bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of a Modified Posterior Approach on Blood flow to the Femoral Head during Hip Resurfacing
Authors: Khan Amer , Lovering Andrew M. , Bannister Gordon C. , Spencer Robert F. , Kalap Nadi
Published: January 2018

The deep branch of the medial femoral circumflex artery is vulnerable to injury during posterior approaches to the hip. We modified the posterior approach during hip resurfacing in 10 patients by dividing the short external rotators 2 cm from their insertion into the femur. The cefuroxime concentrations in bone samples from the femoral heads were compared with results for the extended posterolateral approach from previous published work. There was no difference between the concentration of cefuroxime in bone when using the modified posterior approach (mean 5.6 mg/kg; CI 3.6 – 7.8) compared to the extended posterolateral approach (mean 5.6 mg/kg; CI 3.5 - 7.8; p=0.95). The similarity in femoral head perfusion between approaches suggests that the blood supply may be impaired further by capsulotomy and capsulectomy rather than by damage to the deep branch of the MFCA alone.
Implementation of the NICE Guidelines for Venous Thromboprophylaxis; A National Survey of Hip Surgeons
Authors: Sharif Khalid M. , Rehman Sheikh Fazal , Nunn Timothy , Bagga Tajesh K.
Published: January 2018

The 2007 United Kingdom National Institute for Health and Clinical Excellence (NICE) thromboprophylaxis guidelines concerning hip arthroplasty remain contentious in spite of significant evidence. A survey among British Hip Society members was performed to investigate the impact of these guidelines. Information on thromboprophylactic measures before and after guideline publication was gathered for three categories; Total Hip Replacement (THR), hip fracture and high-risk patients (as defined by NICE). The response rate was 185/250 (74%). All responders used thromboprophylaxis, but only 44%, 22% and 7% indicated they were currently acting in accordance with guidance for THR, high risk and hip fracture groups respectively. Only 19%, 14% and 14% had changed their practice since publication of the guidance in THR, high risk and hip fracture groups respectively. The effects of national guidance in influencing thromboprophylactic protocols have therefore been limited. The reasons were not investigated in this survey.
The condition of the Cement Mantle in Femoral Hip Prosthesis Implantations – a Post Mortem Retrieval Study
Authors: Bishop Nicholas E. , Schönwald Martin , Schultz Peter , Püschel Klaus , Morlock Michael M.
Published: January 2018

Despite numerous studies demonstrating the characteristics of the optimal cement mantle in joint replacement, the clinical state of the cement mantle is rarely assessed. A random sample of 214 cemented implated femoral hip components was retrieved post mortem from Hamburg, Germany, and sectioned to investigate the quality of the cement mantle. The most common observation made in at least one measured region per retrieval was debonding (82% of stems), followed by a thin cement mantle (74%), stem-bone contact (48%), soft tissue at the stem interface (44%), no cement-bone interdigitation (30%), a gap at the stem interface (28%), voids in the cement (22%) and cracks and blood in the cement mantle (<10%). 21% of stems demonstrated complete debonding of the interface. However, distributions of all other defects were local, with less than 10% of stems demonstrating any imperfection in more than 21% of the regions assessed. No progressive damage was observed with implantation duration. The results suggest that current implantation technique may be adequate for proper implant function over the service life in the older patient population. However, for younger and more active patients, perfection of the cementation technique is crucial, particularly in modern implant systems such as resurfacing. The frequency of almost all defects could be further reduced by careful implantation technique, providing the increased service life necessary for the ever younger, more physically demanding, patient population.
Mid-term Results of Hydroxyapatite-Coated Threaded Cup Implanted without Supplementary Supporting Screws
Authors: Trapotsis Stergios J. , Petsatodis George E. , Antonarakos Petros D. , Givissis Panagiotis K. , Christodoulou Anastasios G. , Pournaras John D.
Published: January 2018

We retrospectively reviewed the clinical, radiographic, and survivorship outcomes in a series of 180 patients that underwent 204 primary Total Hip Arthroplasties with the use of a second generation threaded hydroxyapatite-coated acetabular cup that was implanted without any supplementary supporting screws. At an average follow-up period of 10.2 (range: 8–14) years, one hundred and seventy-four patients (198 cups) were available for assessment. All patients underwent detailed physical and radiographic examination; their functional status was evaluated according to the Harris Hip Score (HHS). Following their digitization, all radiographs were further reviewed in order to determine the existence of any migration of the acetabular cup. Osteolytic lesions, radiolucent lines or zones of increased bone density were also recorded and classified according to the system of DeLee & Charnley. The modified Engh's criteria were used in order to evaluate the stability of the prosthesis. The patients' mean HHS at their latest follow-up visit (97.24 points) was statistically significantly better than the preoperative mean score of 40.31 points (p<0.001). Radiographic analysis showed “stable with bone ingrowth” fixation (modified Engh's criteria) of all implants with no significant migration of the cup (mean cranial migration: 0.597 mm, mean horizontal migration: 0.607 mm, mean observed difference of the cup's inclination angle: 0.26 degrees). No areas of significant osteolysis were found. The cumulative survival rate of the implants was 97.05%. Our results suggest that second generation hydroxyapatite-coated threaded acetabular cups can be successfully implanted (and achieve excellent results) without the use of any supplementary supporting screws.
Revision for Recurrent Dislocation of Total Hip Replacement
Authors: Rogers Mark , Blom Ashley W. , Barnett Andrew , Karantana Alexia , Bannister Gordon C.
Published: January 2018

Background and purpose

Dislocation is one of the commonest complications of total hip arthroplasty with an incidence of between 0.5 and 9.2%. Despite this, little is known of the outcome of treatment strategies for dislocation. The aim of this study was to establish the optimal strategy for the operative management of recurrent dislocation following THA taking account of the surgical approach employed in the replacement that became unstable and the direction of the instability that followed.

