| 1. |
- Brodén, Cyrus, et al.
(författare)
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Low-dose CT-based implant motion analysis is a precise tool for early migration measurements of hip cups : a clinical study of 24 patients
- 2020
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Ingår i: Acta Orthopaedica. - : Informa UK Limited. - 1745-3674 .- 1745-3682. ; 91:3, s. 260-265
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Early implant migration is known to be a predictive factor of clinical loosening in total hip arthroplasty (THA). Radiostereometric analysis (RSA) is the gold standard used to measure early migration in patients. However, RSA requires costly, specialized imaging equipment and the image process is complex. We determined the precision of an alternative, commercially available, CT method in 3 ongoing clinical THA studies, comprising 3 different cups.Materials and methods - 24 CT double examinations of 24 hip cups were selected consecutively from 3 ongoing prospective studies: 2 primary THA (1 cemented and 1 uncemented) and 1 THA (cemented) revision study. Precision of the CT-based implant motion analysis (CTMA) system was calculated separately for each study, using both the surface anatomy of the pelvis and metal beads placed in the pelvis.Results - For the CTMA analysis using the surface anatomy of the pelvis, the precision ranged between 0.07 and 0.31 mm in translation and 0.20° and 0.39° for rotation, respectively. For the CTMA analysis using beads the precision ranged between 0.08 and 0.20 mm in translation and between 0.20° and 0.43° for rotations. The radiation dose ranged between 0.2 and 2.3 mSv.Interpretation - CTMA achieved a clinically relevant and consistent precision between the 3 different hip cups studied. The use of different hip cup types, different CT scanners, or registration method (beads or surface anatomy) had no discernible effect on precision. Therefore, CTMA without the use of bone markers could potentially be an alternative to RSA to measure early migration.
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| 2. |
- Sotiriou, Dimitrios, et al.
(författare)
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Is two-stage revision surgery for infected hip arthroplasty worth the suffering, resources and results compared to one-stage?
- 2022
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Ingår i: HIP International. - Uppsala Univ, Dept Orthopaed, Cty Council Gavleborg, Gavle Hosp, Gavle, Sweden. Uppsala Univ, Ctr Res & Dev, Cty Council Gavleborg, Gavle, Sweden. : SAGE Publications. - 1120-7000 .- 1724-6067. ; 32:2, s. 205-212
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Periprosthetic joint infection (PJI) is the most serious complication of total hip arthroplasty. The treatment is usually revision in either 1 or 2 stages. This study analyses revision with impaction bone grafting for periprosthetic joint infection of the hip and compares 1- and 2-stage strategies. Patients and methods: We reviewed 55 consecutive cases (54 patients) of revision arthroplasty for PJI carried out at our hospital between 2002 and 2016. Of these, 46 were 2-stage procedures. 21 had vancomycin mixed in with the bone graft, and all had gentamycin-containing bone cement. The total perioperative blood loss, duration of operation, and length of hospital stay were recorded. Clinical and radiological results were analysed for 48 hips at 2-16 years follow-up. Results: No PJI remained at follow-up. 3 patients (6%) had undergone revision for all causes. 1 had radiological signs of mechanical loosening but was not revised. 2-stage procedures had a significantly longer operating time (409 vs. 238 min) and hospital stay (34 vs. 13 days), greater blood loss (2764 vs. 1638 ml), and lower mean functional hip score (15.9 vs. 17.5) at follow-up than the one-stage procedures. Interpretation: Revision total hip arthroplasty for PJI with vancomycin-loaded impaction bone grafting is a safe method that achieves both the restoration of bone stock and resolution of the infection. This single-stage procedure could therefore be the new gold standard for treatment of non-complicated PJI in the hip.
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| 3. |
- 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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| 4. |
- Stigbrand, Hampus, et al.
(författare)
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A 3-to 18-Year Follow-Up of Revision Total Hip Arthroplasty With Impacted Bone Allografts and Cemented Lubinus SP II Stem. Clinical, Radiographic, and Survivorship Analysis With Comparison to the Literature
- 2017
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Ingår i: The Journal of Arthroplasty. - : Elsevier BV. - 0883-5403 .- 1532-8406. ; 32:9, s. 2810-2814
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Tidskriftsartikel (refereegranskat)abstract
- Background: We present the first medium- to long-term follow-up of revision total hip arthroplasty using impaction bone grafting (IBG) combined with the matte and collared Lubinus SP II stem for cases of severe osteolysis and stem loosening.Methods: Sixty-nine femoral revisions were identified for 67 patients consecutively operated with revision femoral arthroplasty using IBG and a cemented Lubinus SP II stem. The mean age was 69 years (standard deviation, 9.9). We retrospectively analyzed 68 cases (1 was lost to follow-up). At the time of the revision surgery, all had substantial femoral bone loss. Fifteen of the revisions were performed due to deep infection. The patients were analyzed by clinical score and radiography.Results: At follow-up, 4 femoral components (6%) had been rerevised or assessed as failure. Of these 4, 3 were assessed as mechanical failure, and 1 for dislocation; none was for infection. Three cups (4%) had been revised for dislocation; 1 of these also had a stem exchange. Three cases (4%) had been reoperated for a periprosthetic fracture in distal femur without stem exchange. Radiologic results were excellent and the clinical Merle d'Aubigne-Postel score had improved from a mean of 12.2 preoperatively to 17.5 at follow-up.Conclusion: IBG combined with the Lubinus SP II stem is safe and results in a low rate of periprosthetic fractures and dislocations. The medium-to long-term clinical result was excellent, with regeneration of living bone in the femur.
