An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

Background: Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. Methods: 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29–89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. Results: 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1–99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2–70), 18 (SD 12.1, range -10–43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. Discussion: This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.

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Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-019-0537-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Karl Philipp Kutzner ◽

Stefanie Donner ◽

Lennard Loweg ◽

Philipp Rehbein ◽

Jens Dargel ◽

...

Keyword(s):

Bone Resorption ◽

Weight Bearing ◽

Short Stem ◽

Long Term Results ◽

Harris Hip Score ◽

Safe Procedure ◽

Cementless Cup ◽

Cortical Hypertrophy ◽

Short Stems

Abstract Background In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available. Materials and methods Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones. Results At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed. Conclusions The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage. Level of evidence IV, Prospective observational study Trial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered)

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Five-year results of a cementless short-hip-stem prosthesis

Orthopedic Reviews ◽

10.4081/or.2013.e4 ◽

2013 ◽

Vol 5 (1) ◽

pp. 4 ◽

Cited By ~ 50

Author(s):

Ralf H. Wittenberg ◽

Reinhard Steffen ◽

Hennig Windhagen ◽

Petra Bücking ◽

Andreas Wilcke

Keyword(s):

Revision Surgery ◽

Bacterial Infections ◽

Primary Standard ◽

Short Stem ◽

Stem Length ◽

Long Term Results ◽

Harris Hip Score ◽

Joint Dislocations ◽

Short Stems

Hip prosthesis stems with a short stem length and proximal fixation geometry support a bone-preserving and muscle-sparing implantation and should also allow for revision surgery with a standard hip stem. We present 250 prospectively documented clinical and radiological results from the Metha Short Hip Stem prosthesis (B. Braun-Aesculap, Tuttlingen, Germany) after an average follow-up of 4.9 years. The average patient age at surgery was 60 years. Indication for total hip replacement was primary osteoarthrosis (OA) (78% of patients), OA based on developmental dyspla- sia of the hip (16%), and other indications (6%). At the last follow-up, the average Harris Hip Score was 97 points. 85% of patients were very satisfied and 14% were satisfied after surgery, whereas 1% were dissatisfied. Pain according to the Visual Analogue Scale improved from 7.4 (min 1.6, max 9.5) pre-operatively to 0.23 (min 0, max 6.6). No joint dislocations occurred when predominantly using 28 mm and 32 mm prosthesis heads. Nine short-stems were revised: three after bacterial infections, two after primary via valsa with penetration of the femoral cortex two and three months after surgery, and three after early aseptic cases of loosening within the first year. A further nine osseously consolidated short-stems had to be replaced due to breakage of the modular titanium cone adapter after an average of 3.1 years (min 1.9, max 4.4). All surgical revisions were performed using primary standard stems. Without taking the material-related adapter failures into account, a five year Kaplan-Meier survival rate of 96.7% (95% confidence interval 93.4-98.3) was determined for the short-stem prostheses. There were no radiological signs of loosening in any of the short-stem prostheses at the last examination. Fine sclerotic lines were detected in Gruen’s AP zones 1 (19%) and 2 (10.5%), individual hypertrophies in zone 3 (3.5%), fine seams in zones 4 (5.5%) and 5 (4%), without pedestal formations in zone 4, clear cancellous bone compressions in zone 6 (97.5%), as well as single fine scleroses (1.5%) and atrophies (2.5%) in zone 7. The mid-term clinical results with periprosthetic bone remodeling and without radiological signs of loosening confirm this metaphyseal short-stem treatment and fixation concept and the possibility of revision surgery using standard hip stems. Long-term results must be further observed on a prospective basis as part of this collective study.

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Midterm Survivorship of an Uncemented Hydroxyapatite-Coated Titanium Femoral Component and Clinically Meaningful Outcomes in Patients Older Than 75 Years

Journal of Clinical Medicine ◽

10.3390/jcm10051019 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1019

Author(s):

Alexander Zimmerer ◽

Luis Navas ◽

Stefan Kinkel ◽

Stefan Weiss ◽

Matthias Hauschild ◽

...

