| 1. |
- Mikhail, W. E., et al.
(författare)
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Femoral bone regeneration subsequent to impaction grafting during hip revision : histologic analysis of a human biopsy specimen
- 1999
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Ingår i: The Journal of Arthroplasty. - Philadelphia, USA : Elsevier. - 0883-5403 .- 1532-8406. ; 14:7, s. 849-953
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Tidskriftsartikel (refereegranskat)abstract
- Cemented revision with impaction grafting shows encouraging early clinical results; postoperative biopsy specimens taken from the proximal femur in humans have demonstrated viable trabecular and cortical bone. Human radiographic studies also illustrate density changes within the proximal femur, consistent with remodeling of bone-graft. In an animal experiment, bone incorporation was shown in the proximal femur, but graft lysis was reported around the distal portion of the implant. We report on a patient who sustained a traumatic femoral fracture at the level of the tip of the femoral component 27 months after revision with impaction grafting and a collarless polished taper stem. At the time of open reduction and internal fixation of the fracture, we obtained circumferential biopsy specimens from the fracture site. Three distinct zones could be identified histologically: i) an inner zone consisting of bone-cement, fibrous tissue, and partially necrotic trabeculae with evidence of bone remodeling; ii) a middle zone consisting of viable trabecular bone and probable neocortex formation with fewer particles of bone-cement; and iii) an outer zone with viable cortex. Fibrous tissue was present around some of the incorporating bone-graft fragments, but no continuous fibrous membrane was present. Cement particles were identified, but no polyethylene debris was found by light microscopy. Biopsy specimens from the distal aspect of the prosthesis may not reflect changes seen proximally, but based on the available tissue, this case illustrated histological evidence of bone-graft remodeling after impaction grafting. These results are consistent with our expectations based on radiographic findings and clinical results.
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| 2. |
- Stigbrand, Hampus, et al.
(författare)
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A 2-to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New Acetabular Implant Combined With Impacted Bone Allografts and a Cemented Cup
- 2018
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Ingår i: The Journal of Arthroplasty. - : CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. - 0883-5403 .- 1532-8406. ; 33:3, s. 815-822
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Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell.Methods: We retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.8) after IBG combined with a graft-compressing titanium shell implant. The patients were reviewed by clinical score and radiography. Three patients were lost to follow-up. The medical journals of the 33 deceased cases were reviewed for any reoperation. Of the 170 cases, 74 had a cavitary acetabular bone defect, 93 had combined segmental and cavitary bone defects, and 3 had a pelvic dissociation. Bone graft incorporation was assessed and correction of the hip center of rotation was calculated. Results: Five cases (3%) were reoperated for mechanical loosening. One more was assessed as loose but asymptomatic and was not planned for revision. There were 3 reoperations for recurrent dislocation, 2 for deep infection and 1 for technical error. Reoperation for any reason, as the end point of survivorship, showed a survival rate of 92% after 10 years. Hip score according to Merle, d'Aubigne, and Postel increased from 10.8 (preoperatively) to 16.4 at follow-up. The clinical and radiological results were excellent.Conclusion: IBG combined with the compressing shell results in excellent results for this challenging condition.
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| 3. |
- Al-Amiry, Bariq Sh. 1976-, et al.
(författare)
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The Influence of Radiological Severity and Symptom Duration of Osteoarthritis on Postoperative Outcome After Total Hip Arthroplasty : A Prospective Cohort Study
- 2018
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Ingår i: The Journal of Arthroplasty. - : CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. - 0883-5403 .- 1532-8406. ; 33:2, s. 436-440
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Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to investigate the influence of preoperative radiological severity and symptom duration of hip osteoarthritis (OA) on the postoperative functional outcome, quality of life, as well as abductor muscle strength after total hip arthroplasty (THA). Methods: In this prospective cohort study, we studied 250 patients. Preoperatively, we evaluated the function with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life with euroqol-5D (EQ-5D). At 1 year after THA, the same scores and also hip abductor muscle strength were measured in 222 patients. We divided the cohort twice, first according to the radiological OA severity [Kellgren-Lawrence classification (KL)] and then according to the OA symptom duration. We investigated whether the preoperative KL class and symptom duration influenced the 1-year WOMAC (primary outcome measure) or EQ-5D and abductor muscle strength (secondary outcome measures). Results: The crude results showed that KL class and symptom duration had no influence (P = .90 and P = .20, respectively) on the 1-yearWOMAC. Younger age, male gender, and lower body mass index were associated with a better function. Regarding 1-year EQ-5D, the crude results showed that body mass index and KL class had no influence (P = .83 and P = .39, respectively). The adjusted results showed that only age and gender influenced the postoperative EQ-5D. No influence of the tested factors was found on the 1-year abductor muscle strength. Conclusion: Preoperative radiological OA severity and symptom duration had no influence on the outcome of THA and should probably not affect the decision about timing the operative intervention.
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| 4. |
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| 5. |
- Bjerke, Joakim, et al.
(författare)
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Compensatory strategies for muscle weakness during stair ascent in subjects with total knee arthroplasty
- 2014
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Ingår i: The Journal of Arthroplasty. - : Elsevier. - 0883-5403 .- 1532-8406. ; 29:7, s. 1499-1502
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Tidskriftsartikel (refereegranskat)abstract
- Subjects with total knee arthroplasty (TKA) exhibit decreased quadriceps and hamstring strength. This may bring about greater relative effort or compensatory strategies to reduce knee joint moments in daily activities. To study gait and map out the resource capacity, knee muscle strength was assessed by maximal voluntary concentric contractions, and whole body kinematics and root mean square (RMS) electromyography (EMG) of vastus lateralis and semitendinosus were recorded during stair ascent in 23 unilateral TKA-subjects ~19months post-operation, and in 23 healthy controls. Muscle strength and gait velocity were lower in the TKA group, but no significant group differences were found in RMS EMG or forward trunk lean. The results suggest that reduced walking velocity sufficiently compensated for reduced knee muscle strength.
