bluuebunny/crossref_metadata_2025 huggingface dataset:
Grading Choroidal Neovascular Membrane Regression after Strontium Plaque Radiotherapy; Masked Subjective Evaluation vs Planimetry
Authors: Jaakkola A. , Tommila P. , Laatikainen L. , Immonen I.
Published: January 2018

Purpose

To analyze angiographic changes in choroidal neovascular membranes (CNVM) after strontium-plaque (90Sr) irradiation for exudative age-related macular degeneration (AMD) using masked measurement of the CNVM areas and a masked subjective comparison of CNVM size and leakage.

Methods

We studied the baseline, 3, 6, and 12-month angiograms of 19 eyes treated with 90Sr-plaque irradiation for exudative AMD. The area of CNVM-related hyperfluorescence was measured quantitatively, and the angiograms were subjectively evaluated by a masked grader.

Results

In 7 of the 19 eyes the CNVM-related hyperfluorescence was too scattered to be analyzed by planimetry but masked subjective grading correlated with the clinical response to irradiation. In the remaining 12 eyes, the CNVM decreased in size in 67% of the eyes and showed leakage in 67%. Planimetry and subjective assessment of the size and leakage of the CNVMs similarly reflected the regression after irradiation.

Conclusions

CNVM size and leakage frequently diminish after 90Sr-plaque irradiation. Quantitative measurement of the CNVM areas, or a grading system based on masked subjective assessment, give similar results for evaluating these changes. Masked subjective grading can be used even in cases where the CNVM is too scattered to be outlined for planimetry.
Effect of Hormone Replacement Therapy on Ocular Hemodynamics in Postmenopausal Women
Authors: Atílla H. , Arslanpençe A. , Batioğlu F. , Eryilmaz T. , Aytaç S. , Özcan H. , Kurtay G.
Published: January 2018

Purpose

To evaluate the effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women.

Methods

Ocular Doppler ultrasonography was performed in 20 postmenopausal women on hormone replacement therapy (HRT) and in 20 women without treatment, as the control group. Central retinal artery (CRA), posterior ciliary artery (PCA) and ophthalmic artery (OA) flow velocities and vascular resistances were measured prospectively by a radiologist blinded to the therapy. There were no associated systemic or ocular diseases or any medication history.

Results

The mean age of the patients on HRT was 50.05 ± 4.5 yrs (range 44 - 62). The mean age of the control group was 52.8 ± 4.09 yrs (range 46 - 65). The mean duration of HRT was 1.6 ± 1.4 yrs (range 3 months - 5 years). There were no differences between the groups in terms of flow velocities, vascular resistivities or pulsatility indices of OA, CRA and PCA (p>0.05).

Conclusions

HRT is essential in postmenopausal women for relief of vasomotor symptoms, cardioprotection and prevention of osteoporosis. Even though vaso-occlusive complications of hormone preparations have been reported, we did not observe any changes in ocular hemodynamics detectable with Doppler ultrasonography.
Photodisruptive Nd:YAG Laser in the Management of Premacular Subhyaloid Hemorrhage
Authors: Çelebi S. , Kükner A.S.
Published: January 2018

Purpose

Premacular subhyaloid hemorrhage is usually a benign condition that generally improves spontaneously and rarely causes visual loss. However, because the hemorrhage may cause permanent macular changes before it resolves, Nd:YAG laser posterior hyaloidotomy may be indicated in selected cases. This study investigated the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser treatment.

Methods

This study was conducted between February 1996 and March 1999. Six patients had a circumscribed premacular hemorrhage in one eye and were treated with the Nd:YAG laser to drain the blood into the vitreous cavity. The hemorrhage originated from Valsalva retinopathy (2 cases), proliferative diabetic retinopathy (2 cases), central retinal vein occlusion (1 case), and blunt ocular trauma (1 case). The size of the hemorrhage is expressed in disc diameters.

Results

The mean pretreatment hemorrhage measured 5.7 disc diameters (range 3.5–8.0). Visual acuity in all cases before laser treatment was hand movement. After laser treatment, the hemorrhage instantly drained into the vitreous cavity, resulting in rapid improvement of vision. Drainage was complete within one week and visual acuity improved dramatically. The mean follow-up was 26.3 months (range 7–42 months). No retinal damage or rebleeding occurred due to the laser treatment, and vitrectomy was not required in any eye.

Conclusions

Nd:YAG laser posterior hyaloidotomy may be useful for draining a premacular hemorrhage into the vitreous cavity in selected cases. To establish this as a routine procedure, a randomized prospective study is needed to compare observation, primary vitrectomy, and Nd:YAG laser treatment.
Surgical Removal of Subfoveal Choroidal Neovascularization: Visual Outcome and Prognostic Value of Fluorescein Angiography and Optical Coherence Tomography
Authors: Brindeau C. , Glacet-Bernard A. , Coscas F. , Mimoun G. , Boukhli L. , Coscas G. , Soubrane G.
Published: January 2018

Purpose

To study the functional results of macular surgery and determine pre-operative features associated with better final visual outcome.