Methods

We reviewed 70 patients who underwent revision surgery for recurrent dislocation after total hip arthroplasty (THA), 38 through the transgluteal (Hardinge) and 32 through the posterior approach. 52 of these followed primary and 18 followed revision THA for reasons other than instability. We recorded the surgical approach, the direction of dislocation and the operative strategy employed for each case.

Results

We achieved stability in 75% of patients who dislocated after primary and 50% after revision THA. 77% of dislocations performed initially through the transgluteal approach were anterior and 88% through the posterior approach were posterior. Following the transgluteal approach, we stabilised anterior dislocation in 54% of cases. Following the posterior approach we stabilised posterior dislocation in 79%. The most successful operative strategy overall was cup augmentation which conferred stability in 90% of cases.

Interpretation

Instability after primary total hip replacement is easier to treat (75% chance of success) than after revision total hip replacement (50% chance of success). Although previous studies have shown that the posterior approach has a slightly higher risk of dislocation, this study has shown that achieving stability after a posterior dislocation is more likely than after an anterior dislocation. The outcome of revision for instability depends on the surgical approach used initially, and the direction of dislocation.
Hip Resurfacing using the Trochanteric Flip Osteotomy
Authors: Killampalli Vijay V. , Hayes Andrew , Parsons Nick , Costa Mathew L. , Prakash Udai
Published: January 2018

We report the early results and complications of resurfacing arthroplasty using the ‘Trochanteric Flip Osteotomy’ approach to the hip. There are no published clinical results of this approach used for resurfacing arthroplasty. One hundred consecutive patients were assessed prospectively for a minimum follow-up of 2 years (range 2 - 5 years). The Oxford Hip Score fell from a median of 30 pre-operatively to 5 at two years. Similar improvement was found in the UCLA Activity Score. There were no cases of component failure or fractures. However, nine patients had minor complications related to the osteotomy. Resurfacing Arthroplasty of the hip may be successfully performed through a trochanteric flip osteotomy. This surgical approach may avoid some of the complications associated with avascular necrosis of the femoral head.
A Manoeuvre to Facilitate Acetabular Component Retrieval following Intra-Pelvic Migration
Authors: Ahmad Mudussar A. , Biant Leela C. , Tayar Rene , Thomas Paul R. , Field Richard E.
Published: January 2018

Acetabular component extraction following intra-pelvic migration of a total hip replacement can be hazardous to pelvic tissues, vessels and organs. Acetabular component removal is usually performed using an abdominal retroperitoneal approach. We describe a closed reduction of the acetabular component using a traction/manipulation technique. This manoeuvre can be used in cases of intra-pelvic acetabular component migration where the surface contour of the acetabular component is uncomplicated and an interposition membrane separates the implant from adjacent intra-pelvic structures.
The Mayo Cementless Femoral Component in Active Patients with Osteoarthritis
Authors: Goebel Dietmar , Schultz Wolfgang
Published: January 2018

This prospective study reports the clinical and radiological results of a single-surgeon series using the Mayo conservative hip stem in a district hospital. 30 total hip arthroplasties were performed in 26 physically active patients. There were 18 women and 8 men, with a mean age of 57.4 years (range 36–79). 4 cases were bilateral. The operation was performed for severe primary or secondary osteoarthritis of the hip. Duration of follow-up ranged from 67–87 months (mean 81 months). There were no early complications relating to the surgical procedure. There was one case of traumatic fracture of the femur during rehabilitation, while late complications included two cases of late infection (4 months and 16 months after surgery) both revised in two-stage procedures. There was considerable improvement in Merle d'Aubigne score following surgery. There were no revisions for aseptic loosening, but we identified 2 implants with significant radiolucent lines and subsidence six years after the index operation. Neither patient experienced pain in the hip or restriction of activity. Therefore, the aseptic loosening survival rate was 100% (end point = revision operation). Taking radiological loosening as the end point survivorship was 93.3%. The use of the Mayo short stem component in active patients may preserve bone and enable subsequent revision operations to proceed using primary implants. Our results suggest that conservative designs of this type may be of benefit in selected individuals.
Medium Term Results of Revision Total Hip Replacement Using Radial Impaction Grafting and a Collared Textured Stem
Authors: Kakwani Rajesh G. , Saquib Mohammed , Kashyap Shankar
Published: January 2018

