| 1. |
- Bragdon, Charles R, 1959, et al.
(författare)
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Comparison of femoral head penetration using RSA and the Martell method
- 2006
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Ingår i: Clin Orthop Relat Res. - 0009-921X. ; 448, s. 52-7
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Tidskriftsartikel (refereegranskat)abstract
- Radiostereometry has high precision and accuracy measuring polyethylene wear in total hip arthroplasty but requires a specialized setup. The Martell method is simpler and can be used on larger populations. The hypothesis that the radiostereometry analysis and the Martell analysis would yield comparable wear data from the same group of patients having total hip arthroplasty was tested. A group of twenty-five total hip arthroplasty patients who had both radiostereometry and standard anterior-posterior pelvic and cross-table lateral radiographs of sufficient quality for analysis were identified. The films were taken at postoperative periods of 6 weeks, 1 year, 2 years, and 5 years. Femoral head penetration was measured by both methods at each time point. The median penetration rates measured by each method decreased over time. Penetration results were affected by method of analysis, time, and dimension, with greater penetration for Martell compared with radiostereometry at each time point, greater penetration with increasing time for each method, and larger three-dimensional magnitude compared with two-dimensional analysis. LEVEL OF EVIDENCE: Case series Level IV. See Guidelines for Authors for a complete description of levels of evidence.
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| 2. |
- Bragdon, Charles R, 1959, et al.
(författare)
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Comparison of two digital radiostereometric analysis methods in the determination of femoral head penetration in a total hip replacement phantom
- 2004
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Ingår i: J Orthop Res. - : Wiley. - 0736-0266. ; 22:3, s. 659-64
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Tidskriftsartikel (refereegranskat)abstract
- Radiostereometric analysis (RSA) has been used extensively to evaluate the magnitude and direction of penetration of the femoral head into the acetabular component of a total hip replacement as a result of polyethylene wear and creep. The accuracy and precision of an RSA study depends on several factors, including the radiographic technique, the analytical software, and the positioning of the tantalum markers. This study had three sequential purposes. First, an in vitro phantom model was used to quantify the accuracy and precision of digital images versus conventional radiography in RSA measurements of penetration of the femoral head into the acetabular shell in a total hip replacement. The Umea RSA software package was used for analysis of both the conventional films, which were digitized at a resolution of 300 DPI, and digital radiographs, which were converted from a DICOM format at a resolution of 218 DPI. Digital radiography was found to be superior. Next, two methods of RSA analysis currently in use for determining femoral head penetration into polyethylene of total joint replacements were compared. Using the phantom model, we compared the Umea RSA system (Biomedical Innovations AB) to the RSA-CMS (RSA Clinical Measurement Solution) and in both cases used the digital radiographs. The Umea RSA system was found to be superior. Finally, two methods of marking the position of the acetabular component with tantalum beads were compared: one in which beads were inserted into previously described towers protruding from the back of the acetabular shell and another in which beads were placed into the peripheral flange of the polyethylene liner using the Umea RSA analysis system of the digital radiographs. The results using the two marker configurations were similar.
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| 3. |
- Bragdon, Charles R, 1959, et al.
(författare)
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Standing versus supine radiographs in RSA evaluation of femoral head penetration
- 2006
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Ingår i: Clin Orthop Relat Res. - 0009-921X. ; 448, s. 46-51
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Tidskriftsartikel (refereegranskat)abstract
- Evaluation of polyethylene acetabular component wear in total hip arthroplasties commonly is performed using serial radiographs of the hip by measuring the change in the location of the center of the femoral head in relation to the acetabular component. Of the different methods currently used for this purpose, radiostereometric analysis (RSA) is considered the most accurate and precise. In all such radiographic studies, it is assumed the femoral head is seated into the deepest portion of the acetabular component during all radiographic examinations. Although most radiographs used for wear measurements are taken with the patient supine, we questioned whether standing radiographs, with substantial joint load, are better suited for these measurements. We evaluated two groups of patients having total hip arthroplasty who had radiostereometric radiographs taken in supine and standing positions. The average femoral head penetration that occurred between the 6-month and 2-year time interval was measured with radiographs taken in the standing or supine position. We found no difference between the average total femoral head penetration when using supine or standing radiographs.