Methods

Forty-two consecutive patients underwent surgical removal of subfoveal choroidal neovascularization (CNV), related to age-related macular degeneration (AMD) in 8 eyes, degenerative myopia in 14 eyes, multifocal choroiditis (MFC) in 10 eyes, idiopathic CNV in 6 eyes and other etiologies in 4 eyes. Mean age was 49 years. Pre-operative visual acuity (VA) was 20/200 or less in 30 eyes (71.4%) and never better than 20/40. Fluorescein angiography was analyzed before and after surgery. Pre-operative optical coherence tomographs (OCT) were studied in a masked fashion. Mean follow-up was 12 months (range 4–48 months).

Results

Final VA was 20/200 or less in 25 eyes (60%). According to the CNV etiology, the percentage were 87.5%, 80%, 57.1% and 20% respectively in eyes with AMD, MFC, high myopia, and idiopathic or other diseases. Post-operative VA improved in 21 eyes (50%) but subsequently declined in 7% by the final examination. Patients younger than 50 years had better functional results (p=0.006). Lack of retinal pigment epithelium (RPE) changes on pre-operative angiography was correlated with good visual outcome (p<0.001). The OCT study confirmed some features already described and showed some different CNV patterns: above and usually separated from the RPE, below and not separated from the RPE, and ungradable. Eyes with the first OCT pattern had the best visual outcome. Main complications included 4 (10%) retinal detachments and 9 (21%) recurrences. OCT was also useful to confirm CNV recurrences post-operatively.

Conclusions

CNV surgical excision results vary depending on the underlying disease, the RPE and choriocapillaris function, and the features observed on pre-operative OCT images.
Ultrastructural Study of Primary Lacrimal Adenocarcinoma
Authors: Gong H. , Hayashida H. , Kitaoka T. , Amemiya T.
Published: January 2018

Purpose

Primary adenocarcinoma of the lacrimal gland is a rare malignant tumor of the orbit. Up to now, there has been no presentation of its ultrastructural features. The histopathological findings and fine structures of one case of adenocarcinoma of the lacrimal gland are described in the present work.

Methods

The patient was a 59-year-old Japanese man with proptosis that had persisted for one month. A tumor was extirpated, and the tissues were prepared for light and electron microscopic examination.

Results

Electron microscopic examination demonstrated that the tumor cells had well-developed microvilli and lumens. These ultrastructure features are similar to those seen in adenocarcinomas at other sites.

Conclusions

These observations suggest that the accurate diagnosis of rare malignant adenocarcinoma depends not only on routine techniques such as light microscopy of hematoxylin-eosin and PAS-diastase stained slides, but also on electron microscopic findings.
Intraocular Invasion by Malignant Orbital Fibrous Histiocytoma: A Case Report
Authors: Marback E.F. , Marback P.M.F. , Sento SÉ D.C. , Marback R.L.
Published: January 2018

Purpose

To present a case of intraocular invasion by an orbital malignant fibrous histiocytoma.

Methods

Case report.

Case Report

An 84-year-old man was exenterated due to a malignant fibrous histiocytoma of the right orbit. On image investigation and histologic sections, the tumor entirely filled the right eye and orbit. The patient died of intracranial spread of the lesion.

Conclusions

Fibrous histiocytoma of the orbit can invade the eye.
Femoral Impaction Bone Grafting with the Elite plus Stem
Authors: Robinson D. E. , Lee M. B. , Smith E. J. , Learmonth I.D.
Published: January 2018

This study evaluates the results of impaction grafting of the femoral stem with the Elite Plus system (DePuy, Leeds, UK) in revision hip arthroplasty with irradiated allograft. Nineteen hips in 19 patients (12 men and 7 women), at an average age of 59 years were followed for an average of 33 months. Endo-Klinik grading of bone stock loss was 5 grade 1, 6 grade 2, 8 grade 3 and no grade 4. Radiographic analysis revealed evidence of graft incorporation in 32% but no evidence of trabecular remodelling or cortical repair. Four patients have undergone revision of the femoral stem, one patient died while awaiting revision and one patient is unfit for revision. Most complications occurred in patients classified as Endo-Klinik grade 3. We found that impaction grafting with the Elite Plus system was associated with a high failure rate, especially in those cases with more severe bone stock loss.
Primary Total Hip Arthroplasty Using a Grit-Blasted, Press-Fit Femoral Prosthesis. Long-Term Results with Survivorship Analysis
Authors: Grappiolo G. , Blaha J.D. , Gruen T.A. , Burastero G. , Spotorno L.
Published: January 2018

Background

This report presents the initial experience with the use of a grit-blasted, press-fit femoral prosthesis.

Methods

The first 300 consecutive primary total hip arthroplasty procedures using a collarless, three-dimensional tapered, straight, titanium alloy stem with a grit-blasted surface (performed in 299 patients) were evaluated with independent clinical and radiographic follow-up examinations up to sixteen years. Eight different types of acetabular components, including a cementless all-polyethylene socket in 80 percent of the cases, were used. Radiographic evaluation, performed by an independent observer using a zonal analysis method, included assessment of component migration, Engh's implant-bone femoral fixation score, implant-bone demarcations, and periprosthetic osteolysis. The average duration of long-term radiographic follow-up was 12.6 years (range; 10 to 16 years).

