| 1. |
- Belfrage, Ola, et al.
(author)
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Locally administered bisphosphonate in hip stem revisions using the bone impaction grafting technique : a randomised, placebo-controlled study with DXA and five-year RSA follow-up
- 2019
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In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 29:1, s. 26-34
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Journal article (peer-reviewed)abstract
- Background: Bisphosphonates have previously been shown to increase the density of impacted graft bone. In the present study we hypothesise that bisphosphonates also reduce early stem subsidence. We examined the effect of locally applied bisphosphonate to allografts on prosthetic micromotion and bone density in femoral stem revision with impaction grafting. Methods: 37 patients were randomised to either clodronate or saline as local adjunct to the morsellised allograft bone. 24 patients were finally analysed per protocol and evaluated by dual-energy x-ray absorptiometry (DXA) during the first year and with radiostereometric analysis (RSA) for 5 years. Results: There were no significant differences neither in bone density, nor in migratory behaviour between the groups. The femoral stems had subsided 3.6 mm in both groups (p = 0.99) at 5 years and there was no difference as measured over time with mixed models analysis. The clinical outcome was good in both groups. Conclusion: Clodronate as a local addendum to allograft bone in hip revision did not increase bone density or reduce micromotion of the implant.
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| 2. |
- Bergkvist, Magnus, et al.
(author)
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Debridement, antibiotics and implant retention in early periprosthetic joint infection
- 2016
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In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 26:2, s. 138-143
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Journal article (peer-reviewed)abstract
- Introduction: Periprosthetic joint infection (PJI) is a devastating complication in hip arthroplasty surgery. Debridement, antibiotics (AB) and implant retention (DAIR) is recommended in early PJI in association with stable implants. The aim of this study was to evaluate the success rate of DAIR in early PJI (<4 weeks) and to identify factors predicting the outcome. Methods: This cohort study included a consecutive series of 35 patients (median age 74 years, 25 women, 26 primary arthroplasties) treated with DAIR for an early PJI in a regional hospital. Results: 28 patients (80%) had their infection eradicated. DAIR-only eradicated the PJI in 22 (63%) patients with a median follow-up of 50 (24-84) months. In 17 (49%) patients, oral AB had been given prior to intraoperative cultures, which delayed first debridement with average 6 days and delayed hospital stay. Primary surgery for a hip fracture increased the risk of DAIR-failure. Surgical experience did not affect the outcome. 17% (n = 6) of the patients sustained a secondary infection during their hospital stay; the majority was beta-lactam resistant coagulase negative Staphylococcus aureus. Conclusions: The success rate of DAIR was inferior to pervious controls from experienced revision centers. Hip fracture patients should be informed about the increased risk of DAIR treatment failure. In order not to delay surgery, empirically based oral AB should not be administered prior to deep cultures.
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| 3. |
- Bunyoz, K. I., et al.
(author)
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No difference in whole-blood metal ions between 32-mm and 36-to 44-mm femoral heads in metal-on-polyethylene total hip arthroplasty: a 2-year report from a randomised control trial
- 2023
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In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 33:2, s. 184-192
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Journal article (peer-reviewed)abstract
- Aim: To investigate the effect of femoral head size on blood metal-ion levels caused by taper corrosion in metal-on-polyethylene total hip arthroplasty, comparing 36- to 44-mm heads with 32-mm heads. Methods: In a randomised, controlled, single-blinded trial, 96 patients were allocated to receive either a 32-mm metal head or the largest possible metal head (36-44 mm) that could be accommodated in the thinnest available vitamin E, cross-linked polyethylene insert. Blood metal ion levels were collected at 1- and 2-year follow-ups. Results: At 1-year, metal-ion levels did not differ between the groups. The median (interquartile range) blood-ion levels for the 32-mm versus the 36- to 44-mm group were 0.11 mu g/L (0.08-0.15) versus 0.12 mu g/L (0.08-0.22), p = 0.546, for cobalt, 0.50 mu g/L (0.50-0.59) versus 0.50 mu g/L (0.50-1.20), p = 0.059, for chromium and 1.58 mu g/L (1.38-2.05) versus 1.48 mu g/L (1.14-1.87), p = 0.385, for titanium. At 2 years, there was no difference either and the corresponding values were 0.15 mu g/L (0.12-0.24) versus 0.18 mu g/L (0.12-0.28), p = 0.682 for cobalt, 0.50 mu g/L (0.50-0.50) versus 0.50 mu g/L (0.50-0.57), p = 0.554, for chromium and 1.54 mu g/L (1.16-1.87) versus 1.42 mu g/L (1.01-1.72), p = 0.207 for titanium. Conclusions: The use of the largest possible metal head (36-44 mm) compared to a 32-mm head in metal-on-polyethylene bearings does not appear to elevate blood metal-ion levels up to 2 years postoperatively. As taper corrosion is probably time-dependent, longer-term reports are needed to evaluate the association between large metal heads and blood metal ion levels. Trial registration: ClinicalTrials.gov (reg. ID NCT0231 6704)
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| 4. |
- Chatziagorou, Georgios, et al.
(author)
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Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis.
- 2019
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In: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 29:3, s. 282-288
-
Journal article (peer-reviewed)abstract
- Periprosthetic femoral fractures (PPFF), treated surgically, have been recorded in the Swedish Hip Arthroplasty Register (SHAR) since 1979. It is postulated that fractures treated with other methods other than stem revision have a lower registration rate, which may lead to incomplete registry data and thus, inaccurate information. We collected all PPFFs surgically treated in Sweden between 2001 and 2011 with the purpose of studying the annual incidence, demographics and distribution of fracture types with regard to type of fixation.Data was linked between the SHAR and the National Patient Register (NPR) in order to detect even those PPFFs not reported to the SHAR. Fractures were classified according to the Vancouver classification system, based on information collected from the medical charts. This procedure was validated with observer variation analysis compared to fracture classification based on radiographs. In total 1751 first-time PPFFs around primary conventional stems were included.The incidence of PPFF increased from about 1.0 per 1000 primary THRs to 1.4. Vancouver type C fractures (37% of all fractures) were more common than previously reported, and more common in cemented than in uncemented stems. The 3 most common stem designs involved were Exeter polished, Lubinus SPII, and Charnley (66.3% of all stems), partly reflecting their occurrence in the Swedish THR population.The incidence of PPFFs has increased in Sweden during the period 2001 to 2011. The improved reporting of type C fractures, after data-linking, revealed an almost 4 times higher incidence compared to previous register studies in Sweden.
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| 5. |
- Donahue, GS, et al.