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| 4. |
- Cassuto, Jean, et al.
(författare)
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Concerted actions by MMPs, ADAMTS and serine proteases during remodeling of the cartilage callus into bone during osseointegration of hip implants.
- 2020
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Ingår i: Bone reports. - : Elsevier BV. - 2352-1872. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Although the number of patients undergoing total hip arthroplasty is constantly on the rise, we only have limited knowledge of the molecular mechanisms necessary for successful osseointegration of implants or the reasons why some fail. Understanding the spatiotemporal characteristics of signaling pathways involved in bone healing of implants is therefore of particular importance for our ability to identify factors causing implants to fail. The current study investigated the role of three families of proteases, i.e. MMPs (matrix metalloproteinases), ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) and serine proteases, as well as their endogenous inhibitors during osseointegration of hip implants that have endured two decades of use without clinical or radiological signs of loosening.Twenty-four patients that had undergone primary THA due to one-sided osteoarthritis (OA) were monitored during 18years (Y) with repeated measurements of plasma biomarkers, clinical variables and radiographs. All implants were clinically and radiographically well-fixed throughout the follow-up. Eighty-one healthy donors divided in three gender and age-matched groups and twenty OA patients awaiting THA, served as controls. Plasma was analyzed for MMP-1, -2, -3, -8, -9, -10, -13, -14, tissue inhibitor of metalloproteinase (TIMP)-1, -2, -3, ADAMTS4, ADAMTS5, the serine proteases neutrophil elastase (NE), proteinase 3 (PR3) and their endogenous inhibitors, secretory leucocyte proteinase inhibitor (SLPI), trappin-2/elafin and serpina1 (α-1 antitrypsin). Cartilage turnover was monitored using two markers of cartilage synthesis, type II procollagen and PIICP (procollagen II C-terminal propeptide), and two markers of cartilage degradation, CTX-II (C-terminal telopeptide fragments of type II collagen) and split products of aggrecan (G1-IGD-G2).MMP-1, MMP-9, ADAMTS4, NE and PR3 were above healthy in presurgery OA patients but returned to the level of healthy within 6weeks (W) after surgery. MMPs and serine proteases were counter-regulated during this phase by TIMP-1, SLPI and trappin-2/elafin. Type II procollagen, PIICP and CTX-II increased to a peak 6W after surgery with a gradual return to the level of controls within weeks. Significant increases by MMP-8, MMP-9, ADAMTS4, ADAMTS5, NE, PR3 and the protease inhibitors, TIMP-3 and serpina1, were seen 5 Y after hip arthroplasty paralleled by a sharp increase in the levels of the cartilage degradation markers, CTX-II and G1-IGD-G2. All the above mediators were normalized before 18 Y, except MMP-1 and MMP-9 that remained above healthy at 18 Y. MMP-14 increased immediately after surgery and remained elevated until 5 Y postsurgery before returning to the level of controls at 7 Y.Notwithstanding temporal differences, the molecular processes of bone repair in arthroplasty patients show great spatial similarities with the classical phases of fracture repair as previously shown in animal models. Cartilagenous callus, produced and remodeled early after hip arthroplasty, is replaced with bone 5 Y to7 Y after surgery by the concerted actions of MMP-8, MMP-9, ADAMTS4, ADAMTS5, NE and PR3, thus suggesting that a complex regulatory cross-talk may exist between different families of proteases during this transitional phase of cartilage degradation. Regulation and fine-tuning of cartilage remodeling by MMPs and ADAMTS is controlled by TIMP-3 whereas serine proteases are regulated by serpina1. Increased MMP-1 and MMP-9 beyond 10Y post-THA support a role during coupled bone remodeling.
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| 5. |
- Cassuto, Jean, et al.