Massive bone loss is a problem frequently encountered during revision hip surgery. Several ways of addressing the bone loss in proximal femur have been described with varying results. We present our results with the use of a radial impaction grafting technique and a collared textured component. 107 consecutive cases of Revision Total Hip Arthroplasty, who underwent radial impaction grafting and had a textured collared implant inserted for femoral deficiencies were assessed. The average follow up was seven years and four months (3 to 11 years). All the patients experienced a significant improvement in the clinical scores. Oxford Hip scores improved from an average of 41.2 (30 - 56) to 19.3 (12 - 32). Harris Hip scores improved from an average of 40.8 (28 - 65) to 83.4 (60 -99). There were no cases of subsidence at follow up. Using revision for any cause as the end point the survivorship at an average of 88.8 months was 93.8%. Three revisions were performed for deep infection within the first year. There were three cases of peri-prosthetic fractures distal to the tip of standard length stems at an average of 8.4 months after surgery. We recommend the use of morsellised allografts with radial impaction grafting and textured, collared stems for selected cases with paprosky type ii and type iii femoral defects. We also recommend use of long stems bypassing the tip of the previous implant with impaction grafting to avoid peri-prosthetic fractures.
Resurfacing and Uncemented Arthroplasty for Young Hip Arthritis: Functional Outcomes at 5 Years
Authors: Killampalli Vijay V. , Kundra Rakesh K. , Choudary Fouad , Chowdhry Majid , Fisher Noel E. , Reading Alexander D.
Published: January 2018

The management of osteoarthritis of the hip in young active patients is challenging. We compared the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. Mean follow-up period was five years (4–7 years). Within each group there was a statistically significant improvement in the mean university of California at Los Angeles (UCLA) and Oxford Hip Score (OHS) scores following surgery. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA which in itself has longer follow-up compared to resurfacing.
Modification of Pelvic Orientation after Total Hip Replacement in Primary Osteoarthritis
Authors: Sariali Elhadi , Lazennec Jean Yves , Khiami Frederic , Gorin Michel , Catonne Yves
Published: January 2018

The acetabular anteversion angle varies according to the position of the pelvis. The objective goal of our study was to investigate changes in pelvic orientation after total hip replacement for primary osteoarthritis. We studied 89 patients who underwent total hip replacement for primary unilateral osteoarthritis. Lateral pelvic X-rays that included the hips were performed pre-operatively and one year post-operatively. Reference values were calculated by carrying out the same analysis in 100 asymptomatic healthy volunteers. Pelvic orientation was analyzed using the sacral slope.

Patients having surgery for osteoarthritis had a decreased pelvic range of motion pre-operatively and post-operatively when compared to healthy volunteers. Post-operatively, this range of motion increased by 3° but remained lower than the norm. Compared to asymptomatic healthy volunteers, patients affected by osteoarthritis had a posterior pelvic extension that decreased post-operatively but did not return to norm. This post-operative pelvic inclination generates a significant decrease in the final cup anteversion and thus may predispose to posterior dislocation. As this post-operative alteration to pelvic orientation cannot be anticipated, computer-aided surgery for cup positioning may not improve the accuracy of the acetabular anteversion in some patients.
Bilateral total hip Arthroplasty in Severe Hereditary Multiple Exostosis: A report of two Cases
Authors: Moran Matthew , Krieg Andreas H. , Boyle Richard A. , Stalley Paul D.
Published: January 2018

Staged bilateral hip arthroplasties were carried out in two patients with osteoarthritis of the hip secondary to the development of hip dysplasia in Hereditary Multiple Exostosis (HME). Both patients had near ankylosis of their hips with pain and difficulty in performing activities of daily living. A proximal femur replacing prosthesis was implanted through an extended trochanteric osteotomy, with preservation of as much proximal bone stock as possible. At latest follow up (two to five years), there was a sustained improvement in range of motion and symptoms. The Harris Hip Scores improved from 25 and 31 to 83 and 78. The Toronto Extremity Salvage Scores improved from 49% and 55% to 88% and 75%. Radiographs show bony ingrowth and healing of the trochanteric fragments. In severe HME, hip arthroplasty with replacement of the proximal femur provides good symptomatic relief and return of hip joint movement.
A Comparison of Clinical Results of Hip Resurfacing Arthroplasty and 28 mm Metal on Metal Total Hip Arthroplasty: A Randomised Trial with 3–6 Years Follow-Up
Authors: Vendittoli Pascal-André , Ganapathi Muthu , Roy Alain G. , Lusignan Daniel , Lavigne Martin
Published: January 2018

Two hundred and nine hips were randomised to receive either a 28 mm total hip athroplasty (THA, 100 hips) or hybrid hip resurfacing (HR, 109 hips). At 1 and 2 years post-operatively, patients with HR achieved statistically significantly better WOMAC functional scores. However, differences in scores were of slight clinical relevance with a difference of 2.2/100 and 3.3/100, at 1 and 2 years respectively (p=0.007). After an average follow-up of 56 months (range 36–72) there were similar reoperation rates 7/100 THA and 6/109 HR (p=0.655) and revision rates 2/100 THA and 4/109 HR (p=0.470). However, the types of complications were different. Higher early aseptic loosening rate was found in HR and long-term survival analysis of both patient cohorts is necessary to determine whether the potential bone preservation advantage offers by HR will overcome its earlier higher failure rate.
Preoperative Digital Templating of Birmingham HIP Resurfacing
Authors: Konan Sujith , Rayan Faizal , Meermans Geert , Geurts Jan , Haddad Fares S.
Published: January 2018