(author)
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Risk factors for mid-term revision surgery in patients with articular surface replacement total hip arthroplasty
- 2018
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In: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 28:1, s. 44-49
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Journal article (peer-reviewed)abstract
- This study assessed the associations between gender and implant survival, as well as adverse local tissue reaction (ALTR), in patients with articular surface replacement (ASR) XL total hip arthroplasty (THA). Secondly, we sought to report the differences between genders in metal ion levels and patient reported outcome measures (PROMs) in these patients. Methods: 563 unilateral ASR XL THA patients were enrolled in a multicentre follow-up study at a mean of 6.4 years after index surgery. All patients had blood metal ion levels and PROMs obtained annually, and a valid anteroposterior pelvis radiograph. A sub-set of patients from a single centre had annual MRI performed and were analysed for the presence of moderate-to-severe ALTR. Results: 60 hips (11%) were revised during the study period. The only variables found to be associated with revision surgery in patients with unilateral THA were VAS pain (hazard ratio [HR], 1.35; p<0.001) and elevated cobalt metal ion levels (HR, 1.05; p<0.001). No variables assessed were found to be associated with prevalence of ALTR. Chromium concentrations were greater in female patients than males, while cobalt levels were similar between genders. Males reported higher HHS, EQ-5D and UCLA scores than females. Conclusions: Both males and females with metal-on-metal THA implants should be followed with equal vigilance as gender does not appear to be associated with poor outcomes, such as revision surgery and presence of ALTR.
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| 6. |
- Gjertsen, Jan-Erik, et al.
(author)
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Hemiarthroplasties after hip fractures in Norway and Sweden: a collaboration between the Norwegian and Swedish national registries
- 2014
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In: HIP International. - : SAGE Publications. - 1724-6067 .- 1120-7000. ; 24:3, s. 223-230
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Journal article (peer-reviewed)abstract
- National registration of hemiarthroplasties after hip fractures has been established in both Norway and Sweden. We aimed to investigate differences in demographics, choice of implant selection, surgical approaches, and reoperations between the Norwegian Hip Fracture Register (NHFR) and the Swedish Hip Arthroplasty Register (SHAR). As part of the Nordic Arthroplasty Register Association (NARA) project a common hemiarthroplasty dataset has been established. 36,989 primary hemiarthroplasties (HAs) for acute hip fractures reported to NHFR (n = 12,761) and SHAR (n = 24,228) for the period 2005-2010 were included. Cemented prostheses were used in 78% of the operations in Norway and in 95% of the patients in Sweden. In Norway HAs almost exclusively had bipolar design (98%), whereas in Sweden HAs with unipolar design were used in 42% of the cases. Monoblock (non-modular) prostheses were uncommon, but still more frequently used in Sweden than in Norway (6.9% and 2.1% respectively). The lateral approach was more common in Norway (83%) than in Sweden (52%), where the posterior approach was used in 42% of the cases. The five-year survival of all HAs was 95.5% (95% CI: 94.8-96.2) in Norway and 94.8% (95% CI: 94.4-95.3) in Sweden. We concluded that surprisingly large differences between the two countries in demographics, implant design, and surgical technique had been revealed. This common dataset enables further investigations of the impact of these differences on revision rates and mortality.
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| 7. |
- Itayem, Raed, et al.
(author)
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A two-year radiostereometric follow-up of the first generation Birmingham mid head resection arthroplasty.
- 2014
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In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 24:4, s. 355-62
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Journal article (peer-reviewed)abstract
- During the first decade of the 21st century, metal-on-metal hip resurfacing became one of the main treatment options for younger, more active patients with osteoarthritis. However, as a result of the reported failure rate of both total hip replacement (THR) and resurfacing in patients with considerable loss of bone stock in the femoral head (e.g., in extensive avascular necrosis), other solutions have been sought for these patients. The short-stemmed Birmingham Mid Head Resection prosthesis (BMHR) combines a metal-on-metal articulation and a femoral neck preserving feature. In this study, radiostereometric analysis (RSA) was used to study migration of the BMHR femoral component in 13 hips. Translations and rotations were measured up to two years. Relative values showed no statistically significant migration. Absolute values demonstrated settling in occurring between zero and two months postoperatively in all directions studied. From two months to two years no significant migration occurred except for rotation around the x-axis of the femoral segment (p = 0.049). After initial settling-in, absolute values were low, indicating that there was no evidence of early migration or loosening of the components.
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| 8. |
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| 9. |
- Korsnes, Lars, et al.
(author)
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Undersizing the Exeter stem in hip hemiarthroplasty increases the risk of periprosthetic fracture
- 2020
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In: HIP International. - : Sage Publications. - 1120-7000 .- 1724-6067. ; 30:4, s. 469-473
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Journal article (peer-reviewed)abstract
- Introduction:: Whether under- or oversizing of the femoral component of cemented hip hemiarthroplasties impacts the risk of periprosthetic fractures (PPF) has only been examined experimentally. This study was carried out to add more knowledge about the risks of PPF in cemented polished tapered hemiarthroplasties.Methods: 20 patients with PPF following hip hemiarthroplasty with cemented Exeter V40 stems were compared to 50 controls who never suffered PPF having received the same type of Exeter hemiprosthesis for the same indication. The difference between stem size and post-hoc radiographic ideal templated size was investigated as a predictor of PPF.Results: Cases had a median size difference to post-hoc templating of –2, while controls had a median size difference of –1 (p = 0.09). An ROC curve constructed to find an optimal cutoff point in size difference between cases and controls arrived at an area under curve of 63%, with –1.5 as the cutoff. Patients with size differences exceeding –1.5 had a statistically significant increased PPF risk (odds ratio = 3.8, 95% confidence interval, 1.1–13.3, p < 0.05). This group covered 55% of all cases.Conclusion: An implanted femoral component that is 2 or more sizes smaller than the template that is shown to be appropriate will increase the risk of PPF in Exeter hip hemiarthroplasties.
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| 10. |
- Krupic, Ferid, et al.
(author)
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Influence of immigrant background on the outcome of total hip arthroplasty: better outcome in 280 native patients in Bosnia and Herzegovina than in 449 immigrants living in Sweden
- 2024
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In: HIP INTERNATIONAL. - 1120-7000 .- 1724-6067. ; 34:1, s. 74-81
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Journal article (peer-reviewed)abstract
- Background: Despite the overall success of THA, between 5 and 20% report unsatisfactory results. Several factors may cause this variable outcome. 1 of them might be ethnicity which, because of its potential social impact on living conditions, may influence quality of life too. It should be studied whether patients born and being operated in their home country Bosnia and Herzegovina (BH) had similar results as immigrants being operated in Sweden (IS).Methods: Data of 280 patients were collected prospectively from questionnaires in the BH group. Patients of the IS group were eligible if both of their parents were born outside the Nordic countries, not having Swedish as their native language. Data were gained from the Swedish Arthroplasty Registry (SAR), 449 patients were included. Outcomes were pain VAS, satisfaction VAS, EQ-VAS, and the EQ-5D. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status and educational level were analysed to compare those 2 groups.Results: There were considerable differences in patient demographics between the 2 groups. Before the operation, patients in the BH group reported more problems with self-care and usual activities, even after adjustment for confounding factors (p < 0.0005). Patients in the IS group reported a higher EQ-VAS and more pain VAS (p < 0.0005), the difference in the EQ-VAS was not significant after adjustment for confounding factors (p = 0.41). After 1 year patients in the BH group reported better scores in all dimensions of the EQ-5D (p <= 0.005) apart from self-care. After adjustment for confounding factors, patients in the BH group were more satisfied too (p < 0.0005).Conclusions: Immigrated patients (IS group) seemed to experience less benefit from THA 1 year after the operation despite more symptoms preoperatively. There were considerable limitations affecting the results. Nevertheless, the data are a point of concern, and it is suggested to take more multidimensional care of immigrant patients.