Keyword(s):

Survival Rate ◽

Femoral Component ◽

Survival Rates ◽

Femoral Stem ◽

Harris Hip Score ◽

Rank Test ◽

Kaplan Meier ◽

Clinically Meaningful Outcomes ◽

Modified Harris Hip Score

Purpose: It remains controversial whether cementless femoral components are safe in elderly patients. The aim of this study was (1) to determine the stem survival rate in patients >75 years of age who were treated with an uncemented femoral component and (2) to report clinically significant results on a mid-term follow-up. Methods: 107 total hip arthroplasties (THA) were retrospectively evaluated in 97 patients over 75 years of age (mean age 78 years, range 75–87) treated with an uncemented femoral stem. The minimum follow-up was five years (mean 6.4 years, range 5–8). Stem survival rates, clinically meaningful outcomes, and incidence of complications were evaluated. Results: Kaplan-Meier survival analysis, with the endpoint revision for any reason, showed a 6.4-year survival rate of 98% (95% CI, 95–99%; 63 hips at risk). The survival rates were comparable for male and female patients (log-rank test, p = 0.58). The modified Harris Hip Score (mHHS) improved from 42.2 (12 to 85) points to 81.1 (22 to 97) points (p < 0.0001). Mid-term minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were 25, 84, and 70, respectively. Conclusion: An uncemented stem is a viable option in patients over 75 years with good clinical outcomes and survivorship. Periprosthetic fractures were not a relevant failure mechanism with the stem used.

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Midterm Outcome of the Plasma Cup in Total Hip Arthroplasty

Hip International ◽

10.1177/112070000201200218 ◽

2002 ◽

Vol 12 (2) ◽

pp. 119-125 ◽

Cited By ~ 1

Author(s):

A. Gordon ◽

J.M. Wilkinson ◽

I. Stockley

Keyword(s):

Polyethylene Wear ◽

Harris Hip Score ◽

Osteolytic Lesions ◽

Secondary Osteoarthritis ◽

Total Hip ◽

Midterm Outcome ◽

Kaplan Meier ◽

Age At Surgery ◽

High Incidence ◽

Hip Arthroplasties

One hundred and twenty eight primary total hip arthroplasties (THA) in 104 patients were reviewed to assess mid-term survivorship and clinical outcome of the ‘Plasma’ cup. Outcome was evaluated clinically, radiographically, and by self-administered questionnaires. Patient mean age at surgery was 51 years, and 52 THAs (41%) were performed for secondary arthritis. Prior to surgery the median Merle D'Aubigne score was 8. At 59 (standard deviation 18) months this score had improved to 17, and the median Harris hip score was 85. The mean annual polyethylene wear rate was 0.14mm/year. There were no instances of aseptic loosening but 2 cups had small, focal osteolytic lesions at the site of screw holes. Three cups were revised, two for recurrent dislocations, and one for infection. Cup survivorship at 5 years was 97% (Kaplan-Meier).This data suggests that the Plasma cup performs well in the mid-term and may be used safely in a young population with a high incidence of secondary osteoarthritis.

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Repeated transarterial chemoperfusion and -embolization (TACE) in primary hepatic cholangiocarcinoma (CCC): Local tumor control and survival rate

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15595 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15595-e15595

Author(s):

T. J. Vogl ◽

N. Naguib ◽

S. Zangos ◽

K. Eichler ◽

T. Gruber

Keyword(s):

Survival Rate ◽

Survival Time ◽

Survival Data ◽

Symptomatic Treatment ◽

Local Tumor Control ◽

Tumor Control ◽

Local Tumor ◽

Vessel Occlusion ◽

Kaplan Meier ◽

Chemotherapy Protocol

e15595 Background: To evaluate local tumor control and survival data in the palliative and symptomatic treatment of hepatic cholangiocarcinoma (CCC) using repeated transarterial chemoperfusion and -embolization (TACE) with two different chemotherapy protocols. Methods: 41 patients with primary cholangiocarcinoma (CCC) were repeatedly treated with transarterial chemoembolization (TACE) in 4-week intervals. In total, 291 TACE sessions were performed with a mean of 7.1 sessions per patient (mean age: 57.1 years; range, 37–80 years). 22 patients had multiple tumors, 6 showed 1 lesion, 5 had 2 lesions and 8 presented 3 to 4 lesions. The local chemotherapy protocol consisted of Mitomycin C alone (n=20), or in combination with gemcitabine (n=18). Embolization was performed with lipiodol and starch microspheres for vessel occlusion. Tumor response was evaluated by magnetic resonance imaging (MRI) in 3-month intervals. Results: Evaluation of local tumor control according to the RECIST criteria was as follows: partial response 9.8%, stable disease 43.6%, and progressive disease 46.6%. The 1-year survival rate after TACE was 58%, the 2-year survival rate was 21%. The mean survival time from the date of diagnosis of liver involvement was 34.1 months (according to Kaplan-Meier), after first TACE treatment 16.7 months. The median survival time of the palliative group was 14.5 months and of the symptomatic group 6 months. Conclusions: Our data indicated that repeated TACE using the protocols is well tolerated and yields respectable results in patients with unresectable liver lesions from CCC. No significant financial relationships to disclose.

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Factors predictive of long-term mortality in lupus nephritis: a multicenter retrospective study of a Japanese cohort

Lupus ◽

10.1177/0961203319826690 ◽

2019 ◽

Vol 28 (3) ◽

pp. 295-303 ◽

Cited By ~ 8

Author(s):

K Ichinose ◽

M Kitamura ◽

S Sato ◽

K Fujikawa ◽

Y Horai ◽

...