The aim of our study was to determine the usefulness of preoperative digital templating of Birmingham hip resurfacing (BHR). This prospective cohort of 30 consecutive Birmingham hip resurfacings was templated digitally by two senior hip arthroplasty fellows (GM, JG) independently. A blinded observer then collated information on the actual implant sizes intraoperatively and used this to statistically analyse the correlation (Interclass correlation coefficient) between the digitally templated implant sizes and the actual implant sizes used. A significantly high rate of coincidence between digitally templated estimates and the actual implant sizes was noted for both groups of templates. The Intra class correlation coefficient (ICC) for the acetabular cup in the two groups were 0.798, p=0.013 and 0.870, p=0.0001. For the femoral component, the ICC values in the two groups were 0.888, p=0.005 and 0.784, p=0.003. Similarly a high reliability of digital templating was noted for both acetabular (0.823, 0.888) and femoral components (0.777, 0.8132). In conclusion, digital templating can reliably estimate implant sizes in Birmingham hip resurfacing.
Cortical Strut Allograft as an Adjunct to Plate Fixation for Periprosthetic Fractures of the Femur
Authors: Font-Vizcarra Lluis , FernáNdez-Valencia Jenaro A. , Gallart Xavier , Segur Josep M. , Prat Salvi , Riba Josep
Published: January 2018

The use of cortical strut allografts in the treatment of periprosthetic femoral fractures remain controversial. Complications such as infection and the potential transmission of disease remain concerns.

A retrospective review at a tertiary-care hospital was completed of 21 patients who had sustained a periprosthetic femoral fracture and who were treated using a plate and a deep-frozen cortical strut allograft, between 1996 and 2007. The average age at the time of surgery was 80.3 years old and included 16 women and 5 men. Three patients were lost to follow-up and four died within a few weeks of discharge. The remaining 14 patients were evaluated clinically and radiographically with a mean follow-up of 3.2 years.

Fracture union was observed in 13 patients, and integration of the graft occurred in 12 patients. One of the 14 patients developed a deep infection with Coagulase-Negative Staphylococcus, with a satisfactory outcome after surgical debridement and antibiotic treatment. There were no cases of fixation failure or plate rupture. At the final evaluation, the mean EQ-5D VAS score was 64 (ranging from 40–90 points) and the mean EQ-5D health state index adapted to Spanish value sets was 0.57. The mean Oxford Hip Score was 31.2.

The results support the use of cortical allograft for these fractures to increase the likelihood of fracture healing and to improve the bone stock. We consider that cortical strut grafting is specially indicated for B1 and C fractures in which decreased bone density is present.
A Histological Study of Retrieved Cambridge Acetabular Components
Authors: Brooks Roger A. , Field Richard E. , Jones Eric , Sood Asheesh , Rushton Neil
Published: January 2018

A new uncemented acetabular component, the Cambridge cup, has been designed to mimic the anatomy and physiology of subchondral bone in order to minimise stress shielding and enhance long-term component stability. Cambridge cups were implanted in a cohort of 50 women who presented with displaced sub-capital fracture of the femoral neck. The cups were manufactured with an hydroxyapatite (HA) coating. Twenty six cups were implanted after removal of the HA. Twelve Cambridge cups were retrieved post-mortem between two and 84 months after implantation. Histological and histomorphometric testing was undertaken to analyse the residual HA coating thickness, bone apposition to the implant surface and particulate wear debris in the surrounding tissues.

The HA-coated implants showed significantly greater bone apposition to the implant surface with significantly less fibrous tissue formation than the uncoated implants. Where HA resorption occurred, bone and bone marrow was seen adjacent to the implant. Excessive wear of the ultra high molecular weight polyethylene liner was not seen.

The HA-coated components demonstrated good initial bone implant bonding and the flexible carbon polymer appeared to maintain stability following HA resorption. The uncoated implants showed little or no bony apposition but had a fibrous membrane apposed to the implant surface. This may be explained by a combination of micro-motion at the bone implant interface and having a component surface finish that was poorly suited to osseous attachment.

Hydroxyapatite coated acetabular components can provide reliable osseous attachment. Subsequent HA resorption need not compromise medium-term osseous fixation to an appropriate implant surface.
Meta-Analysis of Low Molecular Weight Heparin versus Placebo in Patients Undergoing Total Hip Replacement and Post-Operative Morbidity and Mortality since their Introduction
Authors: Tasker Andrew , Harbord Roger , Bannister Gordon
Published: January 2018

Objectives

1) To establish the clinical validity for in-patient low molecular weight heparin (LMWH) following total hip replacement (THR) through a meta-analysis of peer reviewed and published randomised placebo controlled trials (RCTs). 2) To establish whether modern peri-operative practices were associated with changes in rates of clinical venous thromboembolic (VTE) and all-cause mortality after THR by review of series of patients receiving in-patient LMWH published between 1985 and 2000.

Datasources

Medline and Embase (from 1980 to 2005), Datastar and Proquest databases were searched and references from bibliographies traced.

Review methods

Studies of adult patients receiving in-patient LMWH following elective primary or revision THR were sought and data abstracted. The first part of our analysis included only randomised placebo controlled trials. For the second part, randomised control trials were included and divided by their year of completion into three groups.

Results

We found no difference between LMWH and placebo in the risk of fatal pulmonary embolism (PE), other deaths, all cause mortality or major bleeding. LMWH reduced non-fatal PE (OR=0.14, 95%CI 0.03 to 0.74, p=0.029) at the expense of haematoma formation (7/147 vs 0/149, p=0.015). 35 studies were included in the second part of our analysis. Point estimates of rates of fatal and non-fatal pulmonary embolism and other deaths suggest a decline over time but fell short of statistical significance.