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| 11. |
- Lazarinis, Stergios, et al.
(author)
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Bone loss around a stable, partly threaded hydroxyapatite-coated cup : a prospective cohort study using RSA and DXA
- 2014
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In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 24:2, s. 155-166
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Journal article (peer-reviewed)abstract
- Study purpose: Aseptic loosening of the acetabular component is the most common reason for revision after primary THA, and periprosthetic demineralisation has been described as a potential cause for this process. The trabeculae-oriented pattern (TOP)-cup is a flat, hydroxyapatite (HA)-coated titanium shell with a threaded rim that was developed in order to minimise periprosthetic bone loss. We hypothesised that this cup provides good primary stability and improves preservation of periprosthetic bone mineral density (BMD). Basic procedures: A prospective cohort study on 30 patients receiving the TOP cup was carried out. Preoperative total hip BMD and postoperative periprosthetic BMD in five periprosthetic regions of interest were investigated by dual energy radiographic absorptiometry (DXA), cup migration was analysed by radiostereometry (RSA), and the Harris hips score (HHS) was determined. Main findings: Mean HHS increased from 49 (24-79) preoperatively to 99 (92-100) after two years. DXA after one year demonstrated substantial BMD loss in the proximal periprosthetic zones 1 (-18%), zone 2 (-16%) and zone 3 (-9%, all p<0.001 when compared with baseline BMD determined immediately postoperatively). The bone loss in these regions did not recover after two years. RSA (performed on 16 patients) showed that only very limited micromotion of the implant occurred: Mean cranial migration was 0.01 mm (95% confidence interval (CI): -0.09-0.12) and mean inclination decreased by 0.02 degrees (CI: -0.43-0.39) after two years. Conclusion: We conclude that the TOP cup provides good primary stability in the short-term. However, substantial BMD loss in proximal periprosthetic areas indicates that the design of this cup cannot prevent periprosthetic bone loss that has also been observed around other uncemented cups.
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| 12. |
- Loiba, Valdemar, et al.
(author)
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The analysis of posterior soft tissue repair durability after total hip arthroplasty in primary osteoarthritis patients
- 2015
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In: HIP International. - : SAGE Publications. - 1724-6067 .- 1120-7000. ; 25:5, s. 420-423
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Journal article (peer-reviewed)abstract
- Background and purpose: The posterior soft tissue repair is 1 of the preventing factors for dislocation after total hip arthroplasty (THA). The aim of our study was to analyse THA patients with posterior soft tissue repair in terms of suture durability, time of suture failure and correlate the changes in leg length and offset postoperatively to suture durability. Methods: A total of 37 consecutive THA patients operated for osteoarthritis were included in the study. The posterior repair included reattaching the piriformis, conjoined tendons and posterior capsule to the greater trochanter through 2, 2 mm drill holes with 2 grasping stitches. A metal indicator wire was stitched into the piriformis tendon at distance of 1 cm from the greater trochanter after the prosthesis had been implanted and the joint reduced. Anteroposterior radiographs were taken immediately after the patients returned from the operating theatre to the intensive care unit, the next day after mobilisation, and at the 5th day of stay and at 3 months postoperatively. Results: Out of 37 THA hips, 6 (16%) had failed immediately after surgery, 25 (68%) at the 1st postoperative day after mobilisation, 2 (5%) at the 5th postoperative day, and 1 (3%) repairs had failed at 3 months after THA. In the remaining 3 hips no failure occurred. Interpretation: We conclude that posterior soft tissue repair in THA often fails and suggest that new posterior soft tissue repair methods be developed.
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| 13. |
- Mahmoud, Ahmed Nageeb, et al.
(author)
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Stable migration pattern of an ultra-short anatomical uncemented hip stem : A prospective study with 2 years radiostereometric analysis follow-up
- 2017
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In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 27:3, s. 259-266
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Journal article (peer-reviewed)abstract
- Introduction: Shorter, anatomically shaped and proximally loading stems have been developed to achieve better stress distribution and be more bone preserving. The purpose of this prospective study was to evaluate the migration pattern of the Proxima™ ultra-short uncemented stem using radiostereometric analysis (RSA), and to review the literature regarding the migration of short stemmed hip arthroplasty. Methods: 25 patients (28 hips) with hip osteoarthritis received a Proxima stem during total hip arthroplasty (THA). To measure stem migration, repeated RSA examinations were done during a 2 year follow up period. The patients were evaluated with the hip specific (HOOS) and the generic health (EQ5D) scores up to 1 year, and clinically for 6 years postoperatively. Results: Almost all migration occurred within the first 3 months, with mean subsidence of 0.22 mm and varus rotation of 1.04°, being the primary effect variables. After the third postoperative month and up to the 2 year RSA follow up no further significant migration occurred. The outcome scores showed substantial improvement after 1 year. No revisions were performed or indicated for any stem after a mean clinical follow up of 72.1 months. Conclusions: Like many other uncemented stems, the Proxima showed early migration up to 3 months hereafter osseointegration seems to have occurred. The achieved stability and clinical outcomes indicate favorable early results for this stem in younger patients who have good bone quality and average BMI. We found, however, the surgical technique to be slightly more demanding compared to conventional stems owing to the unique implant design that necessitates specific adjusted femoral cutting and broaching procedures.
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| 14. |
- Mellner, Carl, et al.
(author)
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Early periprosthetic joint infection and debridement, antibiotics and implant retention in arthroplasty for femoral neck fracture
- 2017
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In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 27:4, s. 349-353
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Periprosthetic joint infection (PJI) is a severe complication of hip arthroplasty for femoral neck fractures (FNF). Debridement, antibiotics and implant retention (DAIR) is recommended in early PJI in association with stable implants. Few studies have evaluated the outcome of DAIR in this fragile population.The purpose of this study was to analyse risk factors for PJI and the short-term outcome of DAIR in FNF patients treated with a hip arthroplasty.METHODS: A consecutive series of 736 patients (median age 81 years, 490 women, 246 men) had been treated with either a total hip arthroplasty or a hemi hip arthroplasty for a displaced FNF at our institution. 33 (4.5%) of the hips developed an early (<6 weeks post operatively) PJI and 28 (3.8%) of these patients were treated according to the DAIR-protocol. Regression analyses were performed to assess risk factors for developing a PJI.RESULTS: DAIR eradicated the PJI in 82% (23/28) of patients at a median follow-up of 31 (SD 29.8) months of the infected hips.The logistic regression analysis indicated that 2 or more changes of the primary dressing due to wound bleeding was associated with an increased risk for developing PJI (OR 4.9, 95% 1.5 to 16.1, p = 0.01).CONCLUSIONS: The short-term success-rate of DAIR was unexpectedly favourable in this fragile patient population; the results being on par with that after PJI in osteoarthritis patients. The need for repeated bandage changes postoperatively indicates an increased risk for PJI and should prompt early surgical intervention.
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| 15. |
- Mohaddes, Maziar, 1974, et al.
(author)
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High proximal migration in cemented acetabular revisions operated with bone impaction grafting; 47 revision cups followed with RSA for 17 years.
- 2017
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In: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 27:3, s. 251-258
-
Journal article (peer-reviewed)abstract
- Bone impaction grafting is a biologically and mechanically appealing option in acetabular revision surgery, allowing restitution of the bone stock and restoration of the biomechanics. We analysed differences in proximal migration of the revision acetabular components when bone impaction grafting is used together with a cemented or an uncemented cup.43 patients (47 hips), revised due to acetabular loosening and judged to have less than 50% host bone-implant contact were included. The hips were randomised to either an uncemented (n = 20) or a cemented (n = 27) revision cup. Radiostereometry and radiography was performed postoperatively, at 3 and 6 months, 1, 2, 3, 5, 7, 10 and 13 and 17 years postoperatively. Clinical follow-up was performed at 1, 2 and 5 years postoperatively and thereafter at the same interval as in the radiographic follow-up.There were no differences in the base line demographic data between the 2 groups. At the last follow-up (17 years) 14 hips (10 cemented, 4 uncemented) had been re-revised due to loosening. 3 additional cups (1 uncemented and 2 cemented) were radiographically loose. There was a higher early proximal migration in the cemented cups.Cups operated on with cement showed a higher early migration measured with RSA and also a higher number of late revisions. The reason for this is not known, but factors such as inclusion of cases with severe bone defects, use of smaller bone chips and issues related to the impaction technique might have had various degrees of influence.
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| 16. |
- Mukka, Sebastian S, et al.
(author)
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An update on surgical approaches in hip arthoplasty : lateral versus posterior approach
- 2014
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In: HIP International. - : Wichtig Editore Srl. - 1120-7000 .- 1724-6067. ; 24:Supplement 10, s. S7-S11
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Research review (peer-reviewed)abstract
- In this update we searched the literature about the outcome of the lateral versus posterior approach in hip arthoplasty for osteoarthritis (OA) and femoral neck fracture (FNF) patients. The available evidence shows that the use of posterior approach in OA patients is associated with lower mortality and better functional outcome while the use of lateral approach in FNF patients gives lower dislocation rate. We recommend therefore the use of posterior approach in OA patients and lateral approach in FNF patients.
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| 17. |
- Olerud, Fredrik, et al.
(author)
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Comparison of Refobacin Bone Cement and Palacos with Gentamicin in total hip arthroplasty: an RSA study with two years follow-up.
- 2014
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In: HIP International. - : SAGE Publications. - 1724-6067 .- 1120-7000. ; 24:1, s. 56-62
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Journal article (peer-reviewed)abstract
- Previous experience has demonstrated the importance of testing new bone cement in vivo before widespread clinical use. We performed a consecutive, radiostereometric (RSA) study comparing Refobacin Bone Cement (RBC) to the well proven Palacos with Gentamicin (PWG). According to the manufacturer of RBC it has the equivalent characteristics as PWG, and in vitro tests show good results. The purpose of this study was to evaluate whether RBC is safe to use in clinical practice for total hip arthroplasty (THA). Two consecutive series of patients with primary osteoarthritis received a THA using a highly polished, collarless, tapered stem with a hollow centralizer. The study comprises 21 hips with RBC and 30 with PWG. The patients were followed up for two years with repeated RSA examinations and clinical outcome questionnaires SF-12 and WOMAC. There were no statistically significant migratory differences between the groups. The mean subsidence after two years was 1.28 mm and 1.40 mm, and the mean retroversion was 1.03° and 0.99°, for the RBC and the PWG groups respectively. Almost all migration occurred in the interface between the stem and the cement. The WOMAC and SF12 clinical scores did not reveal any clinical differences between the groups. We conclude that, as previous in vitro tests indicate, RBC performs as well as PWG and seems to be safe to use in clinical practice for THA.
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| 18. |
- Otten, Volker, 1973-, et al.
(author)
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Evaluation of a new cemented highly cross-linked all-polyethylene cup : a prospective and randomised study assessing wear and fixation characteristics using radiostereometric analysis
- 2022
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In: HIP International. - : Sage Publications. - 1120-7000 .- 1724-6067. ; 32:6, s. 779-786
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Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE: The aim of this prospective, randomised and controlled study was to evaluate the wear and fixation properties of a new cemented highly cross-linked all-polyethylene (HXLPE) cup in comparison with a conventional cemented ultra-high molecular weight polyethylene (ConvPE) cup using radiostereometric analysis (RSA).PATIENTS AND METHODS: A total of 58 patients (58 hips) with primary osteoarthritis (OA) were enrolled in a randomised controlled trial to receive either a ConvPE cup (control) or HXLPE cup (intervention) with identical geometry. The subjects were randomised in a 1:1 ratio. The primary endpoint was proximal wear measured as femoral head penetration into the cup, secondary outcomes were 3D-wear and annual proximal wear from 1 to 5 years. Cup fixation was measured as movement of the cup in relation to the acetabular bone with proximal migration being the primary outcome measure, 3D-migration and change in inclination as secondary outcomes. The patients were followed for 5 years with RSA performed postoperatively, at 3, 12, 24, and 60 months.RESULTS: The HXLPE displayed a lower median proximal femoral head penetration compared to ConvPE, with a median difference at 2 years of -0.07 mm (95% CI, -0.10 to -0.04 mm), and -0.19 mm (95% CI, -0.27 to -0.15 mm) at 5 years. Annual proximal wear between 1 and 5 years was 0.03 mm/year for HXLPE and 0.06 mm/year for ConvPE (mean difference 0.05 mm, [95% CI, 0.03-0.07 mm]). Proximal migration, 3D migration and change in inclination was numerically slightly higher for HXLPE, albeit not statistically significant.CONCLUSIONS: Compared to ConvPE, the HXLPE cup displayed significantly lower polyethylene wear. Cup migration was not statistically significant different.CLINICALTRIALS.GOV IDENTIFIER: NCT04322799.
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| 19. |
- Oxblom, A., et al.
(author)
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Careful patient selection together with optimal implant positioning may reduce but does not eliminate the risk of elevated serum cobalt and chrome levels following metal-on-metal hip resurfacing
- 2023
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In: Hip International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 33:5, s. 872-879
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Journal article (peer-reviewed)abstract
- Background: Elevated serum chrome (sCr) and cobalt (sCo) concentrations are associated with local tissue adverse reactions to metal debris following metal-on-metal hip resurfacing (MoM-HR). Serum metal ions 5 mu g/l. Patients and methods: This is a retrospective, single-institution cohort study of 410 consecutive patients operated on with a Birmingham Hip Resurfacing (BHR) implant between 2001 and 2014. 288 of these had a unilateral MoM-HR, pelvic and true lateral radiographs, and a related sCo and sCr sample, and were included in the final analysis. They were allocated to either a presumed "optimal group" consisting of only men aged <60 years old, with femoral head component >48 mm diameter, and with a cup positioned within Lewinnek's safe zones, or a "suboptimal group" consisting of the remaining patients. Fisher ' s exact test and multiple logistic regression analyses were performed. Results: In the optimal group 48% (47/97) had serum metal ions >2 mu g/l and 8% (8/97) >5 mu g/l compared to 61% (116/191) and 18% (34/191) in the suboptimal group, p = 0.059 and p = 0.034 respectively. Acetabular cups with an anteversion <5 degrees had the highest odds ratio, 6.5 (95% CI, 3.0-14.3), of having sCo and sCr concentrations exceeding 5 mu g/l. Conclusions: A well oriented BHR acetabular component in a presumably "optimal" patient reduces the risk of having elevated serum metal ions but does not eliminate it. Insufficient cup anteversion seems to be the strongest associated factor of elevated serum metals.
