Fourth-generation ceramic-on-ceramic total hip arthroplasty in patients of 55 years or younger: short-term results and complications analysis

Background The incidence of total hip replacement in the younger and more active patients is ever increasing.The ceramic-on-ceramic （COC） bearing was developed to reduce wear debris-induced osteolysis and loosening and to improve the longevity of hip arthroplasties.Few studies have reported the clinical results and complications of the new zirconia-toughened ceramic total hip arthroplasty （THA）.Methods A consecutive series of 132 young patients （177 hips） that underwent primary cementless THAs between January 2010 and December 2012 were included in this study.These arthroplasties all had fourth-generation COC bearings performed through a posterolateral approach.The average age was （41.8±8.3） years （ranging from 22 to 55 years）,and the mean follow-up period was （24.5±9.4） months （ranging from 12 to 47 months）.The results were evaluated both clinically and radiographically.Harris hip score （HHS） was determined before surgery and at the time of each follow-up.Presence of postoperative groin or thigh pain and squeaking were recorded.Other complications such as dislocations,periprosthetic fractures,and ceramic components fractures were diagnosed and treated in emergency.Results The average HHSs improved from preoperative 60.3±10.7 （ranging from 29 to 76） to 91.0±5.1 （ranging from 74 to 100） at the final follow-up （t=-45.064,P ＜0.05）,and 97.7％ of cases were scored as excellent and good results.At the last follow-up,incidental inguinal pain was found in three hips （1.7％） and thigh pain in 11 hips （6.2％）.Radiographs showed a high rate of new bone formation around the acetabular and stem components.No obvious osteolysis or prosthesis loosening was detected.Complications occurred in six hips （3.4％）：posterior dislocation in two hips （1.1％）,periprosthetic femoral fracture in one hip （0.6％）,asymptomatic squeaking in two hips （1.1％）,and ceramic liner fracture in one hip （0.6％）.Conclusions The fourth-generation COC THA showed excelle     

Densitometric evaluation might prevent failure of knee artroplasty for aseptic loosening: An 8-year observational controlled study

Objectives:

To study the correlation between quantitative ultrasound (QUS) expressed as stiffness index (SI) and the risk of aseptic loosening of knee arthroplasty.

Methods:

An observational retrospective controlled study was performed on 85 female patients (mean age: 73.3 years) divided into 2 groups from January 2007 to March 2015 and carried out at the Orthopedic Rehabilitation Unit, Casa di Cura Eremo, Arco, Trento, Italy. Group A included 42 patients who had undergone a revision of knee prosthesis for aseptic-loosening, and group B included 43 age-matched patients who underwent primary replacement of the knee without following aseptic loosening. Patients in both groups were evaluated for SI with Achilles - QUS system at the same side of the surgery.

Results:

In group A, 20/42 patients (47.6%) had an SI T-score below -2.5. In group B, 14/43 (32.5%) patients had a SI T-score below -2.5. The difference between the 2 groups was statistically significant (p=0.015).

Conclusion:

Stiffness index appears to be an important predictor of aseptic loosening of the knee prosthesis. Therefore, densitometric evaluation, including SI, may be recommended before surgical knee replacement.Periprosthetic bone loss is the most common complication of arthroplasty. Some degree of bone loss is present in every failed total knee arthroplasty.1 There are several factors leading to bone loss including wear debris and stress shielding. The implantation of exogenous material into the organism causes foreign body reactions characterized by the activation of macrophages and consequent release of a myriad of bio reactive agents (reactive oxygen intermediates, degradative enzymes and acids). The reaction ends in the formation of foreign body giant cells at the material interface and the consequences can be devastating. Biomaterial surface properties play an important role in the development of the reaction. One of the primary causes of damage is the production of particulate wear debris, which is the consequence of the articular motion. Wear debris is able to induce inflammation at the interface between implants and bone, and osteolysis is the final result.2 Extremely high blood metal ion levels have been found in patients after arthroplasty, even in asymptomatic patients with a stable prosthesis, but the ion levels were significantly higher in patients with severe bone loss.3 Another factor is represented by the stress shielding: in a healthy person the bone will remodel in response to the loads it is placed under, therefore, the absence of the load causes bone loss. In addition to prosthetic shapes and sizes, implant fixation methods (including surface treatments), clinical installation, interface micromotions, and periprosthetic high hydraulic pressure can play a role in the mobilization of the prosthesis.4 Previous osteoporosis may be an important cause of failure of prosthetic implants: it has been demonstrated that low systemic bone mineral density (BMD) evaluated with dual x-ray absorptiometry (DXA) increases migration, and delays osseointegration of cementless femoral stems in women who had underwent cementless total hip arthroplasty.5,6 Quantitative ultrasound (QUS) is a recent developed technique that can assess both bone mass and architecture densitometry.7 Frediani et al8 in 2006 compared QUS (Achilles Express) and DXA for the evaluation of vertebral fracture risk: 764 post-menopausal women with non-traumatic vertebral fractures versus 770 post-menopausal women with normal morphometry were evaluated. The authors concluded that both QUS and DXA were able to discriminate women with from women without fracture and were independent predictors of fracture. Moreover, BMD and stiffness were both able to indicate the risk of fracture.8 The aim of this study is to investigate the correlation between bone mass evaluated with practicable QUS, and the risk of aseptic loosening of knee arthroplasty.     