Conclusion

Clinically relevant VTEs are a rare complication following THR. The lower risk of VTE narrows the risk benefit of potent pharmacological thromboprophylaxis. We do not support their use in patients undergoing THR without additional thromboembolic risk factors.
Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy for Severely Dysplastic or Dislocated Hips
Authors: Yalcin Nadir , Kilicarslan Kasim , Karatas Fuat , Mutlu Tansel , Yildirim Hasan
Published: January 2018

Total hip arthroplasty in dislocated developmental hip dysplasia is a complex, technically demanding procedure with high complication rates. Anatomic abnormalities and the young age of the patients influence the results. Restoration of the anatomic hip center often requires shortening of the femur in order to avoid over-stretching of neurovascular structures.

We performed cementless total hip arthroplasty with subtrochanteric transverse osteotomy on 44 hips in 31 patients. There were 29 female and 2 male patients. The average age at the time of the operation was 43.2 (range, 22–63 years) and the mean follow up period was 62 months (range, 24–96 months). Harris hip scores improved from 36.2 to 81.2 with good and excellent results in 79.5% of the patients. We stabilized the osteotomy line with low contact plates and screws primarily on 10 hips when rotational stability was in doubt. In the other hips, good initial rotational stability was obtained by the femoral component. However, we observed 5 nonunions in patients whose osteotomies were not stabilized with plates. These patients were later treated succesfully with internal fixation and autogenous bone grafting. The osteotomies healed at a mean time of 4 months (range, 2.5–14 months).

Postoperatively two dislocations, one acetabular component displacement under the structural bone autograft and two superficial infections were seen. There were no cases of symptomatic loosening, deep infection, or neurovascular injury.

Subtrochanteric transverse osteotomy is a versatile, relatively easy and reliable method for shortening the femur when performing cementless total hip arthroplasty in hip dysplasia cases. This technique makes it possible to implant standard sized cementless femoral stems. When necessary, tortional stability may further be augmented with a plate and screws.
Failure of Cement-in-Shell Acetabular Liner Exchange
Authors: Blakey Caroline M. , Biant Leela C. , Kavanagh Thomas G. , Field Richard E.
Published: January 2018

Cement-in-shell acetabular liner exchange is a revision surgery option for cases of total hip arthroplasty (THA) with polyethylene wear where direct liner exchange is not possible. A replacement liner is cemented into a well fixed uncemented acetabular shell, avoiding the morbidity associated with acetabular shell component revision. We present a case of dissociation of an acetabular liner at the cement-liner interface, three years following liner exchange without radiographic evidence to indicate the diagnosis.
A comparison of subsidence of Exeter standard and long stems
Authors: Davis Edward T. , Heaver Catriona E. , Pynsent Paul B. , Pearson Andrew M. , Treacy Ronan B.C.
Published: January 2018

The survivorship of the polished, double taper Exeter stem is related to subsidence within the cement mantle. Long Exeter stems have altered geometry which may influence subsidence characteristics. Using digitised x-rays and appropriate computer software we measured the subsidence of 35 standard and 40 long stem Exeter implants. Measurements were taken from initial postoperative radiographs and repeated at intervals up to 5 years. Long stem implants were used in cemented revisions without the use of impaction bone grafting. Subsidence rates of the standard length stems in our study were comparable to that in published literature. Long stems did not replicate this subsidence pattern and had subsided less at 6, 12 and 24 months. However, the 205mm long stem, which has a fully tapered design, did follow the subsidence characteristics of the standard stem.

Subsidence of long stem Exeter implants does not mirror that of the standard length stem. Loss of the fully tapered geometry of the longer stem implants may account for this finding. We suggest that whenever possible, the 205mm long stem should be used if the biomechanical principles of the standard Exeter stem are to be utilised.
Total hip arthroplasty in inflammatory arthritis in patients under 35 years. A 7 to 19 year follow-up
Authors: Simon Jean-Pierre , Maes Michael , Robbens Evelyne , Bellemans Johan
Published: January 2018

Total hip arthroplasty in patients with inflammatory arthritis is compromised by the young age of patients at presentation, intake of non-steroidal anti-inflammatory drugs, steroid use and autoimmune diseases which negatively affect bone quality. This study evaluates the survival of total hip arthroplasties (THA) in 32 patients with inflammatory hip disease who were under the age of 35 at the index operation and on which 57 primary total hip arthroplasties were performed between 1989 and 2001. Polished straight tapered cemented stems were used in all 57 hips. There were 10 cemented and 47 uncemented cups. The average follow-up was 12.2 years (range 7–19). Forty-seven hips had more than 10 years follow-up. There were 3 revisions of cemented metal-backed cups for aseptic loosening at 11, 13 and 16 years post-operatively. No uncemented cups and no stems needed revision. Heterotopic ossifications occured in 3 hips with Brooker type-I ossification in 1 hip and Brooker type-II in 2 hips. Cemented polished tapered straight stems demonstrate excellent survival in young patients suffering from inflammatory arthritis.
Long-term comparison of porous and hydroxyapatite sleeves in femoral revision using the S-ROM modular stem
Authors: Park Youn-Soo , Lim Seung-Jae
Published: January 2018