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| 6. |
- Bjerke, Joakim, et al.
(författare)
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Peak knee flexion angles during stair descent in TKA patients
- 2014
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Ingår i: The Journal of Arthroplasty. - : Elsevier. - 0883-5403 .- 1532-8406. ; 29:4, s. 707-711
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Tidskriftsartikel (refereegranskat)abstract
- Reduced peak knee flexion during stair descent (PKSD) is demonstrated in subjects with total knee arthroplasty (TKA), but the underlying factors are not well studied. 3D gait patterns during stair descent, peak passive knee flexion (PPKF), quadriceps strength, pain, proprioception, demographics, and anthropometrics were assessed in 23 unilateral TKA-subjects ~ 19 months post-operatively, and in 23 controls. PKSD, PPKF and quadriceps strength were reduced in the TKA-side, but also in the contralateral side. A multiple regression analysis identified PPKF as the only predictor (57%) to explain the relationship with PKSD. PPKF was, however sufficient for normal PKSD. Deficits in quadriceps strength in TKA-group suggest that strength is also contributing to smaller PKSD. Increased hip adduction at PKSD may indicate both compensatory strategy and reduced hip strength.
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| 7. |
- Callary, Stuart A, et al.
(författare)
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The 6-Year Migration Characteristics of a Hydroxyapatite-Coated Femoral Stem A Radiostereometric Analysis Study
- 2012
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Ingår i: The Journal of Arthroplasty. - : Elsevier. - 0883-5403 .- 1532-8406. ; 27:7, s. 1344-1348
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Tidskriftsartikel (refereegranskat)abstract
- A prospective cohort of 30 patients undergoing primary total hip arthroplasty for treatment of osteoarthritis was enrolled in a study to characterize the migration behavior of a clinically successful cementless stem. At 6 years, the mean subsidence of the stem was 0.63 mm (range, -0.33 to 3.68 mm); the mean rotation into retroversion was 1.41° (range, -1.33° to 7.48°). No stems had additional subsidence of more than 0.25 mm between 6 months and 6 years. The resultant mean subsidence between 2 and 6 years was 0.03 mm, which is below the limit measurable by radiostereometric analysis. The data demonstrate that subsidence of this cementless stem occurs within the first 6 months, after which there is persistent stabilization.
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| 8. |
- Chen, Antonia, et al.
(författare)
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Prevention of Late PJI
- 2014
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Ingår i: The Journal of Arthroplasty. - : Elsevier BV. - 0883-5403 .- 1532-8406. ; 29:2, s. 119-128
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Tidskriftsartikel (refereegranskat)
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| 9. |
- Dahlstrand, Henrik, et al.
(författare)
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Elevated serum concentrations of cobalt, chromium, nickel, and manganese after metal-on-metal alloarthroplasty of the hip : a prospective randomized study
- 2009
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Ingår i: The Journal of Arthroplasty. - : Elsevier BV. - 0883-5403 .- 1532-8406. ; 24:6, s. 837-845
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Tidskriftsartikel (refereegranskat)abstract
- In this prospective randomized study, we investigate metal ion concentrations and clinical outcome 2 years after metal-on-metal (28 patients) or metal-on-polyethylene (26 patients) hip arthroplasty with 28-mm modular heads. Metal ion concentrations in patient serum were analyzed by high-resolution plasma mass spectrometry. The clinical outcome was almost identical in both groups with respect to the Harris hip score and the Medical Outcome Study Short Form-36; and on plain radiography, no signs of loosening occurred in any group. In the metal-on-metal group, concentrations of all investigated ions increased significantly when compared with preoperative values: cobalt, 15.3-fold (95% confidence interval [CI], 9.4-21.2); chromium, 5.2-fold (CI, 3.5-7.0); nickel, 2.1-fold (CI, 1.2-3.0); and manganese, 1.6-fold (CI, 1.3-2.0). In the metal-on-polyethylene group, a smaller but significant increase in the concentrations of cobalt and nickel occurred, whereas concentrations of the other ions did not change significantly.
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| 10. |
- Flivik, Gunnar, et al.
(författare)
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Improved acetabular pressurization gives better cement penetration : In vivo measurements during total hip arthroplasty
- 2004
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Ingår i: The Journal of Arthroplasty. - : Elsevier BV. - 0883-5403 .- 1532-8406. ; 19:7, s. 911-918
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Tidskriftsartikel (refereegranskat)abstract
- During total hip arthroplasty, the intraoperative cementation pressure was measured inside one of the acetabular anchorage holes. Patients were randomized to pressurization of cement with either a conventional pressurizer or a sequential method including individual pressurization of each anchorage hole. The pressure was correlated to the cement penetration measured on digital radiographs. The early peak pressures were higher for the sequential method, resulting in a significantly better penetration of 2.8 mm compared with 0.7 mm with the conventional pressurizer. We found a strong correlation between early peak cementation pressures and cement penetration into the cancellous bone of the anchoring holes, indicating a cause-effect relationship at this early stage. The highest peak pressures were achieved during the later cup insertion, but these pressures did not correlate with the cement penetration. We conclude that conventional methods for cement pressurization in the acetabulum may not be optimal. © 2004 Elsevier Inc. All rights reserved.
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