| 1. |
- Cebatorius, Algimantas, et al.
(author)
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Choice of approach, but not femoral head size, affects revision rate due to dislocations in THA after femoral neck fracture: results from the Lithuanian Arthroplasty Register
- 2015
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In: International Orthopaedics. - : Springer Science and Business Media LLC. - 1432-5195 .- 0341-2695. ; 39:6, s. 1073-1076
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Journal article (peer-reviewed)abstract
- Purpose Hip dislocation after arthroplasty for femoral neck fractures (FNF) remains a serious complication. The aim of our study was to investigate FNF patients treated with THA, with a special focus of comparing the effect of surgical approach and femoral head size on the risk of revision for dislocation. Methods Data were derived from the Lithuanian Arthroplasty Register, and we calculated the cumulative revision rates after surgery. For survival analysis, we used revision due to dislocation as an end-point. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, femoral head size, surgical approach). Results A total of 8,813 primary THAs were registered from 1 January 2011 to 31 December 2013, of which 1,412 were due to FNF: 899 involved 28-mm femoral heads and the remaining 513 received 32-mm heads. The posterior approach was used in 1,156 cases and the anterolateral approach in 256.. At the end of the follow-up period, 74 hips had been revised for recurrent dislocation. Cox regression adjusting for age, gender and head size showed that the posterior approach had 2.3-times [95% confidence interval (CI): 1.0-5.0, p = 0.04] greater risk of revision for dislocation Conclusions We conclude that in order to reduce the early dislocation rate in FNF patients treated with THA, it is more effective to use the anterolateral approach than it is to select a femoral head size of 32 mm instead of 28 mm.
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| 2. |
- Markeviciute, Vetra, et al.
(author)
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Systemically administered zoledronic acid activates locally implanted synthetic hydroxyapatite particles enhancing peri-implant bone formation : A regenerative medicine approach to improve fracture fixation
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In: Acta Biomaterialia. - 1742-7061.
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Journal article (peer-reviewed)abstract
- Fracture fixation in an ageing population is challenging and fixation failure increases mortality and societal costs. We report a novel fracture fixation treatment by applying a hydroxyapatite (HA) based biomaterial at the bone-implant interface and biologically activating the biomaterial by systemic administration of a bisphosphonate (zoledronic acid, ZA). We first used an animal model of implant integration and applied a calcium sulphate (CaS)/HA biomaterial around a metallic screw in the tibia of osteoporotic rats. Using systemic ZA administration at 2-weeks post-surgery, we demonstrated that the implant surrounded by HA particles showed significantly higher peri‑implant bone formation compared to the unaugmented implants at 6-weeks. We then evaluated the optimal timing (day 1, 3, 7 and 14) of ZA administration to achieve a robust effect on peri‑implant bone formation. Using fluorescent ZA, we demonstrated that the uptake of ZA in the CaS/HA material was the highest at 3- and 7-days post-implantation and the uptake kinetics had a profound effect on the eventual peri‑implant bone formation. We furthered our concept in a feasibility study on trochanteric fracture patients randomized to either CaS/HA augmentation or no augmentation followed by systemic ZA treatment. Radiographically, the CaS/HA group showed signs of increased peri‑implant bone formation compared with the controls. Finally, apart from HA, we demonstrated that the concept of biologically activating a ceramic material by ZA could also be applied to β-tricalcium phosphate. This novel approach for fracture treatment that enhances immediate and long-term fracture fixation in osteoporotic bone could potentially reduce reoperations, morbidity and mortality. Statement of significance: • Fracture fixation in an ageing population is challenging. Biomaterial-based augmentation of fracture fixation devices has been attempted but lack of satisfactory biological response limits their widespread use. • We report the biological activation of locally implanted microparticulate hydroxyapatite (HA) particles placed around an implant by systemic administration of the bisphosphonate zoledronic acid (ZA). The biological activation of HA by ZA enhances peri‑implant bone formation. •Timing of ZA administration after HA implantation is critical for optimal ZA uptake and consequently determines the extent of peri‑implant bone formation. • We translate the developed concept from small animal models of implant integration to a proof-of-concept clinical study on osteoporotic trochanteric fracture patients. • ZA based biological activation can also be applied to other calcium phosphate biomaterials.
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| 3. |
- Širka, Aurimas, et al.