Cemented hemiarthroplasty in traumatic displaced femoral neck fractures and deep vein thrombosis: is there really a link?

INTRODUCTION

Traumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty.

METHODS

The data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared.

RESULTS

There were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53–99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used.

CONCLUSION

Cemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of patients.     

Early Outcomes of Primary Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients with Human Immunodeficiency Virus in China

Background:Studies have reported that patients with human immunodeficiency virus (HIV) have a high incidence of osteonecrosis of the femoral head (ONFH).Total hip arthroplasty (THA) is an effective man...     

Clinical outcomes of single-level lumbar artificial disc replacement compared with transforaminal lumbar interbody fusion in an Asian population

INTRODUCTION

The objective of this study was to examine the clinical outcome of single-level lumbar artificial disc replacement (ADR) compared to that of transforaminal lumbar interbody fusion (TLIF) for the treatment of symptomatic degenerative disc disease (DDD) in an Asian population.

METHODS

This was a retrospective review of 74 patients who had surgery performed for discogenic lower backs that involved only the L4/5 and L5/S1 levels. All the patients had lumbar DDD without radiculopathy or spondylolithesis, and concordant pain with discogram at the pathological level. The patients were divided into two groups – those who underwent ADR and those who underwent TLIF.

RESULTS

A trend suggesting that the ADR group had better perioperative outcomes (less blood loss, shorter operating time, shorter hospital stay and shorter time to ambulation) than the TLIF group was observed. However, a trend indicating that surgical-approach-related complications occurred more frequently in the ADR group than the TLIF group was also observed. The rate of revision surgery was comparable between the two groups.

CONCLUSION

Our findings suggest that for the treatment of discogenic lower back pain, lumbar ADR has better perioperative outcomes and a similar revision rate when compared with TLIF. However, the use of ADR was associated with a higher incidence of surgical-approach-related complications. More studies with bigger cohort sizes and longer follow-up periods are needed to determine the long-term efficacy and safety of ADR in lumbar DDD.     

The Surgical Treatment and Outcome of Nonmetastatic Extremity Osteosarcoma with Pathological Fractures

Background:

Recent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery (LSS) in appropriately selected patients when combined with neoadjuvant chemotherapy. These have largely been single institutional studies with limited numbers. The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients.

Methods:

A retrospective review of the data was conducted. Ninety-five cases of nonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared.

Results:

In the fracture group, the LSS rate was 62.1%, and the rate of amputation was 37.9%. In the nonfracture group, the LSS rate was 74.7%, and the amputation was 25.3%. In patients with a pathologic fracture, the rate of local recurrence for LSS and amputation groups was 8.5% and 2.8%, respectively. In this group, the 5-year survival in the LSS group was 66% as against. 46.8% in the amputation group.

Conclusions:

Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.     

Changes of Hemoglobin and Hematocrit in Elderly Patients Receiving Lower Joint Arthroplasty without Allogeneic Blood Transfusion

Background:It has rarely been reported about the changes of hemoglobin (Hb) and hematocrit (Hct) in elderly patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA).This study a...     

Acoustic monitoring (RFM) of total hip arthroplasty results of a cadaver study

Introduction

At present there are no reliable non-traumatic and non-invasive methods to analyse the healing process and loosening status after total hip replacement. Therefore early as well as late loosening of prosthesis and interface component problems are difficult to be found or diagnosed at any time.

Methods

In a cadaver study the potential application of Resonance Frequency Monitoring (RFM) will be evaluated as a non-invasive and non-traumatic method to monitor loosening and interface problems in hip replacement. In a 65 year old female cadaver different stability scenarios for a total hip replacement (shaft, head/modular head and cup, ESKA, Luebeck, Germany) are simulated in cemented and cement less prosthesis and then analysed with RFM. The types of stability vary from secure/press-fit to interface-shaft disruption.