We prospectively evaluated the results of a single-surgeon series of 28 femoral revision arthroplasties using the S-ROM modular stem with either a porous-coated sleeve (15 hips) or a hydroxyapatite-coated sleeve (13 hips) after a mean of 10 years (range, 8–14 years). Three femoral stems underwent repeat femoral revision for aseptic loosening in association with Paprosky type III bone defects after a mean of 9 years in vivo (range, 8–10 years). One on these 3 had a porous-coated sleeve and the other 2 had a hydroxyapatite-coated sleeve. With repeat revision for any reason as the end point, femoral component survival was 83.8% at 10 years for the entire series, and 93.3% for the porous-coated sleeve group and 76.2% for the hydroxyapatite-coated sleeve group, respectively (log-rank test, P=0.588). No significant difference was detected between the 2 groups regarding postoperative Harris hip scores, bone ingrowth, stress-shielding, osteolysis, or complication rates. At a mean of 10 years postoperatively, hydroxyapatite-coated sleeves offered no clinical benefit over porous-coated sleeves for revision hip replacement using the S-ROM modular stem. Our findings also indicate that hydroxyapatite-coated sleeves did not reduce late mechanical stem failures in cases with a deficient femur.
Impact of Preoperative Variables on the Functional and Radiological Outcome of an Uncemented Femoral Stem: A Prospective Two-Year Follow-Up
Authors: Bergschmidt Philipp , Bader Rainer , Finze Susanne , Tokar Isabella , Kundt Guenther , Mittelmeier Wolfram
Published: January 2018

The demand for improved clinical outcomes in total hip arthroplasty (THA) has led to improvements in fixation, bone ingrowth and designs providing an increased range of motion.

The purpose of this prospective clinical study was to evaluate the outcome of a new cementless stem (Hipstar). The variables of body mass index (BMI), gender, preoperative function and age were explored as predictors for recovery after surgery. Clinical and radiological evaluation of 100 patients were undertaken preoperatively and at 6, 12 and 24 months postoperatively using the Harris Hip Score (HHS), WOMAC-Score and the SF-36-Score.

The mean preoperative HHS was 53.6±14.5 points and it increased significantly to 82.8±15.4 at the postoperative evaluation at 24 months (WI-test p<0.001). Diminished preoperative function led to a lower postoperative score, but BMI, age and gender were not predictors of clinical and radiological outcome. Due to stress-shielding the straight Hipstar stem revealed radiolucent lines of between 41.5% and 68.5% in the proximal Gruen zones, which indicates a higher primary and secondary stability by enhanced osseous integration compared to other straight stems.

Our clinical results are encouraging, but long-term follow-up will be necessary to confirm the successful introduction of the new Hipstar stem.
Migration and wear of the Duraloc “1200 series” cup associated with Enduron UHWMPE using the EBRA method and the Imagika software
Authors: Thirion Thierry , Georis Pierre , Gillet Philippe
Published: January 2018

We report a retrospective study on 122 THA using Duraloc “1200 series” cups. All patients received a 28-mm head (107 Al2O3, 15 CoCr). The mean age of the patients at surgery was 56.3 years and the mean follow-up was 137 months.

Mean migration at two years using the EBRA method was 0.18 mm cranially and 0.16 mm medially. Mean polyethylene wear was 0.03 mm/year using the Imagika software and 0.06 mm/year using EBRA. Only one patient presented with abnormal polyethylene wear of 1.7 mm at 90 months with Imagika and 2.4 mm with EBRA. The Duraloc cup seems to be a reliable implant in respect of bone fixation and resistance to wear.
The Relationship between the Presence of Metallosis and Massive Infection in Metal-on-Metal Hip Replacements
Authors: Donaldson James R. , Miles Jonathan , Sri-Ram Kesavan , Poullis Christopher , Muirhead-Allwood Sarah , Skinner John
Published: January 2018

With the increased use of metal-on-metal as a bearing surface, complications and side effects are being recognised more frequently. We present a small series of a previously unreported complication, which appears specific to metal-on-metal bearing surface arthroplasties: three cases of infection in the presence of local metal debris and histological features of aseptic lymphocytic vasculitis associated lesions (ALVAL). Each case is associated with significant soft tissue loss and bone destruction to such an extent that pelvic discontinuity has occurred.

We postulate that the combination of metal debris, ALVAL and tissue necrosis provides a unique environment for peri-prosthetic bacterial growth and rapid spread of infection.
Total hip arthroplasty using a short-stemmed femoral component in the presence of a proximal femoral fixation device – a case report
Authors: Kim Tae-Young , Lee Kee-Byoung , Kwon Duck-Joo , Ha Yong-Chan , Koo Kyung-Hoi
Published: January 2018

A patient previously treated by cannulated screws fixation of a femoral neck fracture and plate and screw fixation of an ipsilateral shaft fracture presented for a total hip arthroplasty due to femoral head avascular necrosis. The cortical bone at the previous fracture site was weak and damage on the proximal femur was considered likely during removal of the plate. We were also concerned that a periprosthetic fracture might occur during or after the insertion of a conventional femoral stem. We used a short-stemmed femoral component for total hip arthroplasty in this patient, to avoid the risk of potential complications.
Use of a deep polyethylene liner for the treatment of recurrent dislocation
Authors: Tanino Hiromasa , Ito Hiroshi , Banks Scott A. , Harman Melinda K. , Matsuno Takeo
Published: January 2018

