, mean operating time and length of hospital stay. Radiological analysis assessing heterotopic ossification, femoral osteolysis and femoral stem positioning was performed. Data were incomplete for 362 hips (25.5%) There was no difference in the change in the Oxford hip score, complication rates or radiological changes at five years between the groups. The morbidly obese group was significantly younger and required a significantly longer operating time. Obese and morbidly obese patients have as much to gain from total hip replacement as non-obese patients. 相似文献
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Uncemented total hip replacement 总被引:1,自引:0,他引:1
W Groher 《Canadian journal of surgery》1983,26(6):534-536
Between Jan. 1, 1976 and Dec. 31, 1981, 257 patients (age range from 21 to 65 years) with osteoarthritis of one or both hips were treated with ceramic hip replacement (Mittelmeier type). The cause of the osteoarthritis was variable. Hip replacement was carried out for the following conditions: rheumatoid arthritis including ankylosing spondylitis, aseptic necrosis of femoral head including post-traumatic and idiopathic forms, osteoarthritis of unknown origin, osteoarthritis following dysplasia or subluxation of the hips and loosened cemented hip prosthesis. The operative technique is described. Full weight bearing is not permitted for 16 weeks postoperatively, but mobilization and isometric exercises begin 2 days after operation and isotonic exercises are introduced later. Complications included fracture of the femoral shaft during operation, fracture of the acetabulum, protrusion, dislocation and infection early after operation (within 16 weeks) and aseptic loosening and pulmonary embolism (after 16 weeks). The results with this new type of hip replacement are encouraging. Good results based on patient satisfaction were obtained in 79% and poor results in 13%. 相似文献
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We evaluated the effectiveness of a comprehensive program for the use of autologous blood in reduction of the need for transfusion of homologous blood in total hip replacement in a prospective study of a consecutive series of patients. Transfusion of homologous blood was minimized through transfusion of preoperatively deposited autologous blood, intraoperative and postoperative salvage of washed red blood cells, and use of the clinical condition of the patient as the sole criterion for transfusion of non-autologous blood, regardless of the hematocrit. The cases of 143 patients who had had 154 primary total hip replacements were studied. One hundred and forty-three procedures were done on patients who had not been prevented from donating blood for medical reasons, and 93 per cent of these 143 procedures were performed with the availability of one to five units of preoperatively deposited autologous blood. The patients predeposited an average of 2.6 units of blood for each procedure. Ninety-two per cent of the procedures for which autologous blood had been predeposited were performed without transfusion of homologous blood. In the entire group of patients, almost 90 per cent of the transfused blood was autologous blood. Intraoperative salvage of red blood cells was successful in 148 procedures, and salvage was continued in the recovery room for all of these patients. An average of 408 milliliters of red blood cells was saved and reinfused, and this was 28 per cent of the average total loss of blood (1435 milliliters) for this series of procedures.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
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全髋关节置换术髋臼旋转中心的回顾性研究 总被引:5,自引:2,他引:5
[目的]通过手术前后对髋臼旋转中心的X线测量,探讨髋臼旋转中心的变化对髋关节平衡稳定性的影响。[方法]追溯调查近年本院收治120例155髋,均为首次行全髋关节置换术患者,对比术前术后双髋关节正位X线片,比较术后髋臼假体的旋转中心(HJC1)与解剖髋臼旋转中心(HJC0)的符合率。[结果]旋转中心恢复者98髋(63.23%)(A组),未恢复者57髋(36.77%)(B组);A、B两组中因人工髋关节松动、脱位、髋部痛等行髋关节假体翻修术分别为6髋(6.12%)、17髋(29.82%)。[结论]髋臼旋转中心的恢复对人工髋关节置换术后的关节稳定性有直接影响。 相似文献
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Joseph Schatzker David E. Hastings Robert J. McBroom 《Archives of orthopaedic and trauma surgery》1979,94(2):135-141
Summary In conclusion, based on our experimental and clinical material and analysis of failures, we recommend wire mesh reinforcement and bone graft for patients with mild to moderate protrusio. If the floor is strong but the pillars deficient, then the Eichler ring alone is the best implant. The combined system of wire mesh and Eichler ring should be used in cases of protrusio with a large deficiency of the acetabular floor and for protrusio with pillar weakness. Furthermore a bone graft should be used to reinforce the acetabular floor in addition to any prosthetic device.Dedicated Prof. Dr. E. Uehlinger on his 80th birthday 相似文献
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K. M. Peters B. Nachtsheim C. -J. Schuster R. Forst 《Archives of orthopaedic and trauma surgery》1997,116(1-2):83-87
During total hip replacement, identifiable myocardial ischemia occurs intraoperatively, indicating myocardial strain. Coronary heart disease (CHD) patients are at risk during this type of surgery. Perioperatively, CHD patients had significantly longer ST depressions than patients not suffering from CHD (3348 min vs 454 min). The number of depression episodes was also significantly higher for CHD patients (160 vs 36). Comparing the perioperative with the postoperative stage demonstrated that CHD patients experienced a highly significant shift towards shorter periods of ST segment depression postoperatively. 相似文献
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Summary Two hundred and twelve total hip replacements performed in one clinic over 1 year were reviewed. The mean operative time was 89 min and mean total blood loss 1090 ml. Homologous blood was administered to 74% of the patients. Blood loss was dependent on sex, body weight and height, but these correlations were eliminated when blood loss was related to estimated blood volume. There was no correlation to age. There was a positive correlation between operative time and intraoperative blood loss, but not between any of these factors and postoperative blood loss. Operative time varied significantly between surgeons, but there was no correlation between surgeon's experience and operative time or blood loss. Despite a mean of only 12 total hip replacements per surgeon, both operative time and blood loss were small compared to what was found in other studies. The use of a posterior approach is believed to contribute to a shorter operative time as well as to moderate blood loss. Intraoperative blood loss was less under epidural than under general anaesthesia, but in contrast to others we found higher postoperative blood loss after epidural anaesthesia. 相似文献