Results

At last examination only five hips were lost to follow-up and 69 patients were deceased. The overall mechanical failure rate (i.e. unstable with or without revision) of the femoral component was 2 percent. The femoral revision rate was 7 percent (two hips for aseptic loosening, five hips for septic loosening, and twelve hips with osseointegrated stems for severe progressive femoral osteolysis) and the acetabular revision rate was 27 percent (revised for either socket migration or progressive peri-acetabular osteolysis or both). Survivorship, based on any revision (femoral or acetabular) was 89 percent at ten years and 62 percent at fourteen years; survivorship of the femoral component was 95 percent at ten years and 90 percent at fourteen years. The incidence of femoral periprosthetic osteolysis, by radiographic examination at ten years or more was 47 percent, including 12 hips (5 percent) with distal endosteal osteolysis. Femoral implant-bone fixation was stable, bone-ongrowth in 97 percent; stable, fibrous-fixation in 1 percent, and unstable, fibrous-fixation in 2 percent of the cases.

Conclusions

The grit-blasted, press-fit, collarless, tapered femoral component continued to perform well clinically and radiographically up to sixteen years of follow-up despite the challenging environment of periprosthetic osteolysis associated with the acetabular component design. The high incidence of failure among the cementless all-polyethylene sockets was not unexpected and the use of this acetabular implant was discontinued in 1985. While considered a “first-generation” cementless stem, this implant is still in use virtually without design modifications. This study demonstrates the durability of the results of the grit-blasted femoral component and indicates that such an implant offers a viable alternative for fixation without bone cement.
Cross-Linking to Improve Thr Wear Performance
Authors: Crowninshield R.D. , Laurent M.P. , Yao J.Q. , Bhambri S.K. , Gsell R.A. , Gilbertson L.N. , Swarts D.F.
Published: January 2018

Polyethylene wear and associated osteolysis can limit the longevity of total hip replacement. In recent years, many improvements have been made in the consolidation, manufacture, and sterilization of polyethylene acetabular components. These improvements provided reduced polyethylene wear and prolonged usefulness of total hip replacement. Recent advances in extensively cross-linking polyethylene offer the possibility to substantially further reduce wear in total hip replacement. Hip simulator wear testing demonstrates an order of magnitude reduction in wear resulting from cross-linking GUR 1050 polyethylene by exposure to 100 kGy of electron beam radiation followed by annealing to encourage cross-linking and to reduce residual free radicals. Clinical investigation will be required to validate the wear advantage of these materials in vivo.
Arthroplasty in High Grade Congenital Hip Dislocation: Personal Experience and Review of the Literature
Authors: Randelli F. , Randelli P. , Visentin O. , Monteleone M. , Brianza G. , Randelli G.
Published: January 2018

Total hip arthroplasty (THA) in congenital high grade hip dislocation often represents a problematic issue. Reviewing their selected cases and literature data, authors focus on some key points for this demanding surgery. Most important steps are acetabular positioning and surgical approach (exposure and release).

We used two different cups, the Zweymuller and the Wagner cup, with good primary stability. A Conus stem (Wagner) or an Alloclassic stem (in less displastic femoral shape) were used.

We always performed this surgery as a one step procedure.

In the same cases a shortening femoral osteotomy was performed to allow refractory reduction.

Possible complications are discussed.
Bipolar versus Total Hip Arthroplasty in the Treatment of Avascular Necrosis of the Femoral Head in Young Patients
Authors: Scheerlinck T. , Dezillie M. , Monsaert A. , Opdecam P.
Published: January 2018

The authors evaluate medium-term results of bipolar and total hip arthroplasty as a treatment for avascular necrosis of the femoral head. Between 1990 and 2000, 57 hips (45 patients) were treated with a bipolar (BHA: 37 hips) or total hip arthroplasty (THA: 20 hips) depending on the radiographic and macroscopic aspect of the acetabulum. At surgery, all patients were under 65 years of age (average: 45.09 years). All had the same cementless hydroxylapatite coated femoral stem inserted through an anterolateral approach. The BHA were followed during a mean of 4.49 years. One BHA was lost to follow-up. Seven out of 36 hips (19.44%) were considered failures: three due to a poor functional result (Harris Hip Score (HHS) <70) and four which needed conversion to THA for groin pain. Two hips were revised for periprosthetic fracture. Twenty BHA (55.56%) had a good or excellent result (HHS 80).

The THA were followed for a mean of 4.32 years. One THA was lost to follow-up. Four out of 19 hips (21.05%) were considered as failures. Three due to a poor functional result (HHS<70) and one which needed cup revision for recurrent dislocation. Fifteen THA (78.95%) had a good or excellent functional result (HHS80).

BHA as a treatment of avascular necrosis of the femoral head in young patients preserves bone stock for later revisions and can lead to excellent results. But the outcome seems less predictable than after THA. Groin pain associated to BHA can be treated successfully with conversion to THA if necessary.
Mechanical Stability of Custom and Anatomical Femoral Stems: An Experimental Study in Human Femora
Authors: Aamodt A. , Lund-Larsen J. , Eine J. , Andersen E. , Benum P. , Husby O. Schnell
Published: January 2018

