Seventeen to Twenty Years of Follow-Up of the Low Contact Stress Rotating-Platform Total Knee Arthroplasty With a Cementless Tibia in All Cases

Background

Total knee arthroplasty designs can be categorized by bearing design and fixation method. The mobile-bearing concept was developed with the aim of increasing longevity and improving function by reduced polyethylene wear and closer replication of physiological knee motion. Cementless fixation has the goal of achieving a long-lasting “biological” fixation between prosthesis and bone.

髋臼加盖技术行全髋关节置换术治疗发育性髋脱位

目的探讨髋臼加盖技术行生物型全髋关节置换术(THA)治疗发育性髋脱位(DDH)的临床疗效。方法采用髋臼加盖技术行生物型THA治疗30例DDH患者(30髋),观察手术前后双下肢长度差异、髋关节旋转中心高度和水平距离、移植骨块与髂骨融合时间,记录术后骨溶解、骨长入、臼杯松动情况,采用Harris髋关节评分(HHS)评价手术疗效。结果患者均获得随访,时间24~60(38.8±16.9)个月。双下肢长度差异由术前11~55(25.3±17.2)mm下降到术后0~12(3.7±3.5)mm(P<0.001),髋关节旋转中心高度由术前35~65(46.1±16.7)mm下降到术后18~30(23.7±5.9)mm(P<0.001),髋关节旋转中心水平距离由术前35~55(42.8±8.9)mm下降到术后18~29(23.3±2.7)mm(P<0.001)。移植骨块与髂骨融合时间5~12(7.7±4.9)个月。HHS由术前39~65(41.8±14.8)分提高到末次随访时84~100(93.5±7.9)分(P<0.001)。至末次随访,无一例出现假体周围骨溶解,假体均获得骨长入固定。结论采用髋臼加盖技术行生物型THA治疗DDH,可获得满意临床疗效。     

Zweymuller非骨水泥型全髋关节置换术的临床应用体会

目的 :探讨Zweymuller非骨水泥型全髋关节置换术临床应用的有效性。方法 :应用Zweymuller非骨水泥型人工髋关节对 47例 ( 5 2个髋关节 )行置换手术。结果 :所有病例切口一期愈合 ,5 0个髋关节获得 5～ 72个月随访 ,无 1例出现假体脱位、松动等并发症 ,术后Harris评分由术前的平均 48 5分增至术后的平均 88 5分 ,髋关节功能优良率 94%。结论 :Zweymuller非骨水泥型人工髋关节假体的临床初期稳定性及初期随访效果满意。     

A Distal Fluted,Proximal Modular Femoral Prosthesis in Revision Hip Arthroplasty

Most reports on the use of modular femoral stems during revision surgery have involved short follow-up periods. The authors evaluated the clinical and radiographic performance of 59 patients fitted with a distal fix modular stem. The average follow-up period was 8.2 years. Average Harris hip score was improved from 47 to 87.6. Of 19 patients with trochanteric osteotomy, 4 had a displaced greater trochanter. Re-revision was performed in 5 patients, and 3 of these were for subsidence (of these 3, subsidence was associated with dissociation of the coupling part in 1 and with osteotomy nonunion in other 2 [proximal component only]). Modular distally fixed femoral stems were found to offer intraoperative flexibility, but to suffer from subsidence and intraoperative greater trochanter and metaphyseal femoral fractures.     

Durable Fixation With a Modern Fully Hydroxylapatite-Coated Long Stem in Complex Revision Total Hip Arthroplasty

We describe the use of a fully hydroxylapatite-coated long-stem femoral implant in a series of 40 complex revision total hip arthroplasties. All reconstructions involved severe bone loss or malalignment and were accomplished entirely without the use of augmentary bone graft. Outcomes were evaluated at 7 minimum years of follow-up (average, 10.2 years). Three stems were rerevised because of infection, trauma, and loosening with nonunion of a fracture. Bone ingrowth was radiographically evident by one postoperative year in all other cases. There were no cases of subsidence. Stress shielding with thigh pain was seen in one patient. The stem provided immediate stability and excellent long-term fixation in these reconstructions of severely diseased femurs.     

Distribution of Periacetabular Osteolytic Lesions Varies According to Component Design

Using computed tomography, the volume, location, and number of osteolytic lesions were determined adjacent to 38 Harris-Galante 1 (HG-1) acetabular components fixed with screws and 19 porous-coated anatomic (PCA) acetabular components press-fitted without screws. The median implantation times were 16 and 15 years, respectively. The mean total lesion volumes were similar: 11.1 cm³ (range, 0.7-49 cm³) and 9.8 cm³ (range, 0.4-52 cm³), respectively, for hips with HG-1 and PCA components (P = .32). There was a significant difference in the proportion of rim-related, screw or screw hole–related, and combined lesions between the 2 component designs (P < .0001). HG-1 components had more screw and screw hole–related lesions, and PCA components had more rim-related lesions. Although there are concerns regarding screw and screw hole–associated osteolysis, these findings suggest that peripheral fixation may be well maintained in the long term with the use of multiple-hole acetabular components with screw fixation.     

Removing a Well-Fixed Nonmodular Large-Bearing Cementless Acetabular Component : A Simple Modification of an Existing Removal Device

Removing well-fixed cementless acetabular components while minimizing bone loss has been facilitated by the use of a removal device featuring sharp curved gouges, specific to the outside diameter of the existing acetabular shell, mated to a femoral head designed to sit inside the acetabular liner. Nonmodular acetabular components with inner bearing diameters greater than 36 mm are to date not accommodated by femoral head sizes in this system. A simple modification, placement of a bipolar head matching the inner diameter of the fixed shell, allows use of this removal device for nonmodular shells.     

Cementless total hip arthroplasty for osteonecrosis of the femoral head after allogenic bone marrow transplantation

From 1998 until 2004, we performed 26 consecutive cementless total hip arthoplasties in 15 patients who had developed advanced avascular necrosis of the femoral head after allogenic bone marrow transplantation. The average age at transplantation was 31.1 years, and the mean age at implantation was 33.6 years. Follow-up period ranged from 2 to 8 years with an average of 56.4 months. The mean D'Aubigne-Postel score improved from 7.5 points preoperatively to 17 points postoperatively. The overall result was excellent in 92.3%, good in 3.8%, and fair in 3.8% of cases. There were no radiological signs of components loosening and no severe complications. Cementless total hip arthroplasty appears as a favorable alternative for the treatment of avascular necrosis of the femoral heads after allogenic bone marrow transplantation.     

Total hip arthroplasty for posttraumatic arthritis after acetabular fracture

Total hip arthroplasty (THA) outcomes for posttraumatic arthritis after acetabular fracture have yielded inferior results compared to primary nontraumatic THA. Recently, improved results have been demonstrated using cementless acetabular reconstruction. Thirty-two patients underwent THA for posttraumatic arthritis after acetabular fracture; 24 were treated with open reduction internal fixation, and 8 were managed conservatively. Time from fracture to THA was 36 months (6-227 months). Average follow-up was 4.7 years (2.0-9.7 years). Harris Hip score increased from 28 (0-56) to 82 points (20-100). Six patients required revision. Five-year survival with revision, loosening, dislocation, or infection as an end point was 79%. Survival for aseptic acetabular loosening was 97%. Revision surgery correlated with nonanatomic restoration of the hip center and a history of infection (P < .05). Despite obvious challenges, advances in fracture management and cementless acetabular fixation in THA demonstrate improved results for posttraumatic arthritis following acetabular fracture.