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| 20. |
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| 21. |
- Risto, Olof, et al.
(author)
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Outcome after osteochondroplasty and relative neck lengthening for patients with healed Legg-Calve-Perthes disease: a retrospective cohort study of patients with hip-deformities treated with osteochondroplasty and relative neck lengthening
- 2021
-
In: HIP International. - : Sage Publications. - 1120-7000 .- 1724-6067. ; 31:3, s. 417-423
-
Journal article (peer-reviewed)abstract
- Aims: Our main objectives were to evaluate the effect of surgery using self-assessed health scores. Secondary objectives were to correlate outcome with grade of deformity (Stulberg classification I-V) or age at surgery and whether additional periacetabular osteotomy (PAO) is beneficial for patients with concurrent acetabular dysplasia. Methods: This was a retrospective cohort and in part a cross sectional study using a planned clinical and radiological follow-up of patients. All patients with healed Legg-Calve-Perthes disease (LCPD) treated with osteochondroplasty and relative neck lengthening using surgical hip dislocation, with or without periacetabular osteotomy (PAO) were included. A total of 39 patients were identified and invited to participate (29 males and 10 females) of which 32 accepted. Radiographic assessment and Stulberg classification were obtained. The Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS) and the VAS scale of EQ-5D-5L were used. Results: The majority of the patients experienced improvement (74%, n = 27) and 21 patients (78%, n = 27) found the surgery worthwhile. Preoperative Stulberg II and III patients (83% improvement) showed better results than Stulberg IV and V patients (56% improvement) (n = 27, p = 0.121). There was significantly better patient-satisfaction for those younger than 29 years of age (amp;lt;= 18 years old (92%), 19-28 years old (89%), amp;gt; 29 years old (67%), x(2)(2) = 8512, n = 27, p = 0.022) and a negative correlation for age at onset of LCPD and mHHS (r = -0.420, p = 0.046, n = 23). Patients with concurrent acetabular dysplasia (n = 19), 82% (9 of 11) improved after additional PAO compared to 63% (5 of 8) who were not operated on with PAO. Conclusion: This procedure is worthwhile in selected cases except for severe deformity (Stulberg IV and V) and patients amp;gt;28 years of age.
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| 22. |
- Rolfson, Ola, 1973, et al.
(author)
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Patient-reported outcomes in cemented and uncemented total hip replacements
- 2016
-
In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 26:5, s. 451-457
-
Journal article (peer-reviewed)abstract
- Introduction: Data from national registries have favored the use of cemented fixation in total hip replacement (THR) while other reports show no significant differences in implant survival between cemented and uncemented fixation using modern implants. It is important to investigate whether the method of fixation itself may affect patient-reported outcomes. Hence, this study sought to analyse if patient-reported outcomes measures (PROMs) differ depending on the type of fixation. Methods: Data was used from the follow-up programme of the Swedish Hip Arthroplasty Register which comprises the EQ-5D, a visual analogue scale (VAS) on hip pain, as well as a VAS addressing satisfaction with the outcome of the hip replacement. 3,118 patients with uncemented THR due to primary osteoarthritis performed from 2002 to 2011 with complete 1-year follow-up were included in the study. A control group of patients with cemented THR (n = 3,118) were selected by matching on age, gender, Charnley class, and preoperative health-related quality of life. Results: After adjusting for age, gender, Charnley class, and baseline PROMs, multivariate linear regression analyses showed that uncemented fixation is associated with a larger improvement in EQ-5D index (B = 0.03, 95% CI 0.019, 0.041), EQ VAS (B = 2.58, 95% CI 1.65, 3.51), greater pain relief (B = -2.68, 95% CI -3.54, -1.82) and superior patient satisfaction (B = -2.56, 95% CI -3.52, -1.60) (all p< 0.001). Discussions: This study demonstrates that uncemented fixation is associated with better patient-reported outcomes. Factors unrelated to implant fixation, such as performance or selection bias, may also contribute to the difference. © 2016 Wichtig Publishing.
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| 23. |
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| 24. |
- Sotiriou, Dimitrios, et al.
(author)
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Is two-stage revision surgery for infected hip arthroplasty worth the suffering, resources and results compared to one-stage?
- 2022
-
In: 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
-
Journal article (peer-reviewed)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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| 25. |
- Stigbrand, Hampus, et al.
(author)
-
Component dissociation after closed reduction of dual mobility sockets - a report of three cases
- 2011
-
In: HIP International. - 1120-7000 .- 1724-6067. ; 21:2, s. 263-266
-
Journal article (peer-reviewed)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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| 26. |
- Stucinskas, Justinas, et al.
(author)
-
Bipolar hemiarthroplasty versus total hip arthroplasty in femoral neck fracture patients : results from Lithuanian Arthroplasty Register
- 2020
-
In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067.
-
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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| 27. |
- Stucinskas, Justinas, et al.
(author)
-
Dynamics of femoral bone remodelling in well fixed total hip arthroplasty. A 20-year follow-up of 20 hips.
- 2014
-
In: HIP International. - : SAGE Publications. - 1724-6067 .- 1120-7000. ; 24:2, s. 149-154
-
Journal article (peer-reviewed)abstract
- The aim of our study was to investigate the dynamics of cortical thinning around well fixed cemented Muller straight stems without osteolysis at different time periods during long term follow-up. We investigated patients operated on for osteoarthritis with a cemented Muller straight stem, all with more than 15 years follow-up and no radiological signs of osteolysis. Cortical thinning in 20 THA hips (19 patients) followed for a mean of 20 (16 to 22) years was measured medially and laterally at six levels from the first postoperative, five, 10 years and the last follow-up x-rays. Sixty percent of observed cortical thinning occurred during the first five postoperative years, which was more evident proximally. We conclude that significantly greater cortical bone loss occurs around cemented Muller straight stems during the first five years, than is seen subsequently. We feel that this is a non-pathological process mainly related to the Muller straight stem.
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| 28. |
- Ullmark, Gösta, et al.
(author)
-
Analysis of bone formation on porous and calcium phosphate-coated acetabular cups : a randomised clinical [18F]fluoride PET study
- 2012
-
In: HIP International. - 1120-7000 .- 1724-6067. ; 22:2, s. 172-178
-
Journal article (peer-reviewed)abstract
- We present a study using Fluoride-Positron Emission Tomography (F-PET/CT) to analyse new bone formation in periacetabular bone adjacent to press fit cups following THA. In 16 THA (8 patients) with bilateral hip osteoarthritis simultaneous bilateral total hip arthroplasty (THA) was performed, employing electrochemically applied calcium phosphate coated (HA) cups or porous-coated (PC) cups allocated at random to compare the two sides. A reference group of 13 individuals with a normal healthy hip was used to determine 'normal' bone metabolism. [18F]fluoride -PET/CT was used to analyze bone formation adjacent to the cups 1 week, 4 months and 12 months after surgery. Clinical and radiographic evaluation was performed preoperatively, postoperatively and at 2 years. Bone forming activity had a mean of 5.71, 4.69 and 3.47 SUV around the HA- and 5.04, 4.80 and 3.50 SUV around the PC-cups at 1 week, 4 months and 12 months respectively. Normal bone metabolism was 3.68 SUV. After 1 year activity had declined to normal levels for both groups. The clinical results were good in all cases. HA coating resulted in higher uptake indicating higher bone forming activity after 1 week. F-PET/CT is a valuable tool to analyse bone formation and secondary stabilisation of an acetabular cup.
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| 29. |
- Ullmark, Gösta, et al.
(author)
-
Bone metabolism analyzed by PET and DXA following revision THA using a distally fixed stem. A pilot study.
- 2011
-
In: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - 1724-6067 .- 1120-7000. ; 21:1, s. 30-8
-
Journal article (peer-reviewed)abstract
- In a pilot study we analyzed bone remodeling using ¹⁸F-PET (positron emission tomography) scanning or DXA (dual-energy x-ray absorptiometry) in 3 patient groups, one with a loose femoral stem and 2 after revision using a modular stem (MP). In loose implants (group 1), bone formation activity compared to the contralateral healthy femur was 261 %. In the proximal part of the femur bone formation was increased by 253 % one week after revision (group 2) and did not normalize within 1 year. In the distal region it decreased to normal after one year. In the second revision group DXA showed decreased bone mineral density at 6 and 24 months (group 3). The PET technique provided evidence of bone healing despite osteolysis and prosthetic loosening which continued after revision. Decreasing BMD after revision in the third group is multifactorial, but suggests that despite intensive bone formation resorption was still higher.
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| 30. |
- Ullmark, Gösta, et al.
(author)
-
Bone mineralisation adjacent to cemented and uncemented acetabular cups : analysis by [18F]-fluoride-PET in a randomised clinical trial.
- 2020
-
In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 30:6, s. 745-751
-
Journal article (peer-reviewed)abstract
- PURPOSE: We present a randomised clinical trial using F-PET/CT to analyse new bone metabolic mineralisation adjacent to acetabular cups following total hip arthoplasty (THA).PATIENTS AND METHODS: THA was performed on 26 patients (26 cases) with hip OA. Patients with hip osteoarthritis (OA) were randomly assigned to operations with cemented or uncemented acetabular components. The contralateral, healthy acetabulum was used as referent for normal bone metabolism. The patients were analysed with radiography, clinical scoring, and F-PET/CT preoperatively, and at 6 weeks and 6 months postoperatively.RESULTS: No major complications were recorded, and clinical results were good in all patients. Radiography showed all cups to be stable. The bone-forming activity, as measured by F-PET/CT, was quantified as standardised uptake values (SUV). The mean SUV was 4.6 (6 weeks) and 3.5 (6 months) around the uncemented cups, and 4.8 and 4.0, respectively, for the cemented cups. Normal healthy bone metabolism in the referent was 2.8 and 2.7 SUV at 6 weeks and 6 months, respectively. P < 0.01 for the cemented group at 6 weeks and 6 months, for the uncemented group only at 6 weeks.INTERPRETATION: An acetabulum affected by OA has elevated SUV activity. Both cemented and uncemented cups had elevated bone metabolic activity at 6 weeks. The raised activity was interpreted as an effect from bone mineralisation secondary to surgical trauma and healing, and to the OA. At 6 months, activity was more normalised for the uncemented group than for the cemented, suggesting healing may terminate faster in the uncemented group. Postoperative bone metabolic activity can be analysed in detail by F-PET/CT.ClinicalTrials.gov Identifier: NCT01623687.
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| 31. |
- Ullmark, Gösta
(author)
-
Femoral head fractures : hemiarthroplasty or total hip arthroplasty?
- 2014
-
In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 24:S10, s. S12-S14
-
Research review (peer-reviewed)abstract
- Most femoral neck fractures are osteoporotic fractures in the elderly. The one-year mortality after neck fracture in this group is 24%. For hemiarthroplasty (HA) the bipolar heads have a risk reduction for reoperation due to acetabular erosion compared with monoblock heads. Surprisingly, the bipolar head had an increased reoperation risk for dislocation, infection and for periprosthetic fracture. Total hip arthroplasty (THA) after fracture has a four-fold raised risk for dislocation compared with THA after osteoarthritis. A larger head on the same neck (head to neck ratio) results in a theoretically larger range of movement and hence less risk for dislocation. The dual mobility bearing has, theoretically, the largest range of movement and good clinical results. Functional results are better for THA compared with HA. Arthroplasty for fracture has much better results compared with arthroplasty after a failed internal fixation; the risk for reoperation is more than doubled for the latter. A Swedish hip arthroplasty register study found a 20-fold higher risk for periprosthetic fracture when comparing uncemented HA with matt cemented HA. Also a polished cemented stem had 131/2-fold higher risks compared with a matt. The mortality during the first day after surgery is higher for cemented compared with uncemented arthroplasties, but lower after one week, one month and one year. Analysing the time points together resulted in no difference. A matt cemented THA with a maximum head size, maybe dual mobility, has the best results, and is also for the low-demanding elderly.
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| 32. |
- Ullmark, Gösta, et al.
(author)
-
Femoral head viability following resurfacing arthroplasty : A clinical positron emission tomography study
- 2011
-
In: HIP International. - 1120-7000 .- 1724-6067. ; 21:1, s. 66-70
-
Journal article (peer-reviewed)abstract
- Hip resurfacing (HR) carries attendant risks of avascular necrosis (AVN) and femoral neck fracture. We used fluoride positor emission tomography (PET) scans to analyze bone metabolism 2-5 years after surgery in 35 cases. Three of the patients had been clinical failures. Using PET scans in the remaining 32 cases, 7 were found to have an area of non-viable bone in the femoral head. This was seen following both posterior and antero lateral approaches. Fluoride PET is a sensitive and useful method for evaluating bone metabolism following HR.
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| 33. |
- Ullmark, Gösta, et al.
(author)
-
Fingerprint pattern of bone mineralisation on cemented and uncemented femoral stems : analysis by [18F]-fluoride-PET in a randomised clinical trial
- 2019
-
In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 29:6, s. 609-617
-
Journal article (peer-reviewed)abstract
- Purpose: We present a randomised clinical study using 18F-fluoride positron emission tomography/computed tomography (F-PET/CT) to analyse the osteoblastic part of bone metabolism (new bone mineralisation) in periprosthetic bone adjacent to femoral stems following total hip arthoplasty (THA) surgery. Patients with hip osteoarthritis were randomly assigned to THA surgery with cemented or uncemented femoral components.Patients and methods: THA was performed on 26 patients (26 cases) with hip osteoarthritis. The patients received either an uncemented HA-coated femoral stem or a cemented one. The contralateral healthy femur was used as referent for normal bone metabolism. The patients were analysed with clinical score, radiography and F-PET/CT preoperatively, and postoperatively at 6 weeks and 6 months. After 2 years, clinical score and radiography was analysed again. We used the Polar Map system for analysing and presenting the PET results in 13 regions of interest adjacent to the whole stem.Results: The clinical results were good in all patients; there were no major complications. Radiographically, all stems were stable. PET analyses after 6 weeks showed that bone mineralising activity was significantly higher around the uncemented stems, both compared to the cemented group and to the contralateral healthy reference femur group. The cemented group also had elevated activity but only at a barely significant level.Interpretation: Mineralising activity analysed with F-PET/CT was significantly higher for the uncemented group and also decreased at a slower rate. F-PET/CT is a useful new tool for analysing secondary stabilisation of femoral stems after THA.
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| 34. |
- Ullmark, Gösta, et al.
(author)
-
Management of bleeding with a temporary arterial occlusion balloon in revision total hip arthroplasty
- 2023
-
In: HIP International. - : Sage Publications. - 1120-7000 .- 1724-6067. ; 33:2, s. 262-266
-
Journal article (peer-reviewed)abstract
- Purpose: Perioperative bleeding is an undesirable surgical phenomenon. An effective way of diminishing bleeding is by use of a temporary arterial occlusion balloon (TAOB) to produce regional hypotension. We analysed TAOB-related complications at our institution occurring with total hip arthroplasties between years 2000 and 2016. We also compared the effect on bleeding for a TAOB group and a matched group during this same time.Patients and methods: 76 consecutive cases had a total hip arthroplasty (THA) combined with a TAOB. In an analysis of all complications connected to the use of TAOB, 48 of them were revision THAs. The matched reference group consisted of 20 patients with revision surgery, but without TAOB. We analysed and compared perioperative bleeding, surgery, and balloon occlusion time for these 2 groups.Results: No thromboembolic complications or other severe complications were recorded. 1 case had bleeding from the insertion site after catheter removal. 3 cases had balloon failure without the consequences of this complication. The TAOB group had significantly less haemoglobin loss, total perioperative bleeding, bleeding per minute, and total transfusion than the matched reference group.Interpretation: The use of TAOB in elective THA surgery is safe and effective in reducing intraoperative bleeding.
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| 35. |
- Weber, Erik, et al.
(author)
-
Migration pattern of a short uncemented stem with or without collar : a randomised RSA-study with 2 years follow-up
- 2021
-
In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 31:4, s. 500-506
-
Journal article (peer-reviewed)abstract
- Background: There is an increasing interest in shorter, proximally loading, uncemented femoral stems. The aim of this study was to evaluate a new short stem type, its design based on a well-proven precursor, but with several new design features to facilitate easier insertion and possible preservation of proximal bone stock. It is available with or without a collar. Methods: The study includes 50 patients with primary osteoarthritis, mean age 59 (range 36–75) years, randomised to receive either the collar-fitted or the collarless stem. The patients underwent repeated radiostereometry (RSA) examinations (0, 0.5, 3, 12, 24 months), conventional radiography and filled out both hip-specific (HOOS) and general health (EQ-5D) questionnaires. Results: There was no statistically significant difference between the collared and collarless stems regarding migration and clinical outcome. Both stem types exhibit a similar pattern of initial subsidence (collared 0.63 mm vs. collarless 0.75 mm [p = 0.50]) and retroversion (collared 0.71° vs. collarless 0.97° [p = 0.36]) up to 3 months followed by stabilisation, in similarity with its precursors, suggesting good osseointegration. No stem has been revised or considered loose. Conclusions: The new design features, including shortening the stem, do not compromise migration pattern or osseointegration, regardless collar or not.
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| 36. |
- Zampelis, Vasileios, et al.
(author)
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No effect of femoral canal jet-lavage on the stability of cementless stems in primary hip arthroplasty : a randomised RSA study with 6 years follow-up
- 2020
-
In: HIP International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 30:4, s. 417-422
-
Journal article (peer-reviewed)abstract
- Introduction: In contrast to cemented hip prostheses, the effect of washing the bone bed with jet-lavage prior to insertion of cementless stem components in primary hip arthroplasty (THA) is unclear. Jet-lavage potentially decreases the risk of fat embolisation during rasping and stem insertion and might help in avoiding bacterial contamination. An earlier animal study has shown less debris and better-organised trabecular structure of new bone when jet-lavage was used. We hypothesised that the primary stability of cementless femoral stems implanted after jet-lavage of the femoral canal prior to stem insertion would improve with earlier stabilisation, as measured with Radiostereometry (RSA), compared with insertion without prior jet-lavage. Methods: 40 patients with primary osteoarthritis operated on with a cementless titanium grit blasted stem are included in the study. The patients were randomised to either jet-lavage or control without any lavage of the femoral canal prior to insertion of the prosthesis. The stem migration pattern was measured with RSA at 0, 3, 12, 24 and 72 months. Results: At 6 years, 19 patients remained for analysis in the jet-lavage and 18 in the control group. We found no difference in extent or pattern of migration as measured with RSA. Both groups seemed to have stabilised within 3 months after a slight subsidence and retroversion. No stem was revised or considered loose as measured with RSA. Conclusions: Washing the bone bed with jet-lavage prior to insertion of cementless stems does not affect the stability of cementless femoral components. No adverse effects were observed.
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| 37. |
- Zügner, Roland, 1958, et al.
(author)
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1-stage bilateral total hip arthroplasty operation in 22 patients with use of short and standard stem length on either side: gait analysis 1 and 2 years after bilateral THA
- 2018
-
In: Hip International. - : SAGE Publications. - 1120-7000 .- 1724-6067. ; 28:4, s. 391-399
-
Journal article (peer-reviewed)abstract
- Background: According to previous gait analyses, insertion of a total hip arthroplasty (THA) will improve the range of hip flexion-extension but not to normal. Use of short stems could have a potential to improve the motion by preservation of more bone and muscular attachments. We evaluated whether a short femoral stem resulted in improved hip motion compared to a conventional stem in patients who underwent 1-stage bilateral THA. The most painful hip was randomised to either design and the 2nd hip was operated with the design not used on the 1st side. Methods: Gait analysis was performed with an optical tracking system in 22 patients. The follow-up was performed 1 and 2 years after the operation. The mean age was 59 (SD 7.7) years and body mass index was 27.7 (SD 4.3). 66 subjects without hip pathology served as controls. Results: Minimal differences were observed, between or within the 2 different stem designs during gait at the 2 follow-up occasions. Comparison between each of the 2 stem designs and controls at 2 years revealed reduced stride length (p = 0.009), cadence, hip extension (p<0.001) and hip extension-flexion range (p = 0.021) for both designs. Furthermore, the range of hip adduction-abduction (p = 0.046) and hip abduction moment for both designs in the frontal plane was also reduced bilaterally (p<0.001). Conclusions: We found no difference in gait parameters between the short and the conventional stem after 1-stage bilateral THA. Although both hip joints were operated at the same time motions and moments did not normalise after bilateral 1-stage operations.
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| 38. |
- Zügner, Roland, et al.
