bluuebunny/crossref_metadata_2025 huggingface dataset:
Age-Related Macular Degeneration: Review of Pathogenesis
Authors: Zarbin M. A.
Published: March 2018

Age-related macular degeneration is a condition (a) characterized by accumulation of membranous debris on both sides of the retinal pigment epithelium (RPE) basement membrane. Clinical manifestations of drusen, atrophy of the RPE/choriocapillaris, RPE detachment, and choroidal new vessel (CNV) formation occur after age 50 years. A hypothetical pathogenic sequence of events consistent with known data is: 1) RPE dysfunction (e.g., precipitated by an inherited susceptibility and/or environmental exposure); 2) accumulation of intracellular material in the RPE (e.g., accumulation of normal substrate material that is not enzymatically degraded properly vs. abnormal substrate material); 3) abnormal accumulation of extracellular material (basal laminar and basal linear deposit); 4) change in Bruch's membrane composition (e.g., increased lipid deposition and protein crosslinking); 5) change in Bruch's membrane parmeability to nutrients (e.g., impaired diffusion of water soluble plasma constituents across Bruch's membrane); and 6) response of the RPE to metabolic distress (i.e., atrophy vs. CNV growth). Histopathological and clinical studies indicate that areas of choroidal ischemia often are seen near CNVs in AMD patients. In response to decreased oxygen delivery/metabolic “distress”, the RPE may elaborate substances leading to CNV growth. Perhaps RPE atrophy, followed by choriocapillaris and photoreceptor atrophy, is a response to decreased nutrients/increasing metabolic abnormalities in areas of excessive accumulation of extracellular debris. Unanswered questions regarding AMD include: 1) is AMD an ocular manifestation of a systemic disease or purely an ocular disease?; 2) what determines whether CNVs vs.atrophy of the RPE-choriocapillaris-photoreceptors develops?; and 3) what induces the maturation of CNVs into an inactive scar, and what limits the growth of most CNVs to the area centralis?
The Association of Conjunctival Snake-Like Chromatin with Keratoconjunctivitis Sicca
Authors: Rivas L. , Oroza M.A. , Sanz A.I. , Chen Z. , Shalaby O. , Murube J.
Published: March 2018

Purpose

This work describes the snake-like chromatin cells in the conjunctiva of patients with keratoconjunctivitis sicca (KCS), assessing the relationship between tear function parameters and the severity of the disease, and searching for any differential pattern that could lead to early and diagnosis help clarify the etiology of KCS.

Methods

The conjunctiva of 366 eyes from 187 patients with KCS, and 30 eyes from 15 controls, were classified according to the results of the Schirmer I test, break-up time, rose Bengal staining, osmolarity, ferning tests and electrophoresis; they were then studied by impression cytology and electron microscopy.

Results

Snake-like chromatin cells, other nuclear changes, and a decreased number of goblet cells were found by impression cytology in different areas of the KCS conjunctiva. The presence of snake-like chromatin was significantly correlated with the severity of the disease. No nuclear changes were found in the control group.

Conclusions

We assume these findings can be attributed to a natural regeneration of conjunctival cells and to resistance to a pathological reaction to KCS.
The Endocrine Stress Response after Oral Premedication with Low-Dose Midazolam for Intraocular Surgery in Retrobulbar Anaesthesia
Authors: Kiefer R.T. , Weindler J. , Ruprecht K.W.
Published: March 2018

Purpose

It was the purpose of this study to examine the endocrine stess response in patients undergoing elective intraocular surgery in retrobulbar anaesthesia (RBA), and the effect of an oral premedication with 3.75 mg midazolam on this reaction.

Methods

In a prospective double-blind study, 23 patients were randomly assigned to either group I (n=12), receiving 3.75 mg midazolam, or group II (n=11), receiving a matched placebo 60 min before RBA. Plasma concentrations of known mediators of the endocrinological stress response were analysed at five perioperative times: adrenocorticotropic hormone (ACTH), cortisole (CORT), somatotropic hormone (STH), epinephrine (EPI), norepinephrine (NOR), and dopamine (DOP).

Results

The observed endocrinological reaction was moderate. Perioperative anxiety and, above all, RBA were the main stressors. The endocrine stress response could best be seen within the fast-reacting sympathoadrenergic system. Midazolam significantly suppressed the epinephrine and the cortisole answer (p < 0.01). After RBA an ACTH plasma peak only was observed after placebo. Plasma-STH showed extreme variability. An STH-peak after midazolam is presumably due to a gonadotropic hormone-releasing hormone (GHRH) secretion directly stimulated by midazolam. Midazolam had no significant effect upon norepinephrine. A significant (p<0.01) increase for plasma-cortisole was seen 60 min after the operation when compared to preoperative values.