(författare)
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The importance of BMPs and TGF-βs for endochondral bone repair – A longitudinal study in hip arthroplasty patients
- 2023
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Ingår i: Bone Reports. - 2352-1872. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Osseointegration of hip implants, although a decade-long process, shows striking similarities with the four major phases of endochondral bone repair. In the current study we investigated the spatiotemporal involvement of bone morphogenic proteins (BMPs) and transforming growth factor betas (TGF-βs) throughout the process of bone repair leading to successfully osseointegrated hip implants. Materials and methods: Twenty-four patients that had undergone primary total hip arthroplasty (THA) due to one-sided osteoarthritis (OA) were investigated during a period of 18 years (Y) with repeated measurements of plasma biomarkers as well as clinical and radiological variables. All implants were clinically and radiographically well anchored throughout the follow-up. Eighty-one healthy donors divided in three gender- and age-matched groups and twenty OA patients awaiting THA, served as controls. Plasma was analyzed for BMP-1, -2, -3, -4, -6, -7 -9 and TGF-β1, -β2, -β3 by use of a high-sensitivity and wide dynamic range electrochemiluminescence technique allowing for detection of minor changes. Results: Spatiotemporal changes during the follow-up are presented in the context of the four phases of endochondral bone repair shown in earlier studies and transposed to the current study based on similarities in biomarker responses. Phase 1: Primary proinflammatory phase lasting from surgery until day 7, Phase 2: Chondrogenic phase from day 7 until 18 months postsurgery, Phase 3: Secondary proinflammatory and cartilage remodeling phase lasting from 18 months until 7Y, Phase 4: coupled bone remodeling from 7Y until 18Y postsurgery. BMP-1 increased sharply shortly after surgery and remained significantly above healthy during the chondrocyte recruitment, proliferation, and hypertrophy phases with a subsequent return to control level at 5Y postsurgery. BMP-2 was above healthy controls before surgery and 1 day after surgery before decreasing to control level and remaining there throughout the follow-up. BMP-3 was at control level from presurgery until 6M after surgery when it increased to a peak at 2Y during the cartilage hypertrophy phase followed by a gradual decrease to control level at 10Y during the phase of bone formation. In the following, BMP-3 decreased below controls to a nadir 15Y postsurgery during coupled bone remodeling. BMP-4 was at control level from presurgery until 10Y postsurgery when it increased to a sharp peak at 15Y after surgery followed by a return to the level of healthy at 18Y. BMP-6 did not differ from healthy during the follow-up. BMP-7 was at control level from presurgery until 1Y postsurgery before gradually increasing to a peak at 10Y during the early phase of osteogenesis with a gradual return to control level at 18Y during the phase of coupled bone remodeling. BMP-9 was above OA before surgery followed by a decrease to basal level on day 1 after surgery and a renewed increase to a plateau above controls lasting from 6 W until returning to the level of healthy at 18Y postsurgery, i.e., throughout the phases of cartilage formation, cartilage hypertrophy and remodeling, bone formation and coupled bone remodeling. TGF-β1 was above controls presurgery before decreasing to baseline shortly after surgery followed by a renewed increase at 6 M to a peak at 2Y during cartilage hypertrophy/remodeling followed by a gradual return to baseline at 10Y during early osteoblastogenesis. TGF-β2 was at control level from presurgery until the phase of cartilage remodeling at 5Y when it increased sharply to a peak at 7Y with a gradual return to baseline at 18Y postsurgery. TGF-β3 remained at control level throughout the study. Conclusion: This study shows that the involvement of BMPs and TGF-βs in endochondral bone repair is a process of stepwise recruitment of individual biomarkers characterized by distinct, yet overlaping, spatiotemporal patterns that extend from the early phase of pre-chondrocyte recruitment until the late phase of coupled bone remodeling.
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| 6. |
- Cnudde, Peter, 1970, et al.
(författare)
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Trends in hip replacements between 1999 and 2012 in Sweden.
