BIOMECHANICAL RATIONALE FOR CHOICE OF CEMENT MANTLE THICKNESS AROUND A FEMORAL STEM

2018 ◽  
Vol 18 (06) ◽  
pp. 1850064
Author(s):  
IEVGEN LEVADNYI ◽  
JAN AWREJCEWICZ ◽  
OLGA SZYMANOWSKA ◽  
DARIUSZ GRZELCZYK ◽  
JOSÉ EDUARDO GUBAUA ◽  
...  
Keyword(s):  
Bone Density ◽  
Femoral Stem ◽  
Peak Stress ◽  
Proximal Part ◽  
Cement Mantle ◽  
Bone Adaptation ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
High Reduction ◽  
Hip Arthroplasties

The change in mechanical properties of the femoral bone tissue surrounding hip endoprosthesis stems during the post-operative period is one of the causes of implant instability, and the mathematical description of this phenomenon is the subject of much research. In the present study, a model of bone adaptation, based on isotropic Stanford theory, is created for further computer investigation. The results of implementation of such a mathematical model are presented regarding the choice of cement mantle rational thickness in cemented hip arthroplasties. The results show that for cement mantle thicknesses ranging from 1–1.5[Formula: see text]mm, a peak stress value in the proximal part of the mantle exceeds the limit of durability of bone cement. Moreover, results show that high reduction in the bone density of distal and proximal regions was observed in cases of cement mantle thicknesses varying from 1–3[Formula: see text]mm. No significant changes in bone density of the abovementioned regions were obtained for 4[Formula: see text]mm and 5[Formula: see text]mm. The outcome of numerical investigations can be treated as valuable and will lead to the improvement of cemented hip replacement surgery results.

Hip arthroplasty in haemophilia: a systematic review

2018 ◽  
Vol 28 (5) ◽  
pp. 459-467 ◽  
Author(s):  
Ali Parsa ◽  
Mohammad Azizbaig Mohajer ◽  
Maryam Mirzaie
Keyword(s):  
Hip Arthroplasty ◽  
Case Reports ◽  
Femoral Stem ◽  
World Federation ◽  
Complication Rates ◽  
Precise Control ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Number Of Patients ◽  
Uncemented Acetabular Component

Background: Rigorous haemostatic control and careful rehabilitation are essential for haemophilic patients undergoing total hip arthroplasty (THA). Aim: to examine the current literature regarding THA in patients with haemophilia in order to determine clinical outcomes and complication rates. Methods: We included 11 case reports/series and 9 original articles. There was a total of 206 patients who underwent 226 THAs. Findings: The number of patients enrolled in the selected articles varied from 1 in case reports to 34 in the original articles. Gender was documented in 10. Mean age at surgery was 41 years. Mean follow-up was 73 months (standard deviation [SD] 35 months). All but 4 articles specified whether implants were cemented or uncemented, with 95% being uncemented, 3.5% being cemented, and 1.5% being hybrid (uncemented acetabular component, cemented femoral stem). Conclusion: Controlled hypotensive anaesthesia (to reduce preoperative blood loss), consult with haematologist, precise control of haemostasis status per the guidelines defined by the World Federation joint replacement, can improve the success rate and hip replacement surgery can be performed safely.

scholarly journals Our Experience with Short Stem Hip Replacement Surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Sumeet Rastogi ◽  
Sanjiv K S Marya
Keyword(s):  
Soft Tissue ◽  
Hip Replacement ◽  
Stress Shielding ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Hip Implant ◽  
Excellent Outcome ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

Context-A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips.Materials and methods-50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009). Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw) with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter.Statiscal analysis used-VAS and Harris hip score formed the basis of evaluationResults-These patients were followed up for a mean period of 49 months (Range 36-72 months). The average incision size was 14.38 cm (10-18 cm) and blood loss was 269 ml (175-450 ml). There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 %) had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41) patients had an excellent outcome at last follow-up.Conclusion-We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit initially followed by bone in-growth and was ideally suited to satisfy the requirements of a conservative hip implant. Unfortunately, due to unknown reasons, the implant has been recently withdrawn from the market by DePuy and is no longer available for use.Key MessageConservative hip stems that preserve bone and soft tissue at the time of surgery, prevent femoral stress shielding by circumferential loading, promote positive bone remodeling and help to make revision surgeries easier are ideally suited as hip implants for young active adults with end stage hip disease requiring hip replacement surgery.

Pneumatic femoral broaching in direct anterior approach hip arthroplasty

2021 ◽  
pp. bmjinnov-2020-000536
Author(s):  
Ikram Nizam ◽  
Ashish Vinodkumar Batra ◽  
Sophia Gogos ◽  
Avinash Alva
Keyword(s):  
Femoral Component ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Direct Anterior Approach ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Revision Tha ◽  
Hip Arthroplasties ◽  
Standard Table