Results

The RFM shows in cemented as well as cement less prosthesis significant intra-individual differences in the spectral measurements with a high dynamic (20 dB difference corresponding to the factor 100 (10000%)), regarding the simulated status of stability in the prosthesis system.

Conclusion

The results of the study demonstrate RFM as a highly sensitive non-invasive and non-traumatic method to support the application of RFM as a hip prosthesis monitoring procedure. The data obtained shows the possibility to use RFM for osteointegration surveillance and early detection of interface problems, but will require further evaluation in clinical and experimental studies.     

Factors influencing the longevity and replacement frequency of Provox voice prostheses

INTRODUCTION

This study aimed to assess the factors that influence the longevity and replacement frequency of Provox voice prostheses following their placement.

METHODS

The medical records of 27 patients who received Provox voice prostheses after total laryngectomy and attended follow-up regularly between 1998 and 2012 were retrospectively reviewed. The success rate of the Provox voice prostheses (i.e. whether speech was achieved), quality of speech achieved, number and type of complications encountered, frequency of prostheses replacement and reasons for prostheses replacements were evaluated.

RESULTS

All 27 patients were men and their mean age was 63.0 (range 43–78) years. The mean follow-up period was 60.3 (range 1–168) months. Fluent and understandable speech was achieved in 85.0% of the patients. The mean duration before prosthesis replacement had to be performed was 17.1 (range 1–36) months. The most frequent complication was fluid leakage through the prosthesis. There was a strong positive correlation of 77.1% between the longevity of prostheses and postoperative follow-up duration (r = 0.771; p < 0.01).

CONCLUSION

The voice prosthesis is a tool that can be delivered in a practical fashion and replaced easily with no serious complications. It is a means by which speech can be restored, with a high success rate, after total laryngectomy. In the present study, we found that postoperative follow-up duration was the most important factor influencing the longevity of the Provox voice prosthesis.     

Comparison of the effect of selected muscle groups fatigue on postural control during bipedal stance in healthy young women

Background:

The maintenance of balance is an essential requirement for the performance of daily tasks and sporting activities and muscular fatigue is a factor to impair postural control, so this study was done to compare the effect of selected muscle groups fatigue on postural control during bipedal stance in healthy subjects.

Materials and Methods:

Fifteen healthy female students (24.3 ± 2.6 years) completed three testing session with a break period of at least 2 days. During each session, postural control was assessed during two 30-s trials of bipedal stance with eyes close before and after the fatigue protocol. Fatigue protocols were performed by 60% of their unfatigued Maximum Voluntary Contraction of unilateral ankle plantar flexors, bilateral lumbar extensors and bilateral neck extensors. One of the three fatigue protocols was performed on each session.

Results:

The result showed that fatigue had a significant effect on COP velocity and it increase COP velocity but there was not found any difference in postural sway between muscle groups.

Conclusion:

Localized muscle fatigue caused deficits in postural control regardless of the location of fatigue. Authors suggest the possibility of the contributions of central mechanisms to postural deficits due to fatigue and it seems that difference was not between muscle groups due to central fatigue.     

Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults

Background:

Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.

Methods:

Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student''s t-test, independent-sample Student''s t-test, and Pearson''s Chi-square test; the test level was α =0.05.

Results:

Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved.

Conclusions:

THA is effective and safe for DDH. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.     

Clinical and radiographic evaluation of biodegradable bone plates in the treatment of mandibular body fractures

Background:

Many different systems are available for the treatment of fractures ranging from the heavy compression plates for mandibular reconstruction to low profile plates for mid-facial fixation, and are made either from stainless steel, titanium or vitallium. Recently, biodegradable, self-reinforced polylactide plates and screws have been used for the internal fixation of fractures of the mandible with good results.

Aim of this study:

This study evaluated clinically the biodegradable bone plates for treatment of mandibular body fracture and to evaluate bone healing during the follow-up period using digital radiography.

Materials and Methods:

Eight patients had been suffered from mandibular body fractures were treated using Inion CPS^TM bioresorbable fixation system and the healing process were followed up using digitised panoramic radiography at first week and after 1, 3 and 6 months.

Results:

Clinical examination of fractured segments revealed stable fixation across the fracture sites while visual and quantitative assessment of radiograph showed healing process was comparable with results previously reported by titanium bone plates.

Conclusion:

Open reduction and internal fixation of mandibular fractures using bioresorbable fixation system with a brief period of inter-maxillary fixation have evolved to the point where the physical properties are sufficient to withstand the post-operative loads required for fracture repair of mandibular body fractures. The foreign body reaction is a major material-related problem which requires further studies.     

Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods: Early Clinical Outcomes and Implications

Background:

To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures.

Methods:

Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively.

Results:

At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion (ROM) of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. Compared with the contralateral hand, the grip strength of the injured hand was 94.0 ± 9.6%. X-rays showed that the arch of the second to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings.

Conclusion:

The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and fifth metacarpal fractures with good early clinical outcomes and no significant complications.     

Effect of Right Heart Systolic Function on Outcomes in Patients with Constrictive Pericarditis Undergoing Pericardiectomy

Background:

To determine the influence of right ventricular function in patients with constrictive pericarditis (CP) undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically.

Methods:

Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded.

Results:

A total of 58 patients with CP (36 received pericardiectomy, 22 managed medically), and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically (P = 0.003), and higher survival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery.

Conclusions:

Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.     

Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis

Background:

Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system.

Aim:

To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications.

Study Design:

Prospective non-randomized comparative study.

Materials and Methods:

Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ² test.

Results:

Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant (P = 0.609).

Conclusion:

Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.     

Early result of hemiarthroplasty in elderly patients with fracture neck of femur

Background:

Fractured neck of femur is a frequent and severe injury in elderly patients with consequent high morbidity and mortality. Hemiarthroplasty is an established treatment modality for displaced intracapsular femoral neck fractures in elderly patients above 60 years. This study analysed the early functional outcome and complications of Austin Moore endoprosthesis in elderly patients above 60 years with fractured neck of femur.

Materials and Methods:

Retrospective data were obtained over a 5 year period from January 2007 to December 2012. Thirty-five elderly patients of 60 years and above with displaced intracapsular fracture neck of femur treated with hemiarthroplasty using Austin Moore endoprosthesis were included. Data were analysed using SPSS version 21.

Results:

A total of 35 patients were involved. The age-range was 60-90 years with mean age of 69.7 ± 7 years. The predominant mechanism of injury was trivial falls in 18 (66.7%) patients. The commonest complication was pressure sore in 2 (5.7%) patients, followed by surgical site infection in 1 (2.9%) patient and periprosthetic fracture in 1 (2.9%) patients. Early post-operative mortality was 2.9%. Post-operative hip functional status according to Postel and Merle d Aubigne revealed that majority (66.6%) of patients had satisfactory hip function.

Conclusion:

Functional outcome of Austin Moore in elderly patients above 60 years with fracture neck of femur was satisfactory in most of the cases with minimal morbidity. Careful patient selection for hemiarthroplasty is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.     

Hepatitis C treatment – better outcomes through partner support

Background

Globally, it is estimated that 170 million people are living with hepatitis C and between three and four million are newly infected annually. In Australia, around 1% of people are living with chronic hepatitis C, with two-thirds of these being men.

Aims

This research aimed to determine the impact of hepatitis C treatment on partners of patients using in-depth exploratory techniques.

Method

Four infected men and their partners (n= 8 participants) and three service providers were recruited and interviewed separately to identify the needs of female partners supporting patients with Hepatitis C. Discussion was based on the experiences of female partners during the treatment phase of male hepatitis C patients.

Results

All participants recognised a need for greater assistance for partners of hepatitis C treatment patients. It was also recognised that strong social support improved treatment outcomes and helped to maintain the survival of family relationships during the intensive treatment phase.

Conclusion

Although this research was limited by size, it provides valuable insights into ways to enhance hepatitis C management outcomes beyond traditional medical treatment regimes, for example through formal partner support.     

Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

Background:The goal of total knee arthroplasty (TKA) is to restore knee kinematics.Knee prosthesis design plays a very important role in successful restoration.Here,kinematics models of normal and pros...     

Bacteriological evaluation for one-and two-piece implant design supporting mandibular overdenture

Background:

This study evaluated and compared the bacteriological effect of two-piece implants and one-piece implants in complete overdenture cases on supporting structures.

Materials and Methods:

Ten male completely edentulous patients were selected and randomly divided into two equal groups according to the implant design and surgical technique for this study; Group 1: Patients were rehabilitated with complete mandibular overdenture supported by two-piece implants one on each side of the lower arch following two-stage surgical technique and Group 2: Patients were rehabilitated with complete mandibular overdenture supported by one-piece implants one on each side. Evaluation was made at the time of insertion, 6, 12, and 18 months after overdenture insertion, by measuring bacteriological changes around implants abutments.

Results:

Complete overdenture supported by one-piece implants showed better effect on the bacteriological changes as compared to that supported by two-piece implants.

Conclusion:

Complete overdenture supported by one-piece implants one on each side of the lower arch showed better effect on the bacteriological changes than using the same prosthesis supported by two-piece implants.