Conclusions

The results indicate that even at a low dose midazolam positively influences the endocrine stress response. The combination of this stress-reducing effect with the well-known hemodynamic stability, the distinct anxiolytic and sedative action, suggest low-dose midazolam as a favourable premedication for intraocular surgery.
The Role of Osteoporosis and Fracture Comminution in the Outcome of Anatomically Reduced and Adequately Fixed Intertrochanteric Femoral Fractures
Authors: Panagiotopoulos E. , Fortis A.P. , Tyllianakis M. , Armonis A. , Lambiris E.
Published: March 2018

To assess the role of osteoporosis and fracture comminution in the migration of the tip of the sliding screw within the femoral head, as well as the fracture collapse in anatomically reduced and adequately fixed intertrochanteric fractures, 151 patients, whose intertrochanteric fractures had been treated surgically with anatomic reduction and a centrally placed Dynamic Hip Screw (Protek Synthes, Switzerland), were reviewed with an average follow-up of 6 months after the fracture had healed (mean 9 months after fracture fixation). Osteoporosis was determined using the Singh scale, whereas fracture comminution was classified using the Tronzo criteria. Vertical and horizontal screw migration as well as fracture collapse (screw retrolisthesis) were measured in immediate anterioposterior postoperative roentgenograms and in roentgenograms at the end of the treatment. Failure in osteosynthesis occurred in 2.65% of the cases. Osteoporosis is strongly related to vertical (P = 0.00001), and horizontal (P = 0.0125) migration of the tip of the screw within the femoral head and less so to fracture collapse. On the other hand, fracture comminution is strongly related to fracture collapse (P = 0.0124) but not to the migration of the screw within the femoral head. The successful outcome of treating patients with intertrochanteric fractures depends on both adequate biology (no severe osteoporosis) and adequate mechanics (proper implant and surgical technique). Anatomic reduction and central placement of the sliding screw must be performed as a routine. Modifications to decrease the loading of the fractured hip (medial displacement and valgus osteotomy) should only be considered in exceptional cases in the presence of significant osteoporosis, thus avoiding the expected severe vertical and horizontal migration of the tip of the screw as well as fracture collapse.
Down-Hill Skiing after a Total Hip Replacement?
Authors: Kloen P. , De Man H.R. , Marti R.K.
Published: March 2018

This paper presents data on a group of 9 patients (12 hips) who underwent a total hip arthroplasty and subsequently engaged in down-hill skiing. Average follow-up was 6.4 years (range 1–13 years). Average time to return to skiing was 10.3 months after surgery. None of the patients reported difficulties during their skiing activities. Only one acetabular and one femoral component developed grade 2 loosening. None of the hips needed revision. The acetabular wear rate (0.16 mm/year) was comparable to those reported in the literature, although higher than another on average less active group treated with the same prosthesis by the same surgeon. A review of the literature on athletics after hip arthroplasty is given. Based on our early results and the literature, we feel that down-hill skiing is feasible for the THR patient, but they should be advised to ski with long turns on groomed slopes. Longer term follow-up studies are needed to address the issue of athletics after hip arthroplasties in general, and more specifically, of downhill-skiing.
The Effect of In-Stem versus Around-Stem Centralizers on Cement Mantle Thickness and Stem Alignment in Total Hip Arthroplasty
Authors: Wright J.M. , Saleh K. J. , Tolo E. T. , Bostrom M.P G. , Pellicci P. , Salvati E.A.
Published: March 2018

The long term success of cemented total hip arthroplasty has been attributed to the presence of a well pressurized, thick cement mantle around a properly designed stem that has been placed in neutral alignment. Femoral centralizers were developed to achieve this goal more consistently.

While some centralizers fit into the distal tip, others fit around the tip of the prosthesis. We undertook a study to compare the effect of an into-distal-tip (IDT) centralizer versus around-distal-tip (ADT) one. A retrospective review of three groups of primary total hip arthroplasty (THA) patients was performed. Group I consisted of a control population of the last 100 consecutive cases performed with no distal centralizer. Group II consisted of the first 100 consecutive cases performed with the IDT design. Group III consisted of 51 consecutive patients performed using an ADT centralizer. All cases were performed with similar cementing technique by the same senior surgeon (E.S.). Our results show that, while adequate mantles can be obtained, either with or without the use of a centralizer, an around-stem centralizer on a tapered distal stem consistently gave a more neutral stem alignment and a thicker, concentric cement mantle.
Age and Surgical Management Determine Quality of Life after Trochanteric Fracture
Authors: Guillemin F. , Cao M.M. , Delagoutte J.P. , Mainard D.
Published: March 2018

Purpose

The aim of the study was to determine factors influencing functional ability and quality of life six months after trochanteric fracture treated surgically. Patients and method: A multicentre cohort included 459 patients (356 females and 103 males, mean age 80 years) in Eastern France. Sixty-two percent of the fractures were stable and 38% were unstable. Determinants of functional ability assessed by the Merle d'Aubigné and Harris scores, of quality of life by the Duke Health profile, and of return to home at 6 months after surgery were considered using logistic regression analyses.

Result

Older age was the most prominent factor predicting bad functional ability (p<.001) and quality of life (p<.05). The material for surgery predicted 6-month poor functional ability (p<.001), probably through the different strategies for care management involved. The quality of fracture reduction assessed on lateral radiographs, as well as post-operative complications were predictors of a better functional ability (p<.001) and less frequent return to home (p<.001).