AimThe aim of this study is to report the safety and efficacy of the Woodpecker pneumatic broaching system in direct anterior hip arthroplasty.Methods649 primary elective anterior bikini total hip arthroplasties (THA) using Woodpecker broaching over a 5-year period were included. Patients undergoing a THA through a different surgical approach, revision THA or arthroplasties for hip fractures were excluded (n=219). Preoperative and postoperative Harris Hip Scores (HHS) and postoperative radiographs were analysed to identify femoral fractures and femoral component positioning. Complications and component survivorship until most recent follow-up were analysed.ResultsThe average time taken for femoral preparation using Woodpecker broaching system was 2.8 min (1.4–7.5 min) in both cemented and uncemented THAs. Radiographic analysis revealed 67.3% of the stems were placed in 0°–1.82° of varus and 32.7% placed in 0°–1.4° of valgus. Average HHS were 24.4 preoperatively, with significant improvements at 6 weeks (80.95), 6 months (91.91) and 12 months (94.18) of follow-up. Complications not directly attributed to Woodpecker broaching included three intraoperative femoral fractures (0.4%), three periprosthetic postoperative fractures (0.3%), two cases of stem subsidence (0.3%) and two wound infections (0.3%). At the most recent follow-up, the survivorship of the acetabular component was 99.7% and the femoral component was 99.1%, with mean follow-up of 2.9 years (0.5–5 years).ConclusionThe pneumatic Woodpecker device is a safe and effective alternative tool in minimally invasive direct anterior hip replacement surgery for femoral broaching performed on a standard table.

Cementing a collarless polished tapered femoral stem through the anterior approach

2021 ◽  
Vol 103-B (7 Supple B) ◽  
pp. 46-52
Author(s):  
Niall P. McGoldrick ◽  
Daniel Fischman ◽  
Graeme M. Nicol ◽  
Cheryl Kreviazuk ◽  
George Grammatopoulos ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Femoral Stem ◽  
Cement Mantle ◽  
Posterior Group ◽  
Type C ◽  
The Mean ◽  
Hip Arthroplasties ◽  
Anterior Group

Aims The aim of this study was to radiologically evaluate the quality of cement mantle and alignment achieved with a polished tapered cemented femoral stem inserted through the anterior approach and compared with the posterior approach. Methods A comparative retrospective study of 115 consecutive hybrid total hip arthroplasties or cemented hemiarthroplasties in 110 patients, performed through anterior (n = 58) or posterior approach (n = 57) using a collarless polished taper-slip femoral stem, was conducted. Cement mantle quality and thickness were assessed in both planes. Radiological outcomes were compared between groups. Results No significant differences were identified between groups in Barrack grade on the anteroposterior (AP) (p = 0.640) or lateral views (p = 0.306), or for alignment on the AP (p = 0.603) or lateral views (p = 0.254). An adequate cement mantle (Barrack A or B) was achieved in 77.6% (anterior group, n = 45) and in 86% (posterior group, n = 49), respectively. Multivariate analysis revealed factors associated with unsatisfactory cement mantle (Barrack C or D) included higher BMI, left side, and Dorr Type C morphology. A mean cement mantle thickness of ≥ 2 mm was achieved in all Gruen zones for both approaches. The mean cement mantle was thicker in zone 7 (p < 0.001) and thinner in zone 9 for the anterior approach (p = 0.032). Incidence of cement mantle defects between groups was similar (6.9% (n = 4) vs 8.8% (n = 5), respectively; p = 0.489). Conclusion An adequate cement mantle and good alignment can be achieved using a collarless polished tapered femoral component inserted through the anterior approach. Cite this article: Bone Joint J 2021;103-B(7 Supple B):46–52.

scholarly journals The effects of competition and bundled payment on patient reported outcome measures after hip replacement surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fanny Goude ◽  
Sverre A. C. Kittelsen ◽  
Henrik Malchau ◽  
Maziar Mohaddes ◽  
Clas Rehnberg
Keyword(s):  
Hip Replacement ◽  
Health Gain ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Economic Incentives ◽  
Bundled Payment ◽  
Treatment Groups ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Patient Reported

Abstract Background Competition-promoting reforms and economic incentives are increasingly being introduced worldwide to improve the performance of healthcare delivery. This study considers such a reform which was initiated in 2009 for elective hip replacement surgery in Stockholm, Sweden. The reform involved patient choice of provider, free establishment of new providers and a bundled payment model. The study aimed to examine its effects on hip replacement surgery quality as captured by patient reported outcome measures (PROMs) of health gain (as indicated by the EQ-5D index and a visual analogue scale (VAS)), pain reduction (VAS) and patient satisfaction (VAS) one and six years after the surgery. Methods Using patient-level data collected from multiple national registers, we applied a quasi-experimental research design. Data were collected for elective primary total hip replacements that were carried out between 2008 and 2012, and contain information on patient demography, the surgery and PROMs at baseline and at one- and six-years follow-up. In total, 36,627 observations were included in the analysis. First, entropy balancing was applied in order to reduce differences in observable characteristics between treatment groups. Second, difference-in-difference analyses were conducted to eliminate unobserved time-invariant differences between treatment groups and to estimate the causal treatment effects. Results The entropy balancing was successful in creating balance in all covariates between treatment groups. No significant effects of the reform were found on any of the included PROMs at one- and six-years follow-up. The sensitivity analyses showed that the results were robust. Conclusions Competition and bundled payment had no effects on the quality of hip replacement surgery as captured by post-surgery PROMs of health gain, pain reduction and patient satisfaction. The study provides important insights to the limited knowledge on the effects of competition and economic incentives on PROMs.

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