- 2018
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Ingår i: Journal of orthopaedic research. - : Wiley. - 0736-0266 .- 1554-527X. ; 36:1, s. 432-442
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Tidskriftsartikel (refereegranskat)abstract
- National Registers document changes in the circumstance, practice, and outcome of surgery with the passage of time. In the context of total hip replacement (THR), registers can help elucidate the relevant factors that affect the clinical outcome. We evaluated the evolution of factors related to patient, surgical procedure, socio-economy, and various outcome parameters after merging databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged. We studied the evolution of surgical volume, patient demographics, socio-economic factors, surgical factors, length-of-stay, mortality rate, adverse events, re-operation and revision rates, and Patient Reported Outcome Measures (PROMs). Throughout this time period the majority of patients were operated on with a diagnosis of primary osteoarthritis. Comorbidity indices increased each year observed. The share of all-cemented implants has dropped from 92% to 68%. More than 88% of the bearings were metal-on-polyethylene. Length-of-stay decreased by 50%. There was a reduction in 30- and 90-day mortality. Re-operation and revision rates at 2 years are decreasing. The post-operative PROMs improved despite the observation of worse pre-operative pain scores getting over time. The demographics of patients receiving a THR, their comorbidities, and their primary diagnosis are changing. Notwithstanding these changes, outcomes like mortality, re-operations, revisions, and PROMs have improved. The practice of hip arthroplasty has evolved, even in a country such as Sweden that is considered to be conservative with regard taking on new surgical practices. © 2017 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res.
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| 7. |
- Cnudde, Peter, 1970, et al.
(författare)
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Trends in the patient demographics, socio-economic characteristics, surgical factors and outcomes between 1999 and 2012
- 2017
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Ingår i: Orthopaedic Proceedings. 99-B (SUPP 12). - : British Editorial Society of Bone & Joint Surgery. - 1358-992X .- 2049-4416.
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Konferensbidrag (refereegranskat)abstract
- Prospectively collected data is an important source of information subjected to change over time. What surgeons were doing in 1999 might not be the case anymore in 2016 and this change in time also applies to a number of factors related to the performance and outcome of total hip replacement. We evaluated the evolution of factors related to the patient, the surgical procedure, socio-economy and various outcome parameters after merging the databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged with databases including general information about the Swedish population and about hospital care. We studied the evolution of surgical volume, patient demographics, socio-economic factors, surgical factors, length of stay, mortality rate, adverse events, re-operation and revision rates and PROMs. Most patients were operated because of primary osteoarthritis and this share increased further during the period at the expense of decreasing number of patients with inflammatory OA and hip fracture. Comorbidity and ASA scores increased for each year. The share of all cemented implants has dropped from 92% to 68% with a corresponding increase of all uncemented from 2% to 16%. Length of stay decreased with about 50 percent to 4.5 days in 2012. The 30- and 90-day mortality rate dropped to 0.4% and 0.7%. Re-operation and revision rates at 2 years were lower in the more recent years. The postoperative PROMs are improving despite the preoperative pain scores getting worse. Even in Sweden, always been considered as a very conservative country with regards to hip replacement surgery, the demographics of the patients, the comorbidities and the primary diagnosis for surgery are changing. Despite these changes the outcomes like mortality, re-operations, revisions and PROMs are improving.
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| 8. |
- Digas, Georgios, 1963, et al.
(författare)
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Bioactive cement or ceramic/porous coating vs. conventional cement to obtain early stability of the acetabular cup. Randomised study of 96 hips followed with radiostereometry
- 2004
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Ingår i: J Orthop Res. - : Wiley. - 0736-0266. ; 22:5, s. 1035-43
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Tidskriftsartikel (refereegranskat)abstract
- Ninety patients (96 hips) scheduled for THA were stratified to fixation of the acetabular component in three main groups of about equal size. Fluoride cement, porous coated press-fit cup with ceramic coating or Palacos cum Gentamicin cement were used. All patients received Spectron EF stem. The migration of the cups and the femoral head penetration into the socket were measured with radiostereometric analysis. At 2 years the choice of fixation did not influence the migration or rotation of the cup. Patients with compromised bone quality showed increased three-dimensional (3D or total) migration. Proximal and 3D penetration rates were increased in cemented compared with the uncemented cups (p<0.001), which probably not could be related to the choice of fixation. Appearance of radiolucent lines was almost equal in the two cemented groups. Uncemented cups had less radiolucent lines at 2 years. Fluoride containing cement or uncemented fixation did not improve the early postoperative stability of the socket.