(author)
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Calcium Sulphate/Hydroxyapatite Carrier for Bone Formation in the Femoral Neck of Osteoporotic Rats
- 2018
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In: Tissue Engineering. Part A. - 1937-335X. ; 24:23-24
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Journal article (peer-reviewed)abstract
- This study investigated bone regeneration in the femoral neck canal of osteoporotic rats using a novel animal model. A calcium sulphate (CS)/hydroxyapatite (HA) carrier was used to deliver a bisphosphonate, zoledronic acid (ZA), locally, with or without added recombinant human bone morphogenic protein-2 (rhBMP-2). Twenty-eight-week-old ovariectomized Sprague-Dawley rats were used. A 1 mm diameter and 8 mm long defect was created in the femoral neck by drilling from the lateral cortex in the axis of the femoral neck, leaving the surrounding cortex intact. Three treatment groups and one control group were used: (1) CS/HA alone, (2) CS/HA + ZA (10 μg) (3) CS/HA + ZA (10 μg) + rhBMP-2 (4 μg), and (4) empty defect (control). The bone formation was assessed at 4 weeks post surgery using in vivo micro computed tomography (micro-CT). At 8 weeks post surgery, the animals were sacrificed, and both defect and contralateral femurs were subjected to micro-CT, mechanical testing, and histology. Micro-CT results showed that the combination of CS/HA with ZA or ZA + rhBMP-2 increased the bone formation in the defect when compared to the other groups and to the contralateral hips. Evidence of new dense bone formation in CS/HA + ZA and CS/HA + ZA + rhBMP-2 groups was seen histologically. Mechanical testing results showed no differences in the load to fracture between the treatments in either of the treated or contralateral legs. The CS/HA biomaterial can be used as a carrier for ZA and rhBMP-2 to regenerate bone in the femoral neck canal of osteoporotic rats.
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| 4. |
- Smailys, Alfredas, et al.
(author)
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Exeter total hip arthroplasty with matte or polished stems
- 2007
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In: Medicina. - 1648-9144. ; 43:3, s. 215-220
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Journal article (peer-reviewed)abstract
- Objective. To compare implant survival rates after total hip arthroplasty with Exeter matte or polished steins and to determine the relationship of synovitis/joint effusion to signs of implant loosening and stein type. Material and methods. The first part of the study included retrospective revision rate analysis of 118 primary hip replacements performed during 1991-1995. Two different designs of Exeter stems were used: matte surface steins during 1991-1995 (matte surface group - 47 cases), and polished stems during 1992-1995 (polished stem group - 71 cases). During the second part of the study, 24 patients (11 in polished stein group and 13 in matte stem group) were prospectively examined with radiography and sonography. Sonograpky was performed in order to evaluate capsular distension, i.e. the distance between prosthetic femoral neck and anterior capsule. Capsular distension depends oil synovitis and/or synovia in prosthetic hip. The relationship between capsular distension, stein type, and radiographic signs of loosening was assessed. Results. For the first part of our study, total implant survival was 78% with matte stems and 61% with polished stems 13 years postoperatively (P=0.27). Stem survival was 82% for matte steins, and 88% for polished stems (P=0.54). In the second part of study, a significant relationship between increased capsular distension and cup loosening was determined (P=0.04). We did not find significant difference in capsular distension when compared matte and polished stems. Conclusion. Implant survival rates did not differ between the groups. The relationship between capsular distension and clip loosening was statistically significant.
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| 5. |
- Stucinskas, Justinas, et al.
(author)
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Bipolar hemiarthroplasty versus total hip arthroplasty in femoral neck fracture patients : results from Lithuanian Arthroplasty Register
- 2020
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In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067.
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Journal article (peer-reviewed)abstract
- Introduction: Elderly patients with displaced femoral neck fractures (FNF) are usually operated with arthroplasty but with various combinations of implants and approaches. Thus, the optimal treatment is still controversial. We aimed to compare the results between the cemented bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) patients operated for FNF regarding revision rate at 1 year postoperatively. Methods: The data were derived from the Lithuanian Arthroplasty Register. We included patients operated with cemented bipolar HA and compared them to the most frequently used cemented THA with 28-mm head during 2011–2016. For survival analysis, we used both revision for all reasons and for dislocations as an endpoint. Cox proportional hazards models were used to analyse the influence of covariates (age groups, gender, surgical approaches and arthroplasty groups). Results: There were 1177 bipolar HA and 514 THA included in our study. 26 (2.2%) revisions had occurred among the bipolar HAs as compared to 25 (4.9%) among the THAs 1 year after surgery. The main reason for revision was dislocation. The unadjusted cumulative revision rate for any reason at 1 year after surgery was 2.4% for the bipolar HA group and 5.1% for the THA group (p = 0.0054). Cox regression analysis showed that the use of bipolar HA, anterolateral approach and younger age groups had lower risk of revision for all reasons. Conclusion: Bipolar HA and anterolateral approach had a significantly lower overall 1-year risk of revision in femoral neck fracture patients as compared to THA with 28-mm femoral heads.
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| 6. |
- Stucinskas, Justinas, et al.