In this study we have compared the mechanical stability of custom (n=8) and anatomical (n=8) uncemented femoral components, following insertion into human cadaveric femurs, during simulated single leg stance and stair climbing. In the custom group two specimens were excluded from the study due to detachment of the greater trochanter during cyclical loading. As a consequence of their mechanical behaviour both types of stems could be divided into subgroups of “unstable” and “stable” implants. In the course of one thousand loading cycles three anatomical stems and one custom stem migrated more than 1 mm, which was interpreted as mechanical loosening. This difference in rate of mechanical loosening was not significant. However, the majority of the stems were remarkably stable and showed micromotion of less than 18 μm and migration of less than 35 μm at the proximal implant-bone interface. The corresponding figures for the tip of the stems were 243 μm and 170 μm, respectively. During torsional loading the custom stems showed less rotatory motion than the anatomical stem (p<0.05). There were no significant differences in the magnitude of cyclical micromotion or migration for the two types of femoral stems.
Long-Term Survival of Stanmore Total Hip Replacements Inserted with Radiolucent Bone Cement
Authors: Wimhurst J.A. , Hobby J.L. , Roberts C.P. , Gibbs A.N. , Deliss L.J. , Rushton N.
Published: January 2018

Radio-opacifiers in bone cements are an accepted part of every-day practice. They have, however, been shown to be a potential cause of an increase in third body wear and to excite bone resorption in in vitro and in vivo studies.

We reviewed the results of 228 consecutive Stanmore total hip replacements performed between 1981 and 1985 in 211 patients. All were inserted with radiolucent bone cement. Information regarding whether the prosthesis had been revised was available for all patients. Seventy-three patients (83 hips) were still alive and 41 patients (44 hips) were sufficiently healthy to attend clinic. Information regarding pain level was obtained from the remaining 32 patients. When revision of the implant was taken as the end-point, there was 95% ten-year survival, 91% fifteen-year survival and 75% eighteen-year survival. These long-term results of Stanmore THRs, performed in a district general hospital, with radiolucent bone cement, compare favourably with the other published series for this implant. We did not find the inability to see the bone cement a particular disadvantage when reviewing radiographs for signs of loosening.
Impacted Morsellised Allograft and Cemented Cup in Acetabular Revision Surgery. A Five to Nine Year Follow-Up Study
Authors: Garcia-Cimbrelo E. , Cordero J.
Published: January 2018

Seventy cemented cups associated with impacted morsellised allograft in revision surgery in hips with an acetabular bone defect greater than 30% (Paprosky Grades 3A and 3B) were analyzed. The mean follow-up was 6.8 years. One hip showed cup migration and was re-revised; this represents a total cumulative probability of re-revision of the cup of 1.4 ± 2.8%. Radiolucent lines were uncommon: six cups showed radiolucent lines in DeLee and Charnley zone 1, five in zones 1 and 2, one in all three zones, while one hip showed migration. Although the frequent use of a metallic mesh makes graft remodeling difficult to evaluate, six hips showed minor and one major bone resorption. The midterm results with impacted allograft and cemented all-polyethylene cups are favourable in acetabular revision surgery.
Total Hip Arthroplasty in Neglected Congenital High Dislocation of the Hip. A Comparison of Four Different Surgical Techniques
Authors: Atlihan D. , Bozkurt M.
Published: January 2018

The safest and easiest technique of performing a total hip replacement (THR) in neglected high congenitally dislocated hip (CDH) is still debatable. To find the best method, a prospective randomised trial comparing four different techniques was undertaken. A total of 48 THRs were performed on 40 patients with CDH. Average age was 40.6 years and average follow-up was 42 months. Four different techniques (n=12 each) were used: 1) THR into neo-acetabulum in a single operation, 2) THR into real acetabulum as a one stage procedure, 3) Campbell release operation followed by THR into real acetabulum after three weeks of traction, 4) THR with proximal femoral shortening. Even though shortening and one stage THR is technically more demanding we believe it superior to the other techniques.
Fixclips™ - biological internal fixator for upper femoral osteotomies in cerebral palsy
Authors: Vadivelu R. , Baker A. S. , Clegg J.
Published: January 2018

We describe the technique and results of 63 proximal femoral osteotomies in 39 cerebral palsy patients performed with the Fixclip™ (Corifix, Cirencester, UK) internal fixator system. Post-operative splintage was determined by soft tissue requirements and not to protect the femoral osteotomy. Three patients needed revision surgery for readjustment of the device and two patients had superficial infections. All osteotomies except one healed by 12–16 weeks. There were no mal-unions, or avascular necrosis. One patient had a non-union that united after revision surgery. The Fixclip system is modular and easily adjustable. The fixation, sitting just off the bone, is less disturbing to the periosteal blood supply and lateralises the fixation, like a wave plate, to load both the medial and lateral femoral cortices on weight-bearing. Compared to the other available fixation implants, Fixclips are biologically and mechanically very effective and well suited in cerebral palsy patients where rigid fixation with a plate can cause extensive loss of bone mass.
Cementless Mallory Head Ha-Coated Femoral Prosthesis in Primary Total Hip Arthroplasty: Clinical and Radiological Results of a Four to Nine Year Prospective Study
Authors: Gosens T. , Van Langelaan E.J.
Published: January 2018

We prospectively studied 152 hips in 126 patients with a proximally porous and hydroxyapatite coated double tapered straight femoral prosthesis. The follow-up period was 4.2 to 9.6 years. All but two prostheses showed osseo-integration. The mean Harris hip score (HHS) increased from 40 to 92 points and 97% of the patients had no or only mild pain. Limping and the use of walking aids decreased substantially after the operation. The morphology of positive bone remodelling with either endosteal bone formation or periosteal bone formation was correlated with the stem fit in the medullary canal (p=0.0001). Negative bone remodelling features could not be demonstrated. There was no correlation between the clinical parameters and the radiological phenomena.
Impaction Allografting for Femoral Revision Hip Arthroplasty. Mid-Term Results after Minimum Five Year Follow-Up in 46 Cases
Authors: Lind M. , Krarup N. , Petersen L.G. , Mikkelsen S. , Hørlyck E.
Published: January 2018