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| 5. |
- Stigbrand, Hampus, et al.
(författare)
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Component dissociation after closed reduction of dual mobility sockets - a report of three cases
- 2011
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Ingår i: HIP International. - 1120-7000 .- 1724-6067. ; 21:2, s. 263-266
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Tidskriftsartikel (refereegranskat)abstract
- Dual mobility sockets have been introduced in recent years to manage cases of potential instability after hip arthroplasty, and their use is increasing in revision surgery. We present 3 cases of intra-prosthetic dissociation between the outer polyethylene liner and the femoral head after closed reduction of prosthetic dislocation.
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| 6. |
- Stigbrand, Hampus, et al.
(författare)
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Implant migration and bone mineral density measured simultaneously by low-dose CT scans : a 2-year study on 17 acetabular revisions with impaction bone grafting
- 2020
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 91:5, s. 571-575
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Early postoperative implant migration predicts failure of joint replacements. Bone mineral density reflects bone quality and bone-graft incorporation. Implant migration and bone densitometry analysis usually require special equipment. We investigated cup migration and bone mineral density changes simultaneously with low-dose CT scans after acetabular revision hip arthroplasty using impaction bone grafting.Patients and methods — We performed a low-dose CT postoperatively, after 6 weeks, and after 2 years in 17 patients, all revised using impaction bone grafting and a graft-compressing titanium shell in the acetabulum. 6 patients had combined segmental and cavitary acetabular defects. Cup migration was analyzed using CT-based micromotion analysis (CTMA). Bone mineral density was determined in the graft and in surrounding native bone using volumetric quantitative computed tomography (QCT). The bone graft volume was calculated from 3D reconstructions.Results — At 2 years, the translations were 1.5 (95% CI 0.4–2.6) mm in proximal direction, -0.6 (CI –1.6 to 0.4) in the medial direction and 0.3 (CI 0.0–0.6) in the anterior direction. The mean volume of impacted bone graft was 40 cm³ (CI 28–52). In the graft bone mineral density increased 14% after 6 weeks and 23% after 2 years. There was 1 mechanical failure.Interpretation — Proximal migration of the acetabular component was low and comparable to previous reports. There was a rapid increase of bone mineral density in the bone graft. Low-dose CT scans make migration analysis and bone densitometry measurements possible in the same setting, offering great diagnostic potential for hip arthroplasty patients.
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| 7. |
- Stigbrand, Hampus, 1974-
(författare)
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Revision Hip Arthroplasty : Impaction Bone Grafting and Low-Dose CT-Based Measurements of Bone Density and Migration
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aseptic loosening of total hip replacements is always associated with bone defects, either due to removal of the existing implant or osteolysis. Bone defects can be handled during revision surgery with impaction bone grafting (IBG). Allograft bone is morcellized, washed, and impacted into the defects, after which the new implant is cemented upon the grafted bone. For succesful incorporation, mechanical stability and load are key factors. Femoral IBG was developed for the polished tapered collar-less Exeter stem.The hypothesis in paper I was that additional compression of the acetabular bone graft, with a titanium shell, would increase stability and render good clinical results. 170 patients were systematically reviewed at seven years in mean. Kaplan-Meier analysis showed a ten-year prosthetic survival (all causes) at 92%.The hypothesis in paper II was that femoral IBG works with the matte cemented Lubinus SPII stem. 69 patients were reviewed at a mean time of seven years. With re-operation for any reason as endpoint, the Kaplan-Meier analysis showed a prosthetic survival rate of 93%. The grafted bone was incorporated in most cases. The rate of periprosthetic fractures was 4% and these were all treated with osteosynthesis.In paper III we examined if it would be possible to measure bone mineral denisty and prosthetic migration simultaneously with CT-examinations. 17 patients were followed for two years. The CT-examinations were able to measure prosthetic migration and bone mineral density.In paper IV the precision of CT-based migration analysis was evaluated. Patients from three different clinical trials were analyzed. Analysis was made with and without tantalum markers in the bone. Precise prosthetic migration analysis based on CT-scans was possible, even without tantalum markers.In conclusion, CT-scans can measure prosthetic migration with high precision without tantalum markers in the bone. The scans can simultaenously measure bone mineral density. CT-scans have great diagnostic potential for hip arthroplasty patients. Acetabular IBG, combined with a compressive titanium shell, is safe to use and may enhance incorporation due to increased stability. Femoral IBG works well also with a matte collared and anatomical cemented stem.
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