Conclusion

Age and surgical management procedure are determinants of outcome at 6 month after trochanteric fracture.
Histological Investigation of Polyethylene Particles in Total Hip Replacement: Ceramic versus Metal Heads
Authors: Bos I.
Published: March 2018

Pseudocapsules and interface membranes around hip prostheses with ceramicand metal polyethylene combinations from 128 revision cases and 40 autopsy cases were histomorphologically analysed, including a semiquantitative grading of the wear particles and histological changes. The amount of wear particles increased with increasing implant duration.

Comparing the revision cases with metal-on-polyethylene combinations and ceramic-on polyethylene combinations 4 to 8 years in situ, more than twice as many polyethylene wear particles were produced from prostheses with metallic heads. In the autopsy cases with stable prostheses 3 times more polyethylene wear was found. The synovial layer was found to be thicker in the metal-polyethylene couplings, the villous transformation of the synovial surface and the scar-like fibrosis of the pseudocapsules appeared to be more pronounced too. Differences between the different types of prostheses with metal-polyethylene combinations were not apparent with the exception of the bipolar prostheses, which showed markedly increased polyethylene wear.
A Little too Close to the Bone? Risk of Sciatic Nerve Injury during Hip Arthroplasty
Authors: Mason W.T.M. , Burgess B.M. , Villar R.N.
Published: March 2018

Sciatic nerve palsy is an uncommon but potentially disabling complication of total hip arthroplasty and may be a cause for litigation. At operation, the location of the nerve appears to be extremely variable. In this study, the position of the sciatic nerve in relation to the femoral head, the greater trochanter and the ischial tuberosity was measured in thirty-nine cadavers. The distance between the nerve and the femoral head varied from 15 to 32 mm (mean 23 mm). This distance was unrelated to patient size or sex. Its position between the ischial tuberosity and the greater trochanter was also variable. In view of its variable and unpredictable position, it is recommended that the sciatic nerve is identified in all hip arthroplasties when a posterior approach is used.
The Windsweep Index: A Method of Evaluating Pelvic Asymmetry and Monitoring the Efficacy of Treatment in Cerebral Palsy
Authors: Portinaro N.M.A. , Owers K. , Pyman J. , Gargan M.F.
Published: March 2018

Progressive asymmetry of the pelvis is frequently observed in total body involved cerebral palsy (CP) children, when opposite contractures and deformities affect the two sides of the body. This asymmetry is important in terms of difficulty in standing and seating stability and if untreated can lead to bilateral dislocation of the hip. The visual term “Windsweep” has been used to describe this deformity. We present an equation to determine the extent of this asymmetry - the “Windsweep” Index (WSI). This can be used as a numerical assessment of the deformity and to assess the efficacy of treatment.
Ipsilateral Fractures of the Hip, Femoral Shaft, Distal Femur and Patella
Authors: Bartoníček J. , Stehlík J. , Douša P.
Published: March 2018

The case reports unusual ipsilateral fracture of the femur, i.e. intertrochanteric fracture, diaphyseal fracture, intra-articular fracture of the distal femur and cominuted fracture of the patella. The fracture of the femur was succesfully treated by the long gamma nail and angled condylar plate, the fracture of the patella by tension wiring.
Radionuclide Bone Scan Appearances in Asymptomatic Patients following Hip Hemiarthroplasty
Authors: Khaleel A. , Harden S. , Tuson K.W.R. , Flanagan J.J. , Conry B.G.
Published: March 2018

We report the radionuclide bone scan appearances following hemiarthroplasty of the hip in 15 asymptomatic, active patients at a mean of 14 months following surgery. All patients had a normal clinical examination, white cell count and erythrocyte sedimentation rates.

Tracer activity was graded. Minimal tracer activity especially along the lateral stem and acetabulum were consistent findings. We conclude that this should be regarded as normal in this situation.
The Difficulties of Nutritional Assessment in Major Hip Surgery
Authors: Costa M. , Shepstone L. , Donell S.T.
Published: March 2018

There are many factors affecting the outcome of major hip surgery. One postulated factor is the patient's peri-operative nutritional status. Several papers have confirmed the benefits of dietary supplements for malnourished patients. Despite this, there are currently no guidelines as to how best to assess nutrition in orthopaedic patients.

The aim of this study was to find a simple diagnostic test that accurately reflects nutritional status in patients undergoing major hip surgery. Twentyfive patients with fracture neck of femur and 25 total hip replacement patients were assessed. Nutritional risk assessment scores, body mass index (BMI), anthropometric and biochemical tests were applied. The different indices were correlated. Length of hospital stay was used as a measure of morbidity.

The correlations between the individual indices of nutritional status were disappointingly low. The only significant correlations for the Total Hip Arthroplasty group were BMI to triceps skinfold thickness (rs=0.769, 95%CI: 0.505 to 0.900, p=0.0001) and BMI to skeletal muscle mass (rs=0.501,95%CI: 0.092 to 0.766, p=0.018). The assessment of BMI is in practice very difficult in patients with fractures of the neck of the femur. There were no statistically significant correlations between any of the nutritional indices measured and postoperative morbidity.

This study was unable to accurately assess nutritional status in patients undergoing major hip surgery. A simple nutritional assessment that can be used on a busy orthopaedic ward has not been identified.
Anatomic Cementless Total Hip Arthroplasty with Ceramic Bearings and Modular Necks: 3 to 5 Years Follow-Up
Authors: Toni A. , Paderni S. , Sudanese A. , Guerra E. , Traina F. , Giardina F. , Antonietti B. , Giunti A.
Published: March 2018

The authors reviewed 216 anatomic cementless hip arthroplasties with ceramic bearings and modular necks, followed up for a minimum of 3 years (range 3–5 years), consecutively implanted in 208 patients between June 1995 and December 1997.

The titanium femoral component, proximally hydroxyapatite coated, has 5 different types of prosthetic neck each available in 2 different lengths and is usually articulated with a ceramic on ceramic coupling with a hydroxyapatite coated hemispheric cup.

The Mèrle d'Aubigné-Charnley hip score and the Gruen radiographic analysis were used for the clinical and radiological evaluation. Apart from one revision of both cup and stem for a loose implant after 2 years, no osteolysis was noted in the periprosthetic bone, where 99.4% of the prostheses showed good osseointegration. The survival analysis predicted 98.6% good results at 5 years, where survival analysis was performed for all the parts of the prosthesis.

The advantage of this prosthesis is the possibility of adaptation to different diaphyseal and extradiaphyseal anatomical conditions. With regard to the neck modularity, for primary arthritis a straight neck was chosen for 81% of the cases, for congenital dysplasia of the hip, a neck with a retroversion of 8°or 15° was used in 34% and a straight neck in 59% of the cases.
Long-Term Results of Charnley Low Friction Arthroplasty for Ankylosing Spondylitis
Authors: Sochart D.H. , Porter M.L.
Published: March 2018

The authors determined the long-term results of 95 Charnley low friction arthroplasties performed on 58 patients with ankylosing spondylitis. The average age at the time of operation was 39.7 years (range, 19 - 70 years) and average duration of follow-up was 19 years (range, 10–30 years). All patients had substantial relief of pain, improvement of function, and range of motion of the joint, and 55 patients (95%) were completely free of pain. Twelve acetabular and nine femoral components were revised for aseptic loosening at an average of 13.9 years (range, 4.2 - 20 years) with 79 original femoral components (83%) and 78 acetabular components (82%) remaining in situ. Six femoral and eight acetabular components were radiologically loose and a total of 20 acetabular components (21%) and 15 femoral implants (16%) had loosened aseptically.

There was no heterotopic ossification in 71 hips (75%), with 22 hips (23%) having minor changes (Brooker Class I or 2), two hips (2%) having clinically important ossification (Class 3) and none having reankylosis. Survivorship of the acetabular component (with 95% confidence intervals) was 92% at 10 years (87% - 98%), 85% at 15 years (77% - 93%), and 77% at 25 years (67% - 87%). Femoral implant survivorship at the same time intervals was 90% (84% - 96%), 87% (79% - 94%), and 77% (80% - 99%), respectively. Charnley low friction arthroplasty provided good long-term results in this series of young and active patients, without the increased risk of the development of heterotopic ossification and reankylosis that has been reported previously.
The Effects of Implant Position, Design and Wear on the Range of Motion after Total Hip Arthroplasty
Authors: Bader R.J. , Steinhauser E. , Willmann G. , Gradinger R.
Published: March 2018

Impingement of a total hip prosthesis may lead to restricted range of motion (ROM), which may result in subluxation, dislocation and material failure. Due to wear, the polyethylene cups can be penetrated by the femoral head. Wear and design features may restrict the movement of the artificial joint. In a three-dimensional CAD simulation, different positions and designs of acetabular cup and femoral head and the effect of displacement of the centre of rotation were investigated. The results demonstrate the importance of correct positioning and design of the acetabular component to achieve a near physiological ROM. Using ceramic cups, the inclination angle should be approximately 45°, the anteversion angle approximately 15°, and antetorsion of the stem between 0° and 15°. If the cup is too horizontal, flexion and abduction are greatly limited. With steeper cup position (60° inclination) ROM of flexion increases, but risk of dislocation and so do rim fracture (ceramic cups), and penetration and wear rate of polyethylene cups. ROM is clearly reduced by increasing penetration of the femoral head. For example, at an inclination angle of 45°, a depth of penetration of 1 mm reduces flexion by about 7°. Modern total hip prostheses should provide adequate joint movement, precise positioning of components and low wear bearing couples, in particular for the treatment of young and active patients. In addition, design aspects of liner geometry and head size have to be considered to avoid impingement and dislocation.
Slipped Capital Femoral Epiphysis – Initial Results of Treatment with Fixclips, a Modification of Kirschner Wire Fixation
Authors: Herron M. , Clegg J. , Bache E.
Published: March 2018

26 cases (21 patients) with Slipped Upper Femoral Epiphysis were treated by internal fixation with Fixclips. Of the 19 males and two females with a mean age of 12 l/2 years (range 10–15), 22 were fixed in situ and 4 required Dunn's osteotomies. The Fixclip allows two 2mm K wires, transfixing the proximal femoral epiphysis, to be anchored to the lateral femoral cortex. Post-operatively partial weight bearing was commenced at 6 weeks. The mean follow-up was 17 months (range 8–26), 10 cases being followed up to epiphyseal union. There were no failures of fixation and no significant complications.

Given that the size of implant used to treat slipped femoral epiphyses may be related to the chance of developing avascular necrosis, the small cross sectional area of simple K wires offers a potential advantage. The Fixclip prevents K wire penetration or extrusion, previously a problem with this type of fixation. In addition, ease of removal offers a significant advantage given the inevitability that a proportion of these patients will outgrow their primary fixation and require revision of fixation.
In Vivo Histological Analysis of Bone Hydroxyapatite Interface: A Case Report in a Post-Traumatic Femoral Fracture
Authors: Nizegorodcew T. , Maccauro G. , Falcone G. , De Santis V. , Rosa M.A.
Published: March 2018

The authors analysed the bone implant interface in a hydroxyapatite (HA) coated titanium alloy stem in a femoral fracture occurring 2 years after operation following a trauma, in the absence of any clinical symptoms of failure. A comparison between the coated and the uncoated part was made. In the coated region of the stem, connective tissue with collagen fibres perpendicularly orientated to the implant was observed, increasing stability of the system. On the contrary, in the uncoated part, fibres were orientated in parallel with less stability.
Tuberculous Hip Joint Infection following Internal Fixation of a Subcapital Fracture
Authors: Tamir E. , Itzhaki A. , Mendlovic S. , Herbert M. , Halperin N. , Robinson D.
Published: March 2018

A 62-year old male patient underwent uneventful internal fixation of a sub-capital hip fracture four years previously. Due to aseptic necrosis of the femoral head, the screws were removed. Biopsy demonstrated caseous material and cultures were sterile. Six weeks later, when the patient was re-admitted for total hip replacement, tubercular infection of the hip was apparent. This case describes a queiscent tubercular infection of the hip joint complicating internal fixation of a hip fracture. The infection was activated following hardware removal. To our knowledge this is the first described case of tubercular infection complicating internal fixation of the hip.
Five to Seven Years Survival Analysis of a Modular Titanium Alloy Stem Primary Total Hip Replacement
Authors: Sadiq S. , Hucker J. , Mccarthy I.D. , Hughes S.P.F.
Published: March 2018

We report the results of a retrospective study of 94 primary total hip replacements with a modular implant (Howse II /Ultima) at a minimum of five years’ follow-up, performed since June 1991 to December 1993 for osteoarthritis of the hip. Twenty-one patients (22 THRs) had died and four patients were lost to follow-up. Mean Harris Hip score of 47 ± 8.7 (range 24–64) pre-operatively rose to 84.9 ± 21.5 (range 22–97). The survival rate of femoral stem in patients who had revisions for aseptic loosening was 91% and no stem was diagnosed as radiologically loose in the first five years of insertion. Using radiological criteria by Harris, three stems were definitely loose (3.2%), three were probably loose (3.2%) and two were possibly loose (2.1%). Survival rate of the Ultima cup for aseptic loosening in patients who had revisions was 87% at seven years. At the final follow-up, three sockets were definitely loose, four were probably loose and four more were possibly loose. Risk of failure of primary total hip replacements increased with increased weight (BMI of greater than 1.25 as compared to below 1.0 (p=0.04, chi test); in patients with osteonecrosis (p=0.048, chi test) and patients who were younger than 65 years of age (p=0.039, chi test). This study represented the outcome of Ultima hip arthroplasties performed by a variety of surgeons and included patients in all age groups and all aetiologies leading to osteoarthritis.
Cementless Bicon Cup in Total Hip Replacement
Authors: Janeček M. , Buček P.
Published: March 2018

The purpose of this study was to evaluate the mid-term results of 462 primary implanted Bicon acetabular components. These cups are self-tapping, biconical threaded implants made of titanium and inserted without cement. The mean follow-up was 5 years.

The patients ranged from 17 to 81 years at the time of surgery (mean, 65 years).

The mean HHS was 31 points (range, 5 to 70 points) pre-operatively and 95 points (range, 75 to 200 points) post-operatively. Three patients underwent two stage revision surgery because of septic loosening. In one case, the cup was re-implanted because of aseptic loosening in serious osteoporotic bone. In nine cases, we observed radiolucencies between cups and bone. In ten patients hip dislocation occurred. We treated eight dislocations non-operatively and the other two cases were solved by insertion of a new PE inlay because of incorrect primary position.

The mid-term results are fully comparable with other acetabular components. The osseointegration also promises good long-term outcomes and the authors hope to be able to report on it in next the few years.
Revision of Failed Cemented Total Hip Arthroplasty Using the Charnley Technique and Implants
Authors: Babis G. CH. , Pantazopoulos TH. , Ioannidis TH. , Hartofilakidis G.
Published: March 2018

The authors present the results of 57 revisions in 54 patients performed for aseptic loosening of cemented total hip arthroplasties. The Charnley technique and implants were used in all cases. The mean follow-up was 8 years and 6 months with a minimum of 5 years. The failure rate for the femoral component was 15% and for the acetabular component it was 19.1%. The cumulative success rate at 8 years was 81.7% for the femoral component and 83.4% for the acetabular component.

The Charnley technique and implants were found efficient for revision of cemented total hip arthroplasties in the long term, but there are limitations to their use in the presence of severely compromised bone stock.
Efficacy of Two Types of Femoral Cement Restrictor in Total Hip Arthroplasty
Authors: Jeffery J.A.
Published: March 2018

Distal occlusion of the femoral canal in total hip arthroplasty is important for cement pressurisation. Failure to adequately restrict cement may result in earlier prosthetic loosening and a longer column of distal cement which may make revision surgery more difficult. A standard plastic restrictor (Hardinge type) was compared with a bone plug restriction method in a randomised, prospective trial of 50 patients. Both types of restrictor failed to adequately restrict cement in over 50% of cases.
A Lethal Arterial Injury Associated with Total Hip Replacement
Authors: Tselentakis G. , Patel V. , Parsons D.W.
Published: March 2018

We report a case of vascular damage to the profunda femoris artery following total hip replacement. Arterial injury usually presents with acute haemorrhage but on this occasion the presentation was delayed (16 days). Arterial damage should always be considered when swelling persists or increases.
Effect of Pelvic Tilt on Radiographic Migration and Wear Measurements after Total Hip Arthroplasty
Authors: Ilchmann T. , Kesteris U. , Wingstrand H.
Published: March 2018

Tilt effects on radiographic measurements after total hip arthroplasty should be studied. A new computerized method for measurement, called EBRA, making three-dimensional calculations and intended to identify tilted radiographs was evaluated for its clinical usefulness.

In an experimental set-up repeated radiographs were taken with a human pelvis tilted gradually around its horizontal and vertical axes. Migration and wear were measured with the EBRA method and the results were compared with those made using standard methods.

Tilted radiographs were identified and excluded from analysis by the EBRA method, significantly reducing the maximum error of measurement. A systematic error of measurement was found in the presence of consecutively changing tilt in a single direction. Wear measurements were only slightly affected by pelvic tilt. A pelvic tilt can cause considerable errors in the measurement of cup migration-i.e. up to 8.2 mm. The EBRA method improves the accuracy of measurements by taking the effects of tilt into account.
Natural History and Conservative Treatment of Osteonecrosis (ON) of the Femoral Head
Authors: Mazières B. , Laroche M. , Cantagrel A.
Published: March 2018

Until now the natural history of nontraumatic osteonecrosis of the femoral head (ON) has been poorly understood. The spontaneous course of ON with radiographic changes (even asymptomatic) is regarded as poor with progression in 50–80% of the cases within two years. In contrast, stabilisation or disappearance of the lesions on MRI can occur in early ON with normal radiographs (stage 1), leading to the definition of a purely “magnetic ON”. Furthermore MRI allows us to study the volume of the necrotic area, which seems to be the most important prognostic factor in early ON. If this volume is less than 20% of the femoral head, the percentage of spontaneous progression is very low. The natural history of ON, especially in the early onset of the disease, has be redefined by MR imaging studies.

Conservative treatment in ON is generally regarded as not very successful. Discontinuing weightbearing has shown to be ineffective in numerous studies. Pulsed electromagnetic fields have given promising results in some studies, but the value of this approach is still controversial. Vasoactive drugs have been shown to reduce pain significantly in ON and there might be a possible role for treating early cases. Some other ON disease modifying drugs may be helpful in carefully selected patients in the future. Nevertheless so far no conservative or surgical therapeutic method has been shown to heal the necrotic lesion. Therefore prevention is the only way which may prevent collapse in patients with a high ON risk, other than treatable aetiological factors.
Short to Medium-Term Results with Two Types of Proximally Porous-Coated Long-Stemmed Femoral Components in Revision Surgery
Authors: Garcia-Cimbrelo E. , Cordero J. , Alonso-Biarge J.
Published: March 2018

Results using 30 long-stemmed femoral components in revision surgery were analyzed. There were 15 PCA (Howmedica) and 15 BIAS (Zimmer). The mean age was 50 years (range, 23 to 65 years) for the PCA group and 61 years (range, 35 to 75 years) for the BIAS group. The mean follow-up was 5.2 years (range, 2.5 to 10 years). Using the Endoklinik classification, there were 2 cases of Grade 1 bone defects, 16 cases of Grade 2, and 12 cases of Grade 3. Morcellized graft was used in 21 cases. A Kaplan-Meier survivorship analysis was carried out. The probabilities of re-revision, clinical failure, and loosening were 23%, 32% and 80% at eight years. Subsidence was very common, with means of 15mms in the PCA group and 19mms in the BIAS group. In the grafted cases, minor resorption was found in 17 cases and major resorption in 4 cases. Because of the frequency of poor results using these prostheses, due to failure to obtain bone ingrowth, even in femora with a good bone stock, we do not recommend their use in revision surgery. The results for the PCA and BIAS group were similar.
Surface Replacement: The Hip Replacement of the Future?
Authors: Amstutz H. C. , Sparling E. A. , Grigoris P. , Campbell P. A. , Dorey F. J.
Published: March 2018

Surface replacement is a significant development in the evolution of hip arthroplasty. Unlike conventional total hip arthroplasty, surface replacement does not require resection of the femoral head; thus, it presents a potentially effective, bone-conserving alternative to conventional replacements. Moreover, conversion to total hip replacement can be made readily, if necessary, with fewer complicating factors than with total hip revision surgery. It offers the greatest potential benefit to patients who are young and physically active. Previous surface replacement used metal-on-polyethylene devices; however, the large ball size of the femoral component contributed to high volumes of polyethylene wear. For some patients, osteolysis occurred due to tissue reaction to polyethylene debris, resulting in aseptic component loosening. Recent advances in technology have allowed metal-on-metal implants to be manufactured with great precision. Hybrid and all cementless fixation, have both shown good early results without the prevalence of loosening seen with polyethylene bearings. Metal-on-metal surface replacement has proved to be quite successful. Results from patients with metal-on-metal devices, especially those with ConservePlus™ implants, show no complications; moreover, there has been an absence of pain and a return to high functional levels, including participation in sports. Due to the large ball size, metal-on-metal devices offer high stability and low dislocation rates. Hemisurface replacement of the femoral head has also proved to be successful in patients with osteonecrosis with or without collapse of the femoral head, when the acetabulum remains relatively normal. For this type of surgery, some acetabular articular cartilage must be preserved. With high survivorship over time, it has emerged as the treatment of choice for this patient group.
Vacuum Loading of the Femoral Cement Gun: The Effect on Mantle Porosity
Authors: Kenny P. , Rice J. , McCormack B. , O'Rourke S.K.
Published: March 2018

The femoral cement mantle was reproduced in a laboratory model. This model consisted of rigid plastic tubing, 10 cm long, with an internal diameter of 2.5 cm. One end of the tube was sealed to simulate an intramedullary plug. A wooden model was used to simulate the femoral component of a total hip arthroplasty. Bone cement was mixed in a glass bowl with a steel spatula in a standardised manner for two minutes.

In all cases the model femur was filled with bone cement and a regular mantle around the wooden “femoral stem” was observed. Pores were present on the cut surface of all of the specimens. The pore density (No. of pores per unit area) was measured using an NIH image programme and was found to be dramatically reduced in the experimental cement mantles, when compared to the control specimens.

The porosity in the cement mantles produced by vacuum loading the gun was significantly lower (p< 0.001) than that in the mantles produced by the manually loaded guns.
Assessment of Supero-Lateral Bulk Bone Grafts in Total Hips using Radiographs and Scintigraphy
Authors: Busch C.A. , Drabu K.J.
Published: March 2018

Incorporation of autologous bulk grafts in dysplastic acetabula may be difficult to confirm radiologically. In our series twelve consecutive patients (fifteen hip replacements) were assessed between two and seven years from the time of surgery. All the femoral heads used for bulk autografting showed radiological evidence of cross trabeculation in the load bearing zone of the acetabulum. To confirm the radiological impression of incorporation and consolidation scintigraphy was carried out on 11 out of 12 patients. 5 patients also had tomograms of their graft-host interface. Radiologically resorption of these bulk grafts occurred at the lateral non-weight bearing edge of the graft in a number of patients. Scintigraphy confirmed block graft incorporation in all patients. Tomograms were not found to be a useful assessment of the incorporation of the supero-lateral bulk graft. An indirect measurement of acetabular migration showed no significant migration of the acetabular component over the period of follow up in all patients.
Sciatic Nerve Pain from Proximal Femoral Mesh in Revision Hip Arthroplasty
Authors: Chesser T.J.S. , Learmonth I.D.
Published: March 2018

Sciatic nerve damage is a serious complication of revision hip arthroplasty. We report a case of severe posterior thigh pain produced by sciatic nerve irritation from stainless steel mesh used to reconstruct the proximal femur. The symptoms were not associated with any neurological deficit or electromyographic changes. Surgeons should be aware that nerve compression or irritation is one cause of pain after hip arthroplasty, and the neurological presentation may be atypical.
Initial Stability of Two Different Hip Revision Concepts. A Biomechanical Study
Authors: Palm L. , Ivarsson I. , Jacobsson S.-A.
Published: March 2018

Two fundamentally different revision concepts, a standard stem cemented in a bed of firmly impacted morselized bone graft, and an uncemented long stem implanted with proximal bone grafting, were compared in terms of initial stability under torsional load immediately after implantation. A stem cemented without bone graft was used as a baseline reference. The stems were implanted in identically prepared composite femora inclined at 45° and loaded vertically. During 9 individual tests of each concept, the stems displaced into retroversion with no detectable axial displacement. At a load of 1000 N the average displacement in retroversion of the prosthetic head was 3.9° ± 2.6° for the uncemented long stem and 9.1° ± 2.6° for the stem cemented in impacted morselized bone graft (P < 0.001). Both revision concepts displaced rather dramatically compared to the stem cemented without bone grafting. The magnitude of displacement may indicate insufficient initial rotational stability of both concepts particularly with the stem cemented in impacted morselized bonegraft.
Ender Nails Compared with Nail or Screw Plate Devices for Trochanteric Femoral Fractures: A Meta-Analysis of Randomised Trials
Authors: Parker M.J. , Handoll Hhg , Bhonsle S. , Gillespie W.J.
Published: March 2018