Previously, only short-term follow-up results after femoral revision using impacted allograft and cemented stems – the exchange technique – have been published. We present the results of 46 femoral exchange revision procedures performed on 42 patients with five to nine years follow-up. At follow-up, five patients had died and two patients did not complete follow-up. Two patients were re-revised. One patient underwent re-revision due to early collapse of the impaction construct. In another patient, stem loosening due to acetabular revision occurred and a full re-revision of the impaction area was performed. One patient suffered late post-operative femoral fracture and three patients experienced hip dislocations. Ninety percent expressed satisfaction with the result. Harris Hip Score (HHS) improved from 36 to 82 (p < 0.001). Radiographically, one patient demonstrated stem subsidence of greater than 5mm. Eighty-six percent demonstrated signs of graft incorporation and only one patient demonstrated signs of loosening. Our results after a minimum of five years’ follow-up of patients surgically treated with the exchange femoral revision technique demonstrated good clinical and radiological results. With a re-revision rate of 4.3%, one case with subsidence exceeding 5 mm and one case with diaphyseal fracture, we did not observe the problems of subsidence and femoral fractures described in previous studies.
Uncemented Custom-Made Femoral Components
Authors: Mohan B. , Nixon J.R. , Doran E.
Published: January 2018

We present our experience of total hip replacement (THR) in younger patients using a custom-made smooth titanium alloy femoral prosthesis. Measurements made from pre-operative marker radiographs allowed creation of templates and subsequent computer analysis to mill the stem prior to surgery.

Fifty-one such cementless implants were carried out in 43 patients between January 1993 and June 1996 with follow-up to an average of 47 months. Sixteen hips have required revision to date; 13 of these operations were for aseptic loosening. Two more were awaiting revision, giving an overall failure rate of 35.3 %. The average duration from primary operation to revision was 47 months.

Thus, even though the concept of an uncemented custom-made femoral component is attractive, the failure rate was found to be unacceptably high. This device may achieve “fit and fill”, but adequate bone on- or in-growth was not achieved. On the basis of these data we have discontinued the use of this implant since 1996.
Failure of an Uncemented Press-Fit Acetabular Cup in Primary Total Hip Arthroplasty
Authors: Mohan N. Rama , Grigoris P. , Hamblen D.L.
Published: January 2018

We reviewed fifteen primary total hip replacements performed using the uncemented, non-porous coated press-fit AcSys Shearer Cup. A modular titanium straight femoral stem with a 32mm head was used in all cases. The mean age of the group containing five males and 10 females was 66 years. Eight cups have been revised for aseptic loosening at a mean of seven years and the remaining four cups are radiologically loose. At revision surgery none of the cups showed any evidence of bony ingrowth.

Our 10-year results with this cup indicate an unacceptably high failure rate of 80%. Absence of bony ingrowth and the lack of a secure locking mechanism between the polyethylene liner and the metal shell are the most important causes of failure. The use of a 32mm diameter head and implantation of the cup in an open position contributed to this failure. Even though this cup is no longer manufactured, our experience suggests that all non-porous coated cups should be closely followed up.
Histologic and Ultrastructural Analysis in a Case of Massive Failure of Zirconia Ball Head
Authors: Maccauro G. , Petrella L. , Proietti L. , De Santis V. , Piconi C.
Published: January 2018

The in vivo histological and ultrastructural analysis of periprosthetic tissue collected at time of revision surgery for failure of a 28 mm yttria-tetragonal zirconium oxide polycrystal (YTZP) ball head, 2 years after implantation is reported. Histologic analysis showed Zirconia particles, rounded to polygonal ranging from 2μm to more than 10μm intra or extra cellular in a stroma without vessels with few giant cells. Scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDAX) showed the different shape from rounded to polygonal of Zirconia. SEM analysis of the internal part of Zirconia ball head showed the presence of different fracture lines especially in the internal surface
Giant Synovial Cyst Causing Femoral Occlusion following a Hip Replacement
Authors: Farrington W.J. , Lewis P. , MacEachern A.G.
Published: January 2018

Long-term follow-up of total hip replacements (THR) is essential for accurate recording of complications associated with this procedure, in particular the occurrence of wear and aseptic loosening which may warrant revision surgery.

A significant proportion of patients with aseptic loosening are asymptomatic and radiological signs may be subtle and easily missed. Occasionally a synovial cyst can develop as a result of polyethylene wear debris and aseptic loosening. These cysts are usually small but can expand and become symptomatic. We describe a case where a large cyst caused sufficient extrinsic compression of the femoral vein as to occlude it. This was a potentially life-threatening complication. We emphasize the importance of clinical examination for leg swelling and groin mass in routine surveillance of total hip replacement.
Dual Aetiology Hip Pain Requiring Total Hip Arthroplasty in Hereditary Multiple Exostoses: A Case Report and Review of the Literature
Authors: Annapureddy S.R. , Chapman T.W.L , Charnley G.J.
Published: January 2018