Keyword(s):

Survival Rate ◽

Lupus Nephritis ◽

Renal Biopsy ◽

Induction Therapy ◽

Predictive Factors ◽

Survival Data ◽

Male Gender ◽

Rank Test ◽

Kaplan Meier

Background Lupus nephritis (LN) is a major determinant of mortality in systemic lupus erythematosus (SLE). Here we evaluated the association between complete renal response (CR) and mortality in LN. Methods We retrospectively analyzed the cases of 172 of 201 patients with LN for whom data on the therapeutic response at 6 and 12 months after induction therapy were available. The patients underwent a renal biopsy at Nagasaki University Hospital and community hospitals in Nagasaki between the years 1990 and 2016. We determined the CR rates at 6 and 12 months after induction therapy initiation and evaluated the predictive factors for CR and their relationship with mortality. We performed univariate and multivariable competing risks regression analyses to determine the factors predictive of CR. The patients' survival data were analyzed by the Kaplan–Meier method with a log-rank test. Results The median follow-up duration after renal biopsy was 120 months (interquartile range: 60.3–191.8 months). The 5-, 10-, 15- and 20-year survival rates of our cohort were 99.3, 94.6, 92.0 and 85.4%, respectively. During follow-up, nine patients (5.2%) died from cardiovascular events, infection, malignancy and other causes. The multivariate analysis revealed that the following factors were predictive of CR. At 6 months: male gender (odds ratio (OR) 0.23, 95% confidence interval (CI) 0.08–0.65, p = 0.0028), proteinuria (g/gCr) (OR 0.83, 95% CI 0.71–0.97, p = 0.0098) and index of activity (0–24) (OR 0.84, 95% CI 0.71–0.99, p = 0.0382). At 12 months: male gender (OR 0.25, 95% CI 0.09–0.67, p = 0.0043) and index of activity (0–24) (OR 0.82, 95% CI 0.69–0.98, p = 0.0236). The Kaplan–Meier analysis showed that compared to not achieving CR at 12 months, achieving CR at 12 months was significantly correlated with the survival rate (OR 0.18, 95% CI 0.04–0.92, p = 0.0339). Conclusions Our results suggest that the survival rate of patients with LN is associated with the achievement of CR at 12 months after induction therapy, and that male gender and a higher index of activity (0–24) are the common predictive factors for failure to achieve CR at 6 and 12 months.

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Is a short stem suitable for patients with hip dysplasia? A report on technical problems encountered during femoral reconstruction

Hip International ◽

10.5301/hipint.5000562 ◽

2017 ◽

Vol 28 (3) ◽

pp. 315-323 ◽

Cited By ~ 3

Author(s):

Martin A. Buttaro ◽

Pablo A. Slullitel ◽

Gerardo Zanotti ◽

Fernando M. Comba ◽

Francisco Piccaluga

Keyword(s):

Hip Dysplasia ◽

Short Stem ◽

Harris Hip Score ◽

Acetabular Cup ◽

Technical Problems ◽

End Point ◽

Modified Harris Hip Score ◽

Short Stems ◽

Femoral Reconstruction

Introduction: A wide variety of stems have been used for the treatment of osteoarthritis secondary to advanced hip dysplasia. Since evidence for using short stems in dysplastic hips is limited, we planned to analyse the technical problems encountered when reconstructing the proximal femur of patients with osteoarthritis secondary to congenital dysplasia of the hip treated with total hip arthroplasty (THA) using a type 2B short stem. Methods: We prospectively analysed 17 patients (22 hips) treated with primary THA performed with a single-branded short uncemented stem with metaphyseal fixation (MiniHip™; Corin). We excluded cases in which other type of stems were used, or in which retrospective data was only available. Mean follow-up was 41.22 months (minimum 24). We analysed clinical outcome using the modified Harris Hip Score (mHHS) and pain using the visual analogue scale (VAS). Radiographs were examined in order to determine causes of complications and revision surgery. Results: All patients showed statistically significant improvement when preoperative and postoperative values for mHHS (54.19 vs. 94.57; p = 0.0001) and for pain VAS (8.71 vs. 0.71; p = 0.0003) were compared. No cases of thigh pain, instability or infection were found. 1 case of acetabular cup loosening and 1 case of periprosthetic fracture were diagnosed at 8 months and 45 days, respectively. Overall survival was 84.7% at 5 years (CI 95%, 64.4-105.3) with revision for any reason as an end point. When stem performance was separately evaluated, it showed a survival rate of 100% at 5 years with revision for aseptic loosening as an end point. Conclusions: THA with a type 2B short stem for the treatment of dysplastic osteoarthