bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanical Prophylaxis: Bacterial Colonisation and Sterilisation
Authors: Oakley M.J. , Perry J.D. , Jones A.L. , Morgan S. , McCaskie A.W. 
Published: January 2018

Mechanical forms of deep venous thrombosis (DVT) prophylaxis have been shown to be effective. One factor that has reduced their widespread acceptance is the relatively high cost. Multi-use would greatly reduce the cost but could increase risks of cross-infection. We have investigated the bacterial load on boots after a single use and identified many species of bacteria including multi-resistant strains and others implicated in hospital-acquired infection. These could represent a considerable risk during multi-use. In the second part of the study we have investigated ways of sterilising the boots and have found ethylene oxide to be a low cost and completely effective method of sterilisation.
Analysis of the Factors that Predispose to Wear with a 32mm Femoral Head at 5–15 Year follow-up: Clinical and Radiographic Assessment of the Harris-Galante cup at 5–15 Year follow-up
Authors: Katsimihas M. , Katsimihas G. , Lee M.B , Learmonth I. D. 
Published: January 2018

The clinical and radiographic features of 109 consecutive hybrid total hip replacements performed between 1986 and 1992 in 96 patients were retrospectively reviewed. A cementless Harris-Galante (HGP1) cup and a 32mm monobloc straight Muller stem were used in all cases. At an average 10.11 (range 5 to 15) years following surgery, the excellent durability of fixation of the Harris-Galante cup has been demonstrated with only one cup (0.9%) revised for periacetabular osteolysis and aseptic loosening. The prevalence of polyethylene wear was 27.4%. The mean annual linear wear rate was 0.063mm (range 0.00–0.53mm). There was a significantly increased wear of polyethylene inserts with an outer diameter < 52mm (<10mm polyethylene thickness), (ANOVA Test). However, there was no association found between acetabular liner wear and the following factors: underlying diagnosis, Charnley grade, age, weight and sex of the patient. The Harris Hip Score ranged between 5 and 54 pre-operatively and the average HHS was more than 80 post-operatively with more than 70% of patients pain-free. A liner with a thickness of 10mm or greater may prove beneficial in the prevention and reduction of wear rate particularly in young patients. It is recommended that all patients with this cup design, in which a polyethylene insert that is less than 10mm thick is coupled with a 32mm head, should continue to be regularly followed up.
Our Experience with the SL-Plus Cementless Stem: Mid-Term Results
Authors: Hart R. , Buček P. 
Published: January 2018

The authors reviewed the mid-term results of 474 SL-Plus stems performed on 342 patients with primary and secondary osteoarthritis. The average age at the time of operation was 60.5 years (range, 17 to 81 years) and the average duration of follow-up was 60 months (range 25 to 96 months). The average Harris hip rating was 44 points (range, 30 to 58 points) before and 85 points (range, 72 to 94 points) after the operation. Good or excellent outcomes were observed in more than 90 per cent of the hips, with an average pain score of 43 points and average function score of 45 points. Two incomplete intra-operative fractures of the proximal femur were successfully treated by cerclage fixation. Five fractures of the greater trochanter were encountered. Dislocation occurred in five hips, one of which required revision to a captive polyethylene insert. Late infection with loosening of the femoral component occurred in one case. Radiological assessment identified one loose stem, but the patient refused surgical revision. Lower values for metaphyseal and diaphyseal fill observed in 31 cases had no correlation with implant stability and outcome. No progressive subsidence was detected except for one loose femoral component. Seventy-four hips revealed radiolucent lines at the bone cement interface. These were always less than 2mm. These mid-term results seem promising and authors hope that the long-term outcomes will be equally gratifying.
Results of Hybrid Total Hip Replacement and Resurfacing - Is there a Difference?
Authors: Chirodian N. , Saw T. , Villar R. 
Published: January 2018

Hip resurfacing has in recent years become increasingly popular as an arthroplasty technique, particularly amongst younger patients with more active lifestyles. The procedure has been heralded as a more conservative option, aimed at those wishing to continue strenuous work and recreational activities. Little evidence has appeared in the literature however, either with the results of resurfacing or comparing resurfacing to conventional total hip arthroplasty. We compare the outcomes of a consecutive series of hybrid hip resurfacings against a similar series of conventional hybrid hip arthroplasties. In our series there was no difference in operation time, blood loss, or modified Harris Hip score at 12 months postoperatively. There was a small decrease in length of stay, which was not clinically significant. We conclude that whilst it has been previously shown that there is an overall preservation of bone stock following resurfacing arthroplasty, there is no evidence to back additional claimed benefits.
Total hip arthroplasty with Boneloc cement: Unsatisfactory results in 163 hips after 9 to 11 years
Authors: Van Jonbergen J.P.W. , Anderson P.G. , Faber F.W.M. 
Published: January 2018

Boneloc bone cement was introduced in the Netherlands in 1992. Inferior short-term results were reported which led to the withdrawal of Boneloc from clinical use in 1995. However, little is known about the long-term outcome of hip arthroplasties with Boneloc. Between April 1992 and August 1994, Boneloc was used in 163 Mallory-Head primary total hip arthroplasties in 163 patients. Follow-up analysis was performed in 2003. To date, 27 hips (17%) have been revised for aseptic loosening of the femoral component. Median time to revision was 5.5 years. Survival analysis based on revision for aseptic loosening showed 77% cumulative survival at 11 years. With revision for aseptic loosening and/or definite radiological loosening according to Harris as endpoint, cumulative survival was 59% at 11 years. In 27 of 43 patients with definite radiological loosening, a cement fracture was seen at a median of 2.9 years. These results show failure of Boneloc cemented total hip arthroplasties occurring even during the later follow-up. Continuing periodic clinical and radiological examination is recommended.
Incidence of Early and Late Infection in Revision Hip Arthroplasty with Impacted Morsellised Bone Allograft Technique
Authors: El-Kawy S. , Hay D. , Acton D. , Drabu K. 
Published: January 2018

We retrospectively reviewed 120 patients in order to establish the rate of early and late infection in patients who had undergone revision hip surgery using impacted morsellised bone allograft. Our study is based on clinical and radiological data for a period up to five years following surgery. There was only one case of early superficial wound infection, which resolved following a course of antibiotics, and no cases of late infection in this series. In our study the use of morsellised bone allograft does not appear to have any effect on the incidence of early or late hip joint infection provided contemporary measures are taken.
Results of Total Hip Arthroplasties in the Young Patient; Further Evidence for a Barrier Against Articular wear Debris by Hydroxyapatite Coatings
Authors: Emans Pieter J. , Ten Broeke Rene H.M. , Van Mulken Jeroen M.J. , Kuijer Roel , Van Rhijn Lodewijk W. , Geesink Rudolph G.T. 
Published: January 2018

We examined the hypothesis that the circumferential osseous apposition around HA-coated implants forms a protective barrier against articular wear debris. Sixty-five hydroxyapatite-coated total hip arthroplasties in 57 patients (age <50years) with polyethylene-metal articulation were evaluated regarding PE-wear, osteolysis, and clinical outcome at a minimum of 10 years follow-up. There was no correlation between PE-wear and osteolysis of the femoral zones or cup zones I and III. A strong Pearson correlation was found between polyethylene wear and osteolysis around cup zone II, where the cup only consisted of polyethylene (p<0,01). The aseptic failure rate was 1.5% for the femoral component and 4.5% for the cup after 10 years of follow–up. The average Harris Hip Score was 90 and the average Engh score for fixation was 23 after 10 years. Around HA-coated parts of the prosthesis bone formation remained stable, regardless of the degree of polyethylene wear. The average linear polyethylene wear was 0,16 mm/year. The circumferential osseous apposition of the HA-coated implants possibly formed a protective barrier against articular wear debris. The use of cups with a backside gap resulted in PE-wear associated osteolysis in cup zone II and may be considered to be best avoided.
Midterm Results of Cementless Total Hip Replacement in Rapidly Destructive Arthropathy and a Review of the Literature
Authors: Peters Karin S. , Doets H. Cornelis 
Published: January 2018

Background and Purpose Rapidly destructive arthropathy (RDA) of the hip is a disease of unknown etiology characterized by a rapid destruction of the acetabular and femoral aspects of the hip joint. The purpose of this study was to assess the outcome of cementless total hip replacement in this category of patients. Methods A prospective study was performed of all cases of rapidly destructive arthropathy treated by cementless total hip replacement between 1998 and 2005. There were 6 female patients (8 hips) meeting the criteria of RDA. Median age at surgery was 74 years (range 64–83). Using the Paprosky classification of acetabular defects, five hips had a type 2B acetabular defect and three a type 3A acetabular defect. In all cases a cementless prosthesis was used. In two cases a shelf plasty of the acetabulum was added. Radiographic and clinical follow-up was performed up to 9 years postoperatively (mean follow-up 69 months, range 24–104 months). Results At radiographic follow-up, no signs of prosthetic loosening or migration were seen. Harris Hip Score improved from 25.8 (SD 7.3, range 11–34) preoperatively to 88.3 (SD 9.7, range 71–98) at latest follow-up. Conclusion Cementless total hip replacement in patients with rapidly destructive arthropathy led to a good result in a series of eight cases at midterm follow-up.
8-Year follow-up after Cementless Hip Arthroplasty with a Second Generation Spongy Metal Total Hip Replacement
Authors: Gollwitzer Hans , Gerdesmeyer Ludger , Horn Carsten , Diehl Peter , Töpfer Andreas , Gradinger Reiner 
Published: January 2018

We studied a consecutive series of 81 cementless total hip arthroplasties in 80 patients using the second generation ESKA cementless spongy metal hip replacement. The study end-point was implant revision and both function as well as satisfaction with treatment outcome were assessed. Mean age at the time of surgery was 50.9 years [range 23–73]. No patient was lost to follow-up and 75 patients (76 hips) could be included in the final analysis at a mean follow-up of 7.9 years [range 7.0–10.0]. Survival rate without loosening as the end-point was 100% for the femoral component and 99% for the acetabular component (one cup revision). Two cups and one stem had to be revised for recurrent dislocation, resulting in a total implant survival at follow-up of 99% for the femoral component and 96% for the acetabular component. Very good functional results were obtained with a mean Merle d' Aubigné score of 15.5 ± 2.9 at 7.9 years after surgery. Satisfaction with treatment outcome was reported in 88%. 95% of patients would recommend the performed procedure to a friend. Perioperative complications without revision occurred in eleven patients (14%). We report excellent survival rates of the cementless spongy metal hip arthroplasty at a mean follow-up of eight years, particularly considering the young age of many of the patients.
Early Results and Patient Satisfaction after Total Hip Arthroplasty using a Minimally Invasive Anterolateral Approach
Authors: Walde Tim Alexander , Blattgerste Dirk , Sehmisch Stefan , Kuttler Wolfgang , Walde Hans-Joachim , Köster Georg 
Published: January 2018

Rehabilitation and patient satisfaction following a modified anterolateral approach for implantation of a total hip replacement (THR) were reviewed following 72 consecutive cases. The Harris Hip and merle d'Aubigné Scores were recorded at 6 and 12 weeks postoperatively. The patient's satisfaction with regard to the surgical result and the need for analgesia for mobilization were recorded. Rehabilitation was assessed by postoperative crutch use. Significant improvements of the Harris Hip and merle d'Aubigné scores were demonstrated. All patients thought their surgical outcome was good or better. 2 patients needed pain medicine on an irregular basis and 4 patients used crutches at 12 weeks. This study demonstrates patient satisfaction and satisfactory rehabilitation following a modified anterolateral approach for minimally-invasive implantation of THR.
A New Radiographic Method of Measuring Femoral Offset. The Sundsvall Method
Authors: Kjellberg Martin , Englund Erling , Sayed-Noor Arkan S. 
Published: January 2018

Restoring femoral offset (FO) is an important factor for the success of total hip arthroplasty (THA). However, earlier methods of measuring FO do not take in consideration the positioning of the acetabular component. In this study we introduce and evaluate a new radiological method of measuring FO as the horizontal distance between the femoral axis and the midline of the pelvis, at the height of the lateral tip of the greater trochanter. Ten patients operated with THA underwent a plain radiographic examination of the pelvis (AP view) and a CT scanogram for the pelvis and lower limbs (scout view). The radiological FO measurement using the new method was initially compared to FO measurement on CT scanogram and subsequently to the traditional radiological method of measuring FO. We tested the interobserver reliability and the intraobserver reproducibility of the new method. We found an excellent agreement between the new radiological method and the CT measurement and between the new radiological method and the traditional radiological method. We also found an excellent interobserver reliability and an intraobserver reproducibility of the new method. We believe the new method is easier than and as reliable as previously described methods.
Strategies of Hip Management in Neuromuscular Disorders: Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita
Authors: Canavese F. , Sussman M. D. 
Published: January 2018

Joint contractures, subluxation and dislocation are common problem in children with neuromuscular disorders. Medical, surgical and rehabilitative approaches can be used to maintain patient function and comfort. Contracture release, hip dysplasia correction and procedures to address or prevent hip subluxation or dislocation, are not always necessary since patients can be asymptomatic and surgical treatment will not always be successful in maintaining a reduced hip. In fact, controversy surrounds the management of hip disorder in children with Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita. Patients with neuromuscular disorders also frequently develop a progressive scoliosis with pelvic obliquity which may affect sitting balance and become painful. Most subluxations and dislocations have the tendency to occur on the high side of a tilted pelvis. Spinal stabilisation is sometimes necessary to improve the pelvic tilt and to prevent further increase. The present article provides an overview of the current strategies of hip management in neuromuscular disorders.
“Postural Management” to Prevent Hip Dislocation in Children with Cerebral Palsy
Authors: Picciolini O. , Albisetti W. , Cozzaglio M. , Spreafico F. , Mosca F. , Gasparroni V. 
Published: January 2018

Muscolo-skeletal disorders and hip deformity play a key role on future development of motor and adaptive functions in children with cerebral palsy (CP). Lateral migration of the femoral head increases on average 7.7% per year and may progress in association with acetabular dysplasia to hip dislocation. Conservative preservation of muscle length and balance may prevent or reduce femoral head migration and acetabular dysplasia. Equipment for position lying, sitting, and standing is an established method of maintaining muscle length and joint range. French approach (Le Métayer et al) include the use of customised plaster cast orthoses, for sitting and standing positions, called siège moulé and gouttière, tailor-made according to the child's muscolo-skeletal characteristics and motor abilities. At our department, hips with clinical and radiological evidence of displacement unresponsive to pharmacological and surgical treatment were treated with postural management. The two cases we show in this paper underwent a physiotherapy programme (neurodevelopment treatment) twice a week and a seated postural programme 5 hours a day with the siège moulé. Hip radiographs were measured with the migration percentage (MP) described by Reimers. The follow-up measurements showed a progressive reduction of MP values of the hip treated, confirming the significant benefit from the combined non surgical approach. The study supports the evidence that conservative management of hip deformity with siège moulé can be successful if implemented before the development of hip dysplasia.
Relationship between Kinematic Knee Deviations and Femoral Anteversion in Children with Cerebral Palsy
Authors: Piccinini L. , Cimolin V. , Turconi A.C. , Galli M. 
Published: January 2018

The aim of the study was to determine the possible correlation between the degree of femoral anteversion and the quantitative data obtained by 3D Gait Analysis (GA) and then to investigate the relationship between femoral anteversion and the reduced knee flexion during swing phase in children with Cerebral Palsy. Twenty-seven diplegic children with severe rectus femoris spasticity and 20 healthy children (CG) were considered. Clinical evaluation of femoral anteversion, Duncan Ely test and Gait Analysis were performed in all patients. From Gait Analysis data some indices were identified and calculated and statistical analysis performed. Clinical evaluations made the distinction between patients with excessive femoral anteversion (Group 1) and those with normal value (Group 2). Both groups showed a blunt maximum of knee flexion in swing (KMSw), representative of rectus femoris spasticity, but two different gait strategies were found for the timing of KMSw. Group 1 exhibited a reduced KMSw value with its timing close to normal value and an excessive hip internal rotation (Mean Hip Rotation index), correlated to high femoral anteversion; Group 2 presented a limited KMSw and a significant delay of its timing, with Mean Hip Rotation index close to Control Group. No differences were found for other indices. The results demonstrated that the presence of reduced KMSw only can be directly connected to excessive femoral anteversion; the coexistence of reduced KMSw and its delayed timing reveals that the rectus femoris spasticity may be due to rectus spasticity added to an incorrect motor selective control. The results are clinically crucial for treatment strategies (derotative femoral osteotomy vs rectus transfer).
D.D.S.H.: Developmental Dysplasia of the Spastic Hip: Strategies of Management in Cerebral Palsy. A New Suggestive Algorithm
Authors: Portinaro N. , Panou A. , Gagliano N. , Pelillo F. 
Published: January 2018

Hip problems in cerebral palsy are relatively frequent (25–75%). Subluxation and dislocation of the hip is proportional to the neuromuscular involvement and is often due to alteration caused by spastic muscle forces acting on the femoral head in the acetabular cavity. The EMMA approach (Early Multilevel Minimally-invasive Approach) has been designed to restore muscle balance, decrease hip migration and prevent bone deformities thereby avoiding future pain with minimal biological cost to the patient. EMMA is suitable for most patients, especially those with increased tone, poor muscle control and selectivity, Reimer Index (R.I.) 20%. We consider age and R.I crucial prerequisites for treatment steps. EMMA 1) age 2–4 years, RI 20%: multilevel injection of botulinum toxin in case of muscular hyperactivity without morphological alterations of the couple muscle-tendon (contractures). EMMA 2) age 4–6, RI 20%: multilevel aponeurectomies in case of muscular hyperactivity with morphological alterations of the couple muscle-tendon (retraction). EMMA 3) early bone surgery (growth plates). This approach has been adopted in the last 4 years to prevent bone deformities and give early mobilisation and early control of the pain. EMMA is simple to apply even in infants, both for hip containment and to decrease spasticity.
Mid-Term Results of an Uncemented Femoral Stem with Modular Neck Options
Authors: Benazzo Francesco , Rossi Stefano M.P. , Cecconi Davide , Piovani Lucio , Ravasi Flavio 
Published: January 2018

We prospectively assessed the results of 239 primary total hip replacements performed using a conical stem combined with modular necks of different lengths and inclinations (Modulus System, Lima Corporate San Daniele Del Friuli, Udine, Italia) in 222 patients (50 men, 172 women), undergoing surgery between October 2001 and December 2006 and presenting with anatomical deformities of the proximal femur and/or acetabulum, including developmental dysplasia (DDH), ankylosis, and sequelae of osteotomies or fractures. Such conditions can make hip replacement problematic. The mean age at the time of surgery was 57.6 years (22 ÷ 83). No patients were lost to follow-up. 3 femoral components underwent revision. At a mean of 5 years follow-up the Harris Hip Score showed a significant improvement, increasing from 35 preoperatively to a mean of 96.6. Using Kaplan-Meier analysis the survival rate at 5 years was 98.28%. The Modulus stem showed good mid-term results in terms of survival, as well as clinical and radiographic outcome.
The use of a Constrained Cementless Acetabular Component for Instability in Total Hip Replacement
Authors: Rady Ahmad Emad , Asal Mohammed Kamal , Bassiony Ayman Abdelaziz 
Published: January 2018

Recurrent dislocation after total hip arthroplasty is a disabling complication that can be difficult to treat. We evaluated the early clinical and radiographic outcome associated with the use of a constrained acetabular component for instability in total hip arthroplasty Fifteen patients underwent either primary or revision total hip arthroplasty with a cementless constrained acetabular component for different indications. The mean patient age at surgery was 57.4 years and the mean clinical and radiological follow-up period was 26.4 months. Clinical assessment was performed by the Harris hip score and at the latest follow up patients reported outcome using the Oxford hip score questionnaire. All radiographs were evaluated for evidence of loosening. Only one patient experienced redislocation with the constrained prosthesis. The average Harris hip score increased from a preoperative mean of 22 (range, 16 - 36) to a postoperative mean of 85 (range, 66–94). Preoperatively, the mean Oxford Hip Score was 48.6, which decreased to 20.5 at the final examination. All but one of the 15 hips had a well-fixed, stable cup. Femoral component stability with bone ingrowth was achieved in 10 cases. A constrained acetabular component is an effective option for the treatment of hip instability in primary and revision arthroplasty in those at high risk of dislocation. The potential for aseptic loosening requires evaluation by long term studies.