We report a case of hereditary multiple exostoses (HME) presenting with avascular necrosis of the femoral head and mechanical impingement of an exostosis treated by total hip replacement.
A Simple Technique for Defatting Morsellised Bone Graft in Revision Hip Arthroplasty
Authors: Chapman T.W.L. , Charnley G.J.
Published: January 2018

A method for producing fat-free, non-saline laden morsellised bone graft for use in revision hip arthroplasty is described. The method is easily performed, requires inexpensive and readily available equipment and, we believe, reduces loss of bone graft compared with alternative techniques.
Results of Impaction Grafting in Revision Hip Arthroplasty at Two to Seven Years using Fresh and Irradiated Allograft Bone
Authors: Bankes M.J.K. , Allen P.W. , Aldam C.H.
Published: January 2018

The 2- to 7-year follow-up on 41 revision femoral arthroplasties performed using the impaction grafting technique and a collarless, polished, tapered stem is reported. Average age at surgery was 70 years (range 35 - 85) and femoral bone loss was Endoklinik grade 1 in 13.5%, grade 2 in 43.3%, grade 3 in 29.7% and grade 4 in 13.5%. Four patients died during the study period, three with well functioning implants and one with deep infection. Another implant had failed by 1 year with progressive subsidence and periprosthetic fracture and has been revised. Cumulative survival of femoral stems was 92% at 5 years. There were no dislocations. At latest follow-up (average 4 years) 86% of patients were satisfied and greatly improved with surgery (mean Harris hip score 75.1). Favourable radiological features of graft incorporation were observed in 77.5%. Although the follow-up period for the group receiving irradiated bone was slightly shorter, there was no significant difference in clinical or radiological outcomes between 20 patients who received fresh frozen allograft bone and 18 patients who received frozen irradiated allograft bone.
Mid-Term Results with the Porous-Coated Anatomic Hip Prosthesis with 28mm Head. An Eight to Twelve Year Follow-up of 39 Hips
Authors: Laursen J.O. , Mossing N. B. , Myrthue G.
Published: January 2018

In the 1980s, uncemented prostheses were considered advantageous in younger patients. One of the prostheses used in Denmark was the Porous Coated Anatomic (PCA) prosthesis. Follow-up results from Aarhus University Hospital (AaUH) showed progressive osteolysis along the stem at five to seven years, and use of the prosthesis was no longer recommended.

We used the PCA prosthesis with a modular 28mm head, and so far our results with patients operated on between 1989 and 1993 do not confirm the negative results published. Thirty-nine consecutive cases were followed prospectively with clinical and radiographic assessment.

At the 8–12 year follow-up four patients had undergone revision. Three revisions were for aseptic loosening of the cup at 5, 10 and 12 years, and one was because of thigh pain without radiological signs of loosening at revision. The cumulative survival rate was 95% at five years, 92% at ten years and 85% at twelve years. If we include radiologically loose components, five cups were re-operated or radiographically loose (12.8%) and 4 stems were re-operated or radiographically loose (10.2%). Thus the survival rate at 12 years was 85% and 90% for cup and stem respectively. So far we have not experienced progressive radiographic changes.

The difference in results may stem from the fact that we used 28mm heads (versus 32mm heads in the Aarhus series), which allows a more adequate polyethylene thickness and thereby lesser creep of the polyethylene and less polyethylene debris production.
Subsidence Pattern of Charnley Cemented Femoral Revisions with Impacted Morcelised Bone After a Follow-up of Two to Twelve Years
Authors: Valle A. González Della , Comba F. , Pusso R. , Piccaluga F.
Published: January 2018

We quantified the subsidence in 56 of 59 consecutive Charnley femoral revisions with impacted morcelised bone, after 57 months of follow-up (range 48–144). Subsidence was measured on AP radiographs obtained at regular intervals. Subsidence was analysed together with the development of radiographic loosening or need for re-revision subsidence. During the first two years it was compared with that of 50 Charnley primary arthroplasties. In forty-five revisions no subsidence was detected, and 11 had subsided an average of 6 millimeters (range 2–20). Among 52 successful revisions, 45 had no subsidence detected and 7 subsided less than 5 millimeters (average 2.42; range 2–4). All 4 failed revisions subsided (average: 12 millimeters; range 2–20). The difference between successful and failed revisions was significant (p=0.009). At 2 years of follow-up, 9 revisions and 2 primary arthroplasties had subsidence detected (p=0.14). Subsidence detected after the second year was observed in all failed revisions and in only one successful. Subsidence in successful Charnley revisions is restricted to less than 5 millimeters and occurs during the first two postoperative years. The different subsidence pattern between revision and primary arthroplasties suggests that limited subsidence of the grafts occurs, predominantly during the first two years.
Mechanical Prophylaxis: Bacterial Colonisation and Sterilisation
Authors: Oakley M.J. , Perry J.D. , Jones A.L. , Morgan S. , McCaskie A.W.
Published: January 2018

Mechanical forms of deep venous thrombosis (DVT) prophylaxis have been shown to be effective. One factor that has reduced their widespread acceptance is the relatively high cost. Multi-use would greatly reduce the cost but could increase risks of cross-infection.

We have investigated the bacterial load on boots after a single use and identified many species of bacteria including multi-resistant strains and others implicated in hospital-acquired infection. These could represent a considerable risk during multi-use.