(author)
-
Gait pattern in patients treated with a total hip arthroplasty due to an acute displaced cervical neck fracture: a randomised comparison between 29 cases with a cemented femoral stem and 16 cases with an uncemented femoral stem
- 2024
-
In: HIP International. - 1120-7000 .- 1724-6067. ; 34:3, s. 421-427
-
Journal article (peer-reviewed)abstract
- Background: The choice between cemented or uncemented stem fixation in the treatment of a femoral neck fracture may influence patient rehabilitation and the resulting gait pattern, due to potential differences in implant positioning and fixation. We used gait analysis to study temporal gait parameters, hip kinematics and kinetics in patients who, 2 years previously, had been randomised to treatment with a cemented or uncemented stem and due to an acute femoral neck fracture. Methods: 45 Patients implanted with a cemented Lubinus SP II (n = 29) and an uncemented (n = 16) Corail stem were studied. Gait analysis was performed using a 16-camera motion capture system and force plates. 28 subjects served as controls. Temporal gait parameters, hip kinematics and kinetics were analysed. The patients had no or minimum pain (median Harris pain score 44, range 40–44) and the majority had no limp (median Harris limp score 11, range 5–11). Results: Temporospatial gait parameters and abduction-adduction motions and moments did not differ between patients with cemented or uncemented stems (p > 0.05). Patients with cemented stems did, however, show more hip flexion and less extension during walking than those with an uncemented stem (p < 0.05). Moreover, the flexion-extension range was less in the cemented group (p < 0.04). Compared with controls, the hip fracture patients walked more slowly, with a shorter stride length and a longer stance phase. Conclusions: Increased hip flexion and reduced extension in patients using the Lubinus SP II cemented stem could be an effect of its anteverted neck, but this question requires further study. Despite acute treatment with THA, hip fracture patients demonstrated a change in gait pattern compared with controls 2 years after the operation. This suggests that these changes are caused by the presence of an implant, or the soft-tissue trauma partly caused by the surgery than by any degenerative disease present in patients undergoing elective surgery.
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| 39. |
- Zügner, Roland, 1958, et al.
(author)
-
No difference in gait pattern between a short collum femoris-preserving and a conventional stem: 44 randomised total hip arthroplasty patients stem evaluated after 2years.
- 2020
-
In: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 32:4, s. 452-9
-
Journal article (peer-reviewed)abstract
- The uncemented collum femoris-preserving (CFP) stem offers preservation of the femoral neck and a more conservative soft tissue resection, which may facilitate a more normal walking pattern. We used gait analysis to evaluate if patients operated with a CFP stem showed more favourable hip kinematics and kinetics when compared with a group of patients operated with a conventional uncemented stem.44 patients randomised to receive either a CFP or a Corail stem were studied and were operated using a direct lateral incision. Gait analysis was performed 2years after the operation with a 12-camera motion capture system and 2 force plates. Hip kinematics and kinetics were analysed and 66 subjects served as controls.None of the variables: speed, stride, cadence and stance showed any statistical significant difference between the 2 study groups. Neither did the hip kinematics and kinetics. Compared to controls, patients operated with the CFP stem showed an increased stance (62.5% vs. 61.1%, p < 0.006) and decreased hip abduction (-2.1° vs. -6.5°). Patients operated with the Corail stem showed decreased speed (1.18 vs. 1.23m/second), and stride length (1.26 vs. 1.33m), decreased hip extension (-7.5° vs. -12.8°) and range of hip flexion/extension (38° vs. 40.9°), as well as their hip adduction that was increased (6.3° vs. 4°), whereas their hip abduction was reduced (-2.8° vs. -6.5°), (p < 0.004) compared to the controls.Use of a CFP stem did not significantly influence any of the gait parameters studied when compared to a standard stem, but still both stems studied were associated with gait deviations when compared to controls. Whether these differences could be attributed to the stem used, the underlying hip disease, or both is still unknown.
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| 40. |
- Howald, R, et al.
(author)
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Factors affecting the cement penetration of a hip resurfacing implant: An in vitro study
- 2006
-
In: HIP International. - 1724-6067. ; 16:2, s. 82-89
-
Journal article (peer-reviewed)abstract
- An understanding of how the cementing technique influences cement penetration is important for surgeons to plan and conduct hip resurfacing procedures. Therefore the aim of this study is to determine the influence of the following parameters on cement penetration: use of pulse lavage, type of cement, and the standing period of the cement. Nine fresh frozen paired whole cadaver femora were used to investigate cement penetration. The femora were divided into three paired groups: (A) compared the use of pulse lavage to no pulse lavage, (B) compared two low viscosity bone cements SULCEM-3 (Zimmer GmbH, Switzerland) and Surgical Simplex (Stryker Orthopaedics, USA), and (C) compared bone cement viscosities using standing times of 1.5 min. and 3 min. The Durom Hip Resurfacing implant (Zimmer GmbH, Switzerland) was used in all groups. A single slice was taken out of the center of each head. Cement penetration ratio (penetration area divided by the bone area enclosed by implant) and mean cement penetration depth were measured. Cement penetration is increased using pulse lavage, and has the tendency to increase with increasing the cement standing time from 1.5 to 3 min. No difference in cement penetration was found when different cement brands of comparable viscosity were used.
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| 41. |
- Tarasevicius, Sarunas, et al.
(author)
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A comparison of outcomes and dislocation rates using dual articulation cups and THA for intracapsular femoral neck fractures
- 2013
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In: HIP International. - 1724-6067. ; 23:1, s. 22-26
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Journal article (peer-reviewed)abstract
- Total hip arthroplasty for intracapsular femoral neck fractures (FNF) is associated with a greater risk of dislocation. Dual articulation systems in this group of patients may provide better implant stability and a reduced dislocation rate. The aim of our study was to investigate FNF patients treated with dual articulation cups (DAC) and conventional THA and compare their clinical results at four months and one year after surgery. Our study compared femoral neck fracture patients treated with either DAC or conventional THA during two different time periods. Before surgery and during follow-up, the patients answered questions regarding their mobility, pain and usage of walking aids. Additionally at four-month and one-year follow-ups EQ-5D and HOOS questionnaires were applied for those patients qualifying for functional and quality of life analysis. Out of 125 femoral neck fracture patients 58 were treated with DAC and 67 with conventional THA. At four months and one year follow-up the HOOS and EQ-5D results did not differ significantly between DAC and conventional THA. Five hips in the THA group were revised for recurrent dislocation and two had a single dislocation. One year after surgery, the functional result of DAC and conventional THA are comparable but DAC have a lower risk of dislocation.
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- Tarasevicius, Sarunas, et al.
(author)
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The short rotators do not influence capsular compliance or pain in severe hip osteoarthritis. A randomised controlled trial.
- 2011
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In: HIP International. - 1724-6067. ; 21:3, s. 299-302
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Journal article (peer-reviewed)abstract
- Abstract: A randomised controlled trial was performed to investigate if the short rotators affected the compliance of the capsule in osteoarthritis (OA). 68 OA patients admitted for total hip arthroplasty (THA) were randomised to have their compliance estimated during surgery with either their short rotators intact or released. Radiographic severity of OA, range of motion and pain were assessed in the affected hip before surgery. There was no significant difference in the compliance of the capsule whether the short rotators were intact or released (p= 0.5). Furthermore, there was no significant correlation between pain and capsular compliance (p=0.4 and p=0.5). We found no significant effect of the short rotators on compliance of the hip joint capsule, and no significant correlation between pain and capsular compliance.
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