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- Carlsson, Lars V, et al.
(författare)
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Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: I. Preliminary investigations--52 patients followed for 3 years.
- 2006
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 77:4, s. 549-58
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We developed a total hip system using osseointegration guidelines, a metaphyseal-loading proximal femoral replacement in the retained neck and a dual-geometry titanium shell in the acetabulum. PATIENTS AND METHODS: A randomized controlled clinical trial was undertaken in 52 patients (53 hips), using the cemented Spectron stem and cementless Harris-Galante II cup as control implants (24 patients in experimental group, 29 control patients). Clinical measures of Harris Hip Score (HHS), pain score and radiostereometric analysis (RSA) at regular intervals for up to three years were used to monitor progress. RESULTS: No statistically significant differences were found in HHS and pain score; the stability of the cementless experimental implant was also comparable to that of the cemented controls by RSA. 3 revisions were required for migration in the experimental group and 1 was required for component dislocation in the control group. INTERPRETATION: Our findings indicate the practicality of osseointegration of titanium implants, but suggest that current performance is inadequate for clinical introduction. However, the stable fixation achieved in the retained neck in the majority of patients is indicative of osseointegration. This finding will encourage technical and design improvements for enhancement of clinical osseointegration and should also encourage further study. Periprosthetic osteolysis might be avoided by the establishment and maintenance of direct implant-bone connection: "osseointegration".
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| 2. |
- Carlsson, Lars, 1952, et al.
(författare)
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Bone conserving hip replacement.
- 2004
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Ingår i: 3rd Annual SICOT/SIROT Conference 2004.
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Konferensbidrag (refereegranskat)
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| 3. |
- Carlsson, Lars, 1952, et al.
(författare)
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Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: II. Clinical proof of concept--40 patients followed for 2 years
- 2006
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 77:4, s. 559-566
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We have developed a bone-conserving commercially pure titanium hip replacement system using osseointegration principles: a metaphyseal loading proximal femoral component affixing into the retained neck and metaphysis only, leaving the femoral canal untouched. The acetabular cup closely fits a dual-geometry cavity, avoiding stress protection at the dome. PATIENTS AND METHODS: After extensive laboratory and clinical pilot trial investigations, the surface-engineered implants were submitted to a prospective randomized controlled clinical trial involving 40 patients (40 hips), in which they were compared to the cemented Spectron femoral component and cementless Trilogy cup as control implant. The following clinical measures were used to monitor progress at regular intervals for the first 2 postoperative years: radiostereometric analysis (RSA), Harris Hip Score, pain score, WOMAC, and SF-36. RESULTS: After 2 years of follow-up, no statistically significant differences were seen between the groups concerning rotation or translation along the cardinal axes. The patients receiving the Gothenburg osseointegrated titanium (GOT) system had significantly higher Harris Hip Score at 6 months, suggesting more rapid recovery. WOMAC, SF-36 and pain analysis were similar for the first 2 postoperative years. INTERPRETATION: Our RSA data suggest that osseointegration was achieved for all patients receiving the GOT hip system. This bone-conserving prosthesis may provide a good alternative, especially for young and active patients.
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| 6. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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An Imbalance of the Immune System Instead of a Disease Behind Marginal Bone Loss Around Oral Implants: Position Paper
- 2020
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Ingår i: The International journal of oral & maxillofacial implants. - : Quintessence Publishing. - 1942-4434 .- 0882-2786. ; 35:3, s. 495-502
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this paper is to present evidence that supports the notion that the primary reason behind marginal bone loss and implant failure is immune-based and that bacterial actions in the great majority of problematic cases are of a secondary nature. MATERIALS AND METHODS: The paper is written as a narrative review. RESULTS: Evidence is presented that commercially pure titanium is not biologically inert, but instead activates the innate immune system of the body. For its function, the clinical implant is dependent on an immune/inflammatory defense against bacteria. Biologic models such as ligature studies have incorrectly assumed that the primary response causing marginal bone loss is due to bacterial action. In reality, bacterial actions are secondary to an imbalance of the innate immune system caused by the combination of titanium implants and ligatures, ie, nonself. This immunologic imbalance may lead to marginal bone resorption even in the absence of bacteria. CONCLUSION: Marginal bone loss and imminent oral implant failure cannot be properly analyzed without a clear understanding of immunologically caused tissue responses.
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| 7. |
- Albrektsson, Tomas, 1945
(författare)
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Are Oral Implants the Same As Teeth?
- 2019
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Ingår i: Journal of clinical medicine. - : MDPI AG. - 2077-0383. ; 8:9
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Tidskriftsartikel (refereegranskat)abstract
- Osseointegration of oral implants was initially discovered by Brånemark [...].
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| 9. |
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| 10. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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Bone loss around oral and orthopedic implants: An immunologically based condition
- 2019
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Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 21:4, s. 786-795
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Tidskriftsartikel (refereegranskat)abstract
- Background Marginal bone resorption has by some been identified as a "disease" whereas in reality it generally represents a condition. Purpose The present article is a comparison between oral and orthopedic implants, as previously preferred comparisons between oral implants and teeth seem meaningless. Materials and Methods The article is a narrative review on reasons for marginal bone loss. Results and Conclusions The pathology of an oral implant is as little related to a tooth as is pathology of a hip arthroplasty to a normally functioning, pristine hip joint. Oral as well as orthopedic implants are recognized as foreign bodies by the immune system and bone is formed, either in contact or distance osteogenesis, to shield off the foreign materials from remaining tissues. A mild immune reaction coupled to a chronic state of inflammation around the implant serve to protect implants from bacterial attacks. Having said this, an overreaction of the immune system may lead to clinical problems. Marginal bone loss around oral and orthopedic implants is generally not dependent on disease, but represents an immunologically driven rejection mechanism that, if continuous, will threaten implant survival. The immune system may be activated by various combined patient and clinical factors or, if rarely, by microbes. However, the great majority of cases with marginal bone loss represents a temporary immune overreaction only and will not lead to implant failure due to various defense mechanisms.
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