A systematic review of all randomised trials comparing the use of Ender nails with alternative implants for the reconstruction of extracapsular fractures of the proximal femur has been conducted. Wherever possible the results for the 1.570 patients in the 10 trials identified were pooled. Apparent advantages of Ender nails were reduced deep wound sepsis rate, shorter duration of surgery and lower operative blood loss, but they were associated with an increased risk of re-operation and fracture of the femur. Ender nails were also associated with an increased risk of cut-out of the implant from the femoral head when compared with a sliding hip screw, although not when compared with a fixed nail plate. Additional problems associated with Ender nails included backing out of the nail, shortening of the leg, external rotation deformity and residual pain. The continued use of Ender nails in the fixation of proximal femoral fracture is inappropriate.
Normal Anatomy of the Hip Joint at Birth
Authors: Portinaro N.M.A. , Boniforti F.G. , Hubble M.J. , Gargan M.F.
Published: March 2018

The unusual anatomy of the hip joint at birth is outlined below. The morphology, blood supply, growth and orientation of the acetabulum and proximal femur are described and the interdependence of the various components on subsequent development are discussed.
Diagnostic Imaging in Transient Osteoporosis of the Hip
Authors: Rosa M.A. , Maccauro G. , D'Arienzo M.
Published: March 2018

The clinical aspects, imaging and therapy of Transient Osteoporisis of the Hip (TOH) were examined. Eleven patients, three during pregnancy, were observed. Our conclusion is that magnetic resonance (MR) has a very important role in the diagnosis monitoring of this pathology.
A Comparison of the Survival of Total Hip Replacement Inserted over Two Sequential Time Periods
Authors: Whitehouse S.L. , Gabbar O.A. , Learmonth I.D.
Published: March 2018

Modifications in design and surgical technique have been directed at improving the long-term survival of total hip replacement. This study examines the failure rate, with revision as endpoint, of two large cohorts of primary total hip replacement carried out over consecutive six-year intervals. The intention of the study was not to compare specific prostheses or techniques, but to examine failure rates between two time periods which embraced significant changes of practice. At one specialised centre in Bristol, 2747 primary total hip replacements were performed between 1980 and 1986. Seventy-six failed within 5 years (2.8%) with 23 of these failing in the first year (0.8%). Between 1987 and 1992, 3232 primary total hip replacements were carried out, with 98 hips requiring revision within 5 years (3.0%), 21 of these in the first year (0.6%). There was no statistical difference in the incidence of failure between these two time periods; however, the failure rate for the more recent time period was marginally higher. This indicates that, although techniques and prosthetic design have changed significantly, the anticipated reduction in incidence of failure has not materialised. There is undoubtedly a need for ongoing review to ensure that changes in technique and component design are producing the desired long-term effect.
Failure of Migration by Injected Polyethylene Particles around Press Fit Implants: An Experimental Study in Rabbits
Authors: Frøkjær J. , Overgaard S. , Lind M. , Bünger C. , Søballe K.
Published: March 2018

In a rabbit model, we wanted to study the migration of polyethylene particles into the interface between implant and bone, the effect of these wear particles on periimplant tissue, and whether hydroxyapatite coating inhibited particle migration. Non weight bearing implants were inserted into the distal femur of both knees in 14 rabbits. Hydroxyapatite coated implants were inserted on the right side and non coated, polished titanium implants on the left side. Three, four and five weeks after surgery, group 1 (n=7) had bilateral intraarticular knee injections of polyethylene particles, group 2 (n=7) had bilateral sham injections. Histological analysis after six weeks revealed no osteolysis and showed no difference in bone ingrowth between the two groups, but a significantly higher bone ingrowth around hydroxyapatite coated implants. Around implants in both groups, only trace numbers of polyethylene particles were found in the interface close to the joint surface, and no specific inflammatory reaction could be verified. The tip of all implants, against the joint surface were covered by a massive fibrocartilaginous overgrowth. Synovial tissue contained scattered polyethylene particles in group 1, but histology was similar to group 2. The press fit situation and fibrocartilaginous overgrowth most likely closed the entrance to the interface.
Knowledge of the Anomalies of the Big Central Veins Reduces the Morbidity during the Cannulation for Hemodialysis: Description of a Case of Persistent Left Superior Vena Cava and Revision of Literature
Authors: Dionisio P. , Borsetti C. , Valenti M. , Caramello E. , Bergia R. , Berto I.M. , Cravero R. , Agostini B. , Schillaci E. , Chiappini N. , Tommiselli A. , Bajardi P.
Published: March 2018

The persistence of a left superior vena cava is the result of a lack of an embryological involution of the left anterior cardinal vein. This anomaly is very rare: about 0.3% of the general population. Its incidence increases remarkably from 3–10% in those patients affected with congenital heart disease. Described herein is a case of persistent left superior vena cava, discovered by chance, following the placement of a central venous catheter for hemodialysis. A chest X-ray in projection back-forward showed the central venous catheter along the left sternal margin simulating a placement in the aorta artery. This clinical picture, as described in the literature, is often accompanied by other anatomical anomalies, in our case, by the congenital agenesis of a solitary pelvic kidney. In agreement with the literature and in contrast with what has been reported recently, we sustain that a central venous catheter placed, for any reason, in the persistent left superior vena cava must be removed immediately because it can induce hyperkinetic arrhythmia and cardiac arrest as in our case. Our case report should be a warning that lack of awareness of the anomalies of the big central veins can cause a rise in morbidity.