Modular component exchange is one of several viable options for treating instability after total hip arthroplasty (THA). Recently, we reported that polyethylene liners retrieved from stable THAs had significantly deeper cup articular geometry than liners retrieved from dislocated THAs. Modular liner exchange with implantation of a deeper cup articulation for the treatment of THA instability may be an option in certain cases. We describe the use of modular liner exchange with implantation of a custom polyethylene liner with a deepened articular geometry for surgical treatment of recurrent dislocation after primary THA in a 70 year old patient. The patient did not feel unstable and no symptoms of subluxation or dislocation have been experienced in the 3 years of follow-up subsequent to treatment. Surgeons should consider the articular geometry of the polyethylene liner as an important design parameter, and we recommend that deeper polyethylene liners be considered for treatment of recurrent dislocation after primary THA.
Preoperative versus Postoperative Initiation of Dalteparin Thromboprophylaxis in THA
Authors: Borgen PåL O. , Dahl Ola E. , Reikeras Olav
Published: January 2018

Chemical thromboprophylaxis in total hip arthroplasty (THA) may increase surgical site bleeding. The drug dose and timing of such therapy is therefore important. We studied two cohorts of 298 and 301 patients undergoing THA. The first group received their first dose of dalteparin sodium 5000 IU subcutaneously the evening before surgery and the second group a half dose six hours post-operatively, followed by 5000 units daily in both groups. Blood loss was reduced by 146ml from 1230 ml to 1084 ml (p<0.001) with postoperative prophylaxis alone. The number of patients receiving blood transfusion decreased from 53% to 35% (p=0.001), and the use of transfused packed red blood cells was reduced from 1.25 to 0.83 units per patient (p=0.001). The overall rates of non-vascular complications 6 months after surgery were 12% and 11%, bleeding related events 6.0% and 4.0%, and thromboembolic related events were 2.0% and 2.3% in the preoperative and the postoperative cohorts. Two patients died in the preoperative group and one in the postoperative group due to venous and arterial thromboembolism. This study show that 2500 IU dose of dalteparin started 6 hours after surgery significantly reduced blood loss and transfusions compared to 5000 IU dalteparin injected 12 hours before surgery. Few thromboembolic events occurred, and these were equally distributed.
Femoral Positioning of Tesio Catheters for Hemodialysis
Authors: Pecorari M.
Published: January 2018

Vascular access may be of crucial importance in long-term dialyzed patients when traditional blood access fails.

Long-term central vascular access devices are usually inserted in the internal jugular or subclavian veins but thrombosis may be the major factor limiting their long-term use. To solve this problem the Tesio caheter is one of the most commonly recommended tools for long-term use in RD patients, and is normally placed in the neck veins.

In this study the femoral vein is indicated as an alternative site for positioning the Tesio catheter. The “high” exit (abdominal) reported here presents some advantages for the patient who can then walk without difficulties while maintaining a high blood flow that is similar to those achieved with catheters implanted in other sites.
Ultrasound Guided versus Direct Vein Puncture in Central Venous Port Placement
Authors: Orsi F. , Grasso R.F. , Arnaldi P. , Bonifacio C. , Biffi R. , De Braud F. , Bellomi M.
Published: January 2018

Introduction

This study will report our experience on positioning of totally implanted venous catheter system (port-a-cath) as compared to ultrasound guidance versus blind technique.

Materials and Methods

From July 1996 to November 1999 in the vascular suite of the Europen Institute of Oncology, 427 port-a-cath were implanted in patients with neoplastic disease. All devices were implanted through the subclavian vein. 198 with ultrasound guided puncture and 229 following anatomical landmarks. All patients underwent a close and specific clinical and instrumental follow-up to evaluate possible complications.

Results

Use of Ultrasound (US) in subclavian vein catheterization has reduced the number of puncture attempts, with a better patient complicance, allowing a faster procedure and reducing peri-procedural complications. Ultrasound technique has shown reduction in early complications. In fact in our experience we had no pneumothorax events by using ultrasound guidance, versus 11 events with blind technique. US has shown no reduction in late complications: 3 thrombosis versus 6 thrombosis with US guidance, and 3 fractured and embolized catheter versus 2 cases. Fibrin-cuff percentage was the same in the two groups with only 1 case, as the dislocation of the catheter tip in the jugular vein with 2 cases in both groups. Moreover US let us to avoid the arterial puncture and to perform a more peripheral puncture of the subclavian vein, reducing the risk of “pinch-off” phenomenon and of haematoma, with no cases reported under US guidance versus 1 case respectively in direct vein puncture.

Conclusions

US guided puncture of subclavian vein for the implantation of venous catheter system is faster by reducing procedure time, it is easier for the operator and safer for the patient than blind technique by exposing anatomical structures. Morevover US guidance reduces early complications and limits costs.
The “Sleeve” Anastomosis Method for Hemodialysis Shunts: An Eleven-Year Follow-Up Study
Authors: Kapala A. , SzczeȨsny W. , Hryncewicz W. , Mackiewicz Z. , Zegarski W.
Published: January 2018

Purpose

The problem of long form fistula for hemodialysis is well known among vascular surgeons because of frequent thromboses in anastomotic place. One of the pro-thrombotic factors is suture in the vessel's lumen. Since the “sleeve” method prevents this, the patency rate should improve.