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| 9. |
- Digas, Georgios, 1963, et al.
(författare)
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Fluoride-containing acrylic bone cement in total hip arthroplasty. Randomized evaluation of 97 stems using radiostereometry and dual-energy x-ray absorptiometry
- 2005
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Ingår i: J Arthroplasty. - : Elsevier BV. - 0883-5403. ; 20:6, s. 784-92
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Tidskriftsartikel (refereegranskat)abstract
- Ninety patients (97 hips) scheduled for total hip arthroplasty were stratified to fixation of the femoral component using fluoride-containing cement or Palacos with gentamicin. Whole polyethylene Reflection and press-fit Trilogy cups were used. All patients received Spectron EF stem. The micromotions of the stem were measured with radiostereometric analysis and the periprosthetic bone mineral density with automatic and manual dual-energy x-ray absorptiometry (DEXA) analysis. At 2 years, the choice of cement did not influence the subsidence or rotations of the stem. The DEXA analysis revealed more loss of periprosthetic bone mineral density in fluoride cement group. We speculate that forming of fluorapatite crystals, toxic effects of the fluoride, or lower radiopacity of the fluoride cement might explain this finding. According to our study with 2-year of follow-up, there is no obvious advantage of addition of fluoride to acrylic bone cement when used to fixate the femoral component in total hip arthroplasty.
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| 10. |
- Digas, Georgios, 1963, et al.
(författare)
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The Otto Aufranc Award. Highly cross-linked polyethylene in total hip arthroplasty: randomized evaluation of penetration rate in cemented and uncemented sockets using radiostereometric analysis
- 2004
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Ingår i: Clin Orthop Relat Res. - 0009-921X. ; :429, s. 6-16
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Tidskriftsartikel (refereegranskat)abstract
- The annual wear rate in polyethylene articulations should be 0.1 mm or less to avoid future osteolysis. Highly cross-linked polyethylene shows an 80 to 90% wear reduction in hip simulator testing, but the clinical documentation of this new polyethylene is still inadequate. We evaluated the highly cross-linked polyethylene in two prospective randomized clinical studies. Thirty-two patients (12 men, 20 women; 64 hips) with a median age of 48 years (range, 29-70 years) with bilateral primary or secondary arthrosis of the hip had hybrid total hip arthroplasty with liners made of highly cross-linked polyethylene on one side and conventional polyethylene on the other. Twenty-seven patients in this study have passed 2 years followup. A further group, comprised of 60 patients (61 hips) with a median age of 55 years (range, 35-70 years), was randomized to receive either highly cross-linked polyethylene or conventional cemented all-polyethylene of the same design. Forty-nine of these 60 patients have been observed for 3 years. In both studies all patients received Spectron stems with 28-mm Co-Cr heads. Radiostereometric examinations with the patient supine or standing were done at regular intervals. Wear was measured in the supine position from the first postoperative week, whereas standing examinations were initiated 3 months after the operation. The penetration rate almost was identical in the study and control groups at 6 months after the operation. Thereafter, the penetration rate leveled out in the two groups with highly cross-linked polyethylene. At 2 years the highly cross-linked polyethylene liner showed 62% lower proximal penetration and 31% lower total (three-dimensional) penetration when the patients were examined in supine position. The highly crosslinked all-polyethylene cemented cups showed lower proximal penetration in both positions. The better wear performance of highly cross-linked polyethylene could increase the implant longevity. Longer followup is needed to evaluate if this new material is associated with less occurrence of osteolysis.
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