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K S?balle F Christensen 《Archives of orthopaedic and traumatic surgery. Archiv für orthop?dische und Unfall-Chirurgie》1988,107(1):50-53
Insufficient cementation has been suggested to be the most common cause of loosening of the femoral component after total hip arthroplasty. A clinical and radiographic study of 129 consecutive, primary total hip replacements was performed 5 years after surgery, in order to evaluate the significance of femoral plugging, special attention being focused on cementation and radiographic loosening. A polyethylene medullary plug was used in 78 hips which were compared with 51 non-plugged hips with respect to the clinical course and radiographic appearance. The cement mantle around the femoral component was thicker, and the packing of cement significantly improved when the plug was used. The frequency of radiographic loosening was smaller in the plugged group but with no statistical significance. There was no difference in clinical results between the compared groups. Our results indicate that medullary plugging improves the cementation and in particular prevents insufficient cementation of the femoral component. 相似文献
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Summary In 21 cases of severe secondary protrusio acetabuli with extensive or total destruction of the acetabular cortical structures, the double anchorage of conventional polyethylene cups with nine Müller acetabular reinforcement rings and 12 Burch-Schneider anti-protrusio reinforcement cages was carried out. They were applied in combination with reconstructive surgery of cancellous bone in three primary total hip replacements and in 18 revision operations for lossened acetabular cups following total arthroplasties. Indication for and technique of the acetabular reinforcement are described. The radiological and clinical results in 21 patients followed up were satisfactory. They confirm the efficiency of these screw-fixed reinforcement implants for the solid fixation of the plastic cup in patients with extreme acetabular deficiencies.
Zusammenfassung Bei 21 Patienten mit ausgeprägter sekundärer Protrusio acetabuli und weitgehender oder völliger Zerstörung der kortikalen Pfannenstrukturen wurde die Doppelverankerung der zementfixierten Ersatzpfannen mit 9 Müller Pfannendachschalen und 12 Burch-Schneider Pfannenstützschalen durchgeführt. Sie wurden in Kombination mit einer rekonstruktiven Spongiosaplastik bei 3 Erstimplantationen von Totalendoprothesen und bei 18 Revisionseingriffen zur Auswechslung von ausgelockerten Pfannenimplantaten eingesetzt. Indikation und Technik der Pfannenarmierung werden beschrieben. Die radiologischen und klinischen Resultate der 21 nachuntersuchten Patienten waren zufriedenstellend. Sie bestätigen die Leistungsfähigkeit dieser schraubenfixierten Armierungsimplantate, die eine stabile Pfannenfixation bei hochgradigen zentralen Azetabulumdefekten gewährleisten.相似文献
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Summary Insufficient cementation has been suggested to be the most common cause of loosening of the femoral component after total hip arthroplasty. A clinical and radiographic study of 129 consecutive, primary total hip replacements was performed 5 years after surgery, in order to evaluate the significance of femoral plugging, special attention being focused on cementation and radiographic loosening. A polyethylene medullary plug was used in 78 hips which were compared with 51 non-plugged hips with respect to the clinical course and radiographic appearance. The cement mantle around the femoral component was thicker, and the packing of cement significantly improved when the plug was used. The frequency of radiographic loosening was smaller in the plugged group but with no statistical significance. There was no difference in clinical results between the compared groups. Our results indicate that medullary plugging improves the cementation and in particular prevents insufficient cementation of the femoral component. 相似文献
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Infection management in total hip replacement 总被引:1,自引:0,他引:1
A. Härle 《Archives of orthopaedic and trauma surgery》1989,108(2):63-71
Summary Early diagnosis and determined management of infection after hip replacement are the prerequisites for good end results. Infections that manifest themselves during the first 6 weeks after a prosthetic implant can be mastered by local debridement. The implant can thus be saved, and the functional performance as well. Infections that appear after this 6-week period many require temporary removal of the implant in order to control the infection. When the clinical aspects and laboratory data indicate the infection is under control, the hip endoprosthesis can be reimplanted with a very low rate of recurrence. The method applied for removal of implants and bone cement is of utmost importance for the final results, and a extremely diligent surgical technique is the basis for long-term management of infection and good functional performance. Resection arthroplasty is not the treatment of choice anymore for infected hip prostheses and should be restricted to special cases. 相似文献
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Pseudoachondroplasia is an inherited skeletal dysplasia with short-limbed dwarfism and early onset of osteoarthritis. A 29-year-old pseudoachondroplastic woman presented with progressively painful hips secondary to severe osteoarthritis of both joints, so that total joint replacements were necessary to restore her mobility and quality of life. The implants inserted had to be specifically manufactured in accordance with the individual geometry and reduced bone size. In addition, the implants mechanical resistance to dynamic loading conditions had to be tested prior to total hip replacement surgery. 相似文献