(author)
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Comparison of dual mobility cup and other surgical construts used for three hundred and sixty two first time hip revisions due to recurrent dislocations : five year results from Lithuanian arthroplasty register
- 2018
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In: International Orthopaedics. - : Springer Science and Business Media LLC. - 0341-2695 .- 1432-5195. ; 42:5, s. 1015-1020
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Journal article (peer-reviewed)abstract
- Purpose: Recently, there has been increasing interest in the use of dual mobility systems in the treatment of hip instability. The aim of this study was to investigate the re-revision rate of dual mobility cup compared to different surgical concepts when used for first-time hip revisions due to recurrent dislocations. Methods: The data were derived from the Lithuanian Arthroplasty Register. For survival analysis, we used both re-revision for all reasons and for dislocations as an end-point. Cox proportional hazards models were used to analyze the influence of various covariates (age, gender, and implant concept). Results: A total of 1388 revisions were recorded from 2011 to 2015, of which 362 were performed due to recurrent dislocation. Of the revisions, 247 were performed using dual mobility cups, while 115 were performed using a variety of other surgical constructs including constrained acetabular cups, conventional cups, femoral head exchanges, stem exchanges or anti-luxation rings. There were 27 re-revisions of which 15 were for additional dislocations. There were only 2% re-revisions due to dislocation with dual mobility vs 9% when using other surgical constructs. Cox regression adjusting for age and gender showed that in the short-term, dual mobility cup had a lower risk of revision due to dislocation as well as for all reasons compared to the other surgical constructs. Conclusion: In revision of total hip arthroplasties for dislocation, significantly lower short-term re-revision rate was observed for patients revised with dual mobility cup.
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| 7. |
- Stucinskas, Justinas, et al.
(author)
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Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial
- 2009
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In: International Orthopaedics. - : Springer Science and Business Media LLC. - 1432-5195 .- 0341-2695. ; 33:5, s. 1275-1278
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Journal article (peer-reviewed)abstract
- Total knee replacement in severe osteoarthritis usually requires extensive soft tissue releases often associated with considerable bleeding. In a prospective, randomised trial we compared postoperative conventional suction drainage versus four hour clamping drainage in 60 patients undergoing total knee arthroplasty for severe osteoarthritis. We compared blood loss, number of transfusions, postoperative complications and knee function and found significantly less postoperative blood loss through the drains (p < 0.001), and fewer blood transfusions (p=0.09) were needed in the clamped group. We conclude that clamping drainage after total knee arthroplasty in severe osteoarthritis reduces blood loss through the drains and the need for blood transfusions.
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| 8. |
- Tarasevicius, Sarunas, et al.
(author)
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Intracapsular pressure and elasticity of the hip joint capsule in osteoarthritis
- 2007
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In: Journal of Arthroplasty. - : Elsevier BV. - 0883-5403. ; 22:4, s. 596-600
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Journal article (peer-reviewed)abstract
- We investigated intracapsular pressure and elasticity of the hip joint capsule in osteoarthritis. HOOS hip score, sonography of the hip joint, and radiographic assessment of osteoarthritis were performed in 31 patients before total hip arthroplasty. The intracapsular hydrostatic pressure was measured perioperatively, and 0.9% saline solution was then injected in the hip joint, 1 mL at a time with continuous pressure recording up to 300 mm Hg. The mean radiographic grade of severity of osteoarthritis was 8 (SD, 2.4). The mean hydrostatic intracapsular pressure in 45 degrees of flexion was 2.2 mm Hg (SD, 10.0) in extension, 15.8 mm Hg (SD, 33.0); in inward rotation, 13.7 mm Hg (SD, 26.0); and in outward rotation, 12.1 mm Hg (SD, 24.3). Severe osteoarthritis was associated with lower intracapsular pressure and lower elasticity of the joint capsule.
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| 9. |
- Tarasevicius, Sarunas, et al.
(author)
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Introduction of total hip arthroplasty in Lithuania - Results from the first 10 years
- 2007
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 78:4, s. 454-457
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Journal article (peer-reviewed)abstract
- Background Hip replacement as a routine procedure was introduced in Lithuania in 1991. At Klaipeda Hospital, one of the 2 hospitals at which this was begun, the arthroplasties were followed prospectively from the start. This study concerns the 10-year results from a country with no previous experience of hip replacement. The results are compared with those from a hospital with considerable experience of total hip replacement. Methods We compared the revision rate for the first 658 primary ScanHip arthroplasties inserted at Klaipeda to that for the first 939 ScanHip primary arthroplasties inserted at Lund University Hospital, Sweden. Only patients with osteoarthritis were included, and the end-point was revision for aseptic loosening with exchange of one or both components. Results We found that patients operated at Klaipeda Hospital had a significantly higher risk of revision (12%) than those operated in Lund (6%). Interpretation Although we could not identify any specific reason for the Swedish results being better than the Lithuanian results, it is probable that previous surgical inexperience of hip replacement in Lithuania played a role. We believe that the findings will stimulate surgeons in Lithuania to analyze their failures and improve the results.
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| 10. |
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