Methods

One hundred and eighty-two (182) patients were operated using the “sleeve” method. The operation was done under local anaesthesia and the first step was the dissection of the cephalic vein and the radial artery. Using Prolene 7–0 the artery and the vein were connected as follows: the first suture was placed intramuraly about 5 mm from the artery edge to the vein edge. The second suture (placed in the same way) was on the opposite side. The end of the radial artery was placed into the lumen of the cephalic vein and the sutures were tied. Two additional sutures were placed between them. Finally, four sutures were added to keep the artery in the vein.

Results

In our hands the patency rate of “sleeve” arterio-venous fistulas was high: 95% after one month, 86% after one year, 64% after 5 years and 57% after 10 and 11 years. Every “sleeve” fistula provided adequate blood flow, which increased during the follow-up period.

Conclusions

The authors consider the “sleeve” fistula method as the primary choice because of its simplicity and excellent long-term patency.
Rare Complications during Surgical Vein Cannulation in Extremely Low Birthweight Neonates
Authors: Gamba P. , Midrio P. , Tommasoni N. , Scarpa M.G. , Verlato F. , Verlato G. , Zanon G.F.
Published: January 2018

Extremely low birthweight neonates often require total parenteral nutrition by central venous catheterization. The technique of choice is the percutaneous cannulation via the basilica or cephalic vein; in particular cases, these peculiar patients need a cut down catheterization. This paper describes some unusual complications of this surgical approach.
Which Vascular Access for Chronic Hemodialysis in Uremic Elderly Patients?
Authors: Brunori G. , Verzeletti F. , Zubani R. , Movilli E. , Gaggiotti M. , Cancarini G. , Maiorca R.
Published: January 2018

The type of hemodialysis vascular access (fistula, graft, catheter) employed plays an important role in the results of dialysis treatment. Moreover, different complications can affect the vascular access and interfere with the morbidity and mortality of patients.

The ideal vascular access is the Cimino Brescia fistula. Graft and catheter methods should be considered as “second choice” because they present a higher incidence of complications, mainly due to thrombosis and infections. Finally, in elderly patients the vascular bed is frequently damaged and this may make it difficult to create a Cimino Brescia fistula.

In a 5-year period, 140 elderly patients (>65 years) and 63 “young” patients (< 65 years) started dialysis treatment in our facility. In the elderly group, a native fistula was created in 88% of cases, whereas in the younger patients the percentage was 94% (p: NS). The grafts were, respectively, 11% in elderly and 6% in young patients. Only in one case, in one elderly patient, was a permanent catheter the first vascular access.

We also report survival rate of the first vascular access, the incidence of thrombosis, and the need for creating another type of access.

We suggest that a native fistula can be easily created in elderly patients and a “second choice” access should be limited to a small proportion of patients.
GIT (Glucose Infusion Test): Polycentric Evaluation of a New Test for Vascular Access Recirculation
Authors: Alloatti S. , Magnasco A. , Bonfant G. , Bonello F. , Ciciani A.M. , Fidelio T. , Filiberti O. , Forneris G. , Martina G. , Robaudo C. , Romano U. , Schelotto C.
Published: January 2018

Introduction

Vascular access recirculation (AR), which is often unacknowledged, remains an important cause of inadequate dialytic dose. The glucose infusion test (GIT) is a new method for detecting and quantifying AR. This paper reports on a polycentric evaluation of the new test and a comparison with the classical Urea-test (UT).

Methods

GIT protocol comprises withdrawal from the arterial port (sample A), injection into the venous drip chamber of 1 g glucose in 4 seconds, withdrawal from the arterial port (sample B) continuously from 13 to 17 seconds. Glucose is determined on A and B by a reflectance photometer. If B = A then there is no recirculation. If B exceeds A by at least 20 mg/dl there is recirculation. AR quantification: AR% = (B-A) / 20. GIT was performed on 623 patients from eleven dialysis centers to screen the patients for AR. Subsequently, GIT and Urea-test (UT) were compared in 189 paired tests. The reproducibility of GIT and UT was studied in 28 paired tests performed in sequence.

Results

The screening test by GIT was positive in 68 cases (11 %). The majority of positivities was found in central venous catheters (CVC, 27/50 cases, 54 %), whereas only 7 % of artero-venous fistulas (AVF) were positive. In the CVC group, Tesio catheters were more frequently positive compared to Dual Lumen Catheters (64 % vs. 29 %). The comparison GIT – UT showed that results matched in 162 tests (79 negative and 83 positive both by GIT and UT), showing that on the grounds of UT, GIT has high sensitivity and specificity. In 27 tests GIT was positive, but UT negative. This disagreement is due to the different minimal limit of detection, 1 % for GIT and 5% for UT. The reproducibility was greater with GIT than with UT with a lower D % (respectively −0.6 ± 2.5 and −0.4 ± 6.1 %, p<0.001) and a lower coefficient of variation (17 vs 33 %).

Conclusions

The screening of 623 patients by GIT confirmed that AR in AVF is normally absent, whereas an unexpectedly high frequency of moderate AR in CVC was found. The GIT-UT comparison showed that the new test is simple and immediate, and gives results with higher accuracy, sensitivity and reproducibility than UT.