In the second part of the study we have investigated ways of sterilising the boots and have found ethylene oxide to be a low cost and completely effective method of sterilisation.
Extension of an Aerosol Cloud produced by an Ultrasound Cement Removal System
Authors: Mayr E. , Lass-Flörl C. , Rachbauer F. , Walochnik N. , Bach C. , Nogler M.
Published: January 2018

Ultrasound devices are in use for cement extraction in cemented revision total hip arthroplasties. These instruments vibrate at a high frequency. In contact with fluids they have the potential to produce an aerosol cloud. In case of infected or colonized patients this can be a source of environmental and body contamination for the surgical team. 12 standardized cuts in cement blocks were performed with an ultrasound device. Irrigation fluid was contaminated with Staphylococcus aureus ATTC 12600. Contamination was detected using standard cultures. Bacterial growth was seen in a 5 × 7 m area. Extension was comparable to aerosol contamination produced by high speed cutters in spinal surgery as well as in hip arthroplasty, yet, concentration was lower. Ultrasound devices, such as the one tested, can produce aerosol clouds that can cover the whole operating room and potentially contaminate the surgical personnel. The same protection is necessary for everybody in the operating room for ultrasound devices as for high-speed cutters.
Proximal Femoral Epiphysiolysis Secondary to a Femoral Neck Fracture
Authors: González-López J.L. , Soleto-Martín J. , Quirós R. López-Casero
Published: January 2018

Fractures of femoral neck in children present serious problems related to the fracture itself, or secondary to delayed and inadequate treatment. Urgent and appropriate treatment is therefore required. We present one case in which late diagnosis and inadequate treatment resulted in a varus union of a cervicotrochanteric fracture that seriously increased the shear forces, thus causing a chronic proximal femoral epiphysiolysis with an evolution similar to that seen in adolescents. This requires early surgical treatment and stable internal fixation with a functionally good medium-term result.
Analysis of the Factors that Predispose to Wear with a 32mm Femoral Head at 5–15 Year follow-up: Clinical and Radiographic Assessment of the Harris-Galante cup at 5–15 Year follow-up
Authors: Katsimihas M. , Katsimihas G. , Lee M.B , Learmonth I. D.
Published: January 2018

The clinical and radiographic features of 109 consecutive hybrid total hip replacements performed between 1986 and 1992 in 96 patients were retrospectively reviewed. A cementless Harris-Galante (HGP1) cup and a 32mm monobloc straight Muller stem were used in all cases. At an average 10.11 (range 5 to 15) years following surgery, the excellent durability of fixation of the Harris-Galante cup has been demonstrated with only one cup (0.9%) revised for periacetabular osteolysis and aseptic loosening. The prevalence of polyethylene wear was 27.4%. The mean annual linear wear rate was 0.063mm (range 0.00–0.53mm).

There was a significantly increased wear of polyethylene inserts with an outer diameter < 52mm (<10mm polyethylene thickness), (ANOVA Test). However, there was no association found between acetabular liner wear and the following factors: underlying diagnosis, Charnley grade, age, weight and sex of the patient. The Harris Hip Score ranged between 5 and 54 pre-operatively and the average HHS was more than 80 post-operatively with more than 70% of patients pain-free. A liner with a thickness of 10mm or greater may prove beneficial in the prevention and reduction of wear rate particularly in young patients. It is recommended that all patients with this cup design, in which a polyethylene insert that is less than 10mm thick is coupled with a 32mm head, should continue to be regularly followed up.
Early Detection of Occult Fractures around the Hip with Magnetic Resonance Imaging
Authors: Della Valle A. González , Ibáñez U. Macea , Buttaro M. , Rolón A. , Piccaluga F.
Published: January 2018

Hip fractures may not be evident on initial radiographs but can be demonstrated with special imaging studies. These “occult fractures” can displace if not promptly treated. In a four-year period, 34 occult fractures around the hip in 33 patients were diagnosed in one general hospital. There were 6 men and 27 women, with a mean age of 74 years (22/92). The medical records and imaging studies were retrospectively reviewed. Two patients presented with a displaced femoral neck fracture one month and 10 days respectively after a fall and initial radiographs resulting normal. In the remaining 31 patients with normal radiographs, 30 fractures were detected with MRI obtained at an average of 6.8 days (0/35) from the onset of symptoms, and one with bone scan. Treatment consisted in partial weight-bearing or surgery, depending on the location and displacement of the fracture. Fractures united in all patients treated non-operatively and in those treated with internal fixation. One patient with a displaced fracture underwent a hip arthroplasty. At an average follow-up of 16.7 months (6/46) all patients remained ambulatory. In a selected group of patients with high suspicion of hip fracture, full-sequence MRI proved to be useful for early diagnosis and localization of an occult fracture around the hip.
Our Experience with the SL-Plus Cementless Stem: Mid-Term Results
Authors: Hart R. , Buček P.
Published: January 2018

The authors reviewed the mid-term results of 474 SL-Plus stems performed on 342 patients with primary and secondary osteoarthritis. The average age at the time of operation was 60.5 years (range, 17 to 81 years) and the average duration of follow-up was 60 months (range 25 to 96 months). The average Harris hip rating was 44 points (range, 30 to 58 points) before and 85 points (range, 72 to 94 points) after the operation. Good or excellent outcomes were observed in more than 90 per cent of the hips, with an average pain score of 43 points and average function score of 45 points.

Two incomplete intra-operative fractures of the proximal femur were successfully treated by cerclage fixation. Five fractures of the greater trochanter were encountered. Dislocation occurred in five hips, one of which required revision to a captive polyethylene insert. Late infection with loosening of the femoral component occurred in one case.

Radiological assessment identified one loose stem, but the patient refused surgical revision. Lower values for metaphyseal and diaphyseal fill observed in 31 cases had no correlation with implant stability and outcome. No progressive subsidence was detected except for one loose femoral component. Seventy-four hips revealed radiolucent lines at the bone cement interface. These were always less than 2mm.

These mid-term results seem promising and authors hope that the long-term outcomes will be equally gratifying.
Mechanical Strength of Used Ceramic Femoral Heads
Authors: Thomsen M. , Breusch S.J.
Published: January 2018

Twenty retrieved 32mm alumina ceramic femoral heads were investigated for surface structure or mechanical strength. All heads were retrieved at revision hip surgery after (on average) eight and a half years in vivo. In all cases cementless stems (titanium-alloy) and spherical acetabular components with a polyethylene inlay had been used. For surface analysis EDX analysis and scanning electron microscopy were used. Fracture strength of the heads according to ISO 7206–5 was measured and a fracture analysis was performed. Frequently appositional metal marks on the ceramic surface were found. These were allocated to three zones. Depending on surface zone different metal composites were detected. Their possible origin and relevance are discussed. The fracture strength ranged from 46 kN to 104 kN. Ceramic femoral heads of high quality seem to maintain a high degree of fracture strength for a considerable period after implantation.
Flagpole Femoral Prosthesis Trial: An Aid to Leg Length Equalization in Revision of the Deficient Proximal Femur
Authors: Roberts P.J. , Gregson P.A. , McGeoch C.
Published: January 2018

Obtaining soft tissue balance and correct tension across a total hip arthroplasty can be challenging. This is particularly so following revision of a proximally deficient femur. Although stability of the hip arthroplasty is the paramount concern, limb length inequality is a consideration that is of importance to both surgeon and patient. We describe a novel adaptation in instrumentation to help the surgeon faced with these problems when using cemented Exeter components.
Acetabular Erosion following Cemented Titanium Thompson's Hemiarthroplasty: A Case Report and Review of the Literature
Authors: Temple A.J. , Reading A.R.
Published: January 2018

Thompson's hemiarthroplasties are in widespread use, and acetabular erosion is a reported complication. We report on a case where a titanium prosthesis was used, with the later development of acetabular erosion, and the management of this complication. Whilst no link between the use of titanium and subsequent complications is proven in this case, it is a factor to be aware of when implanting Thompson's prostheses made of titanium, particularly in the younger patient.
Mechanical causes of osteoarthritis in young adults
Authors: Hofmann S. , Tschauner CH. , Graf R.
Published: January 2018

Femoroacetabular impingement is a very common cause of secondary osteoarthritis (OA) in the young adult. It is an important co-factor in the better recognized prearthritic deformities such as residual hip dysplasia (RHD), Perthes disease and slipped capital femoral epiphysis (SCFE). Another subgroup of patients has isolated malrotation of the hip joint and/or reduced femoral head-neck offset causing femoroacetabular impingement and chronic hip joint pain. Special clinical tests and imaging modalities can identify these patients at an early stage when they have little or no OA. The common biomechanical pathway for deformities causing chronic femoroacetabular impingement is local damage of the capsular-labrum complex and the cartilage. Understanding the anatomy, biomechanics and pathophysiology of these conditions of the hip joint is a prerequisite for planning treatment.
Wear of Historical Polyethylenes in Hip Prostheses. Biomechanical Success and a Biological Failure
Authors: Ingham E. , Fisher J. , Stone M.H.
Published: January 2018

Polyethylene wear debris induced osteolysis is a major cause of failure in artificial hip joints. Sub micrometre size particles are taken up by macrophages which are stimulated to release osteolytic cytokines such as TNFα. This leads to bone resorption, loosening and failure. In vitro cell culture studies have shown particles in the size range 0.1 to 1 micrometre to be at least six times more reactive than larger particles. Studies of historically used gamma irradiated in air polyethylene show increased wear rate with damaged femoral heads and with aged and oxidised polyethylene. The aged and oxidised polyethylene also produced a greater percentage of smaller particles leading to increased osteolytic potential. Combined tribological and biological simulation models have been developed for pre-clinical assessment of osteolytic potential of artificial hip joints.
Development of Metal/Metal Hip Resurfacing
Authors: McMinn D.J.W.
Published: January 2018

This author's development of metal/metal hip resurfacing began in 1989, with the first patient implantation in February 1991. In the first three years a pilot study identified optimum fixation as hydroxyapatite coated uncemented cups and cemented femoral components. From March 1994 hybrid fixed components have been used. These implants have generally been satisfactory with respect to fixation but high wear of the bearing, metallosis and osteolysis have been seen with some components inserted during 1996, a period during which the metal microstructure was altered by the heat processes, hot isostatic pressing and solution heat treatment. The Birmingham Hip Resurfacing was developed taking account of experience with earlier resurfacing designs. This implant employs hybrid fixation with a porous ingrowth acetabular component and has an as-cast metal microstructure having had no post casting heat treatments. During the past 4 years the author has performed over 1,000 Birmingham Hip Resurfacingís with a total failure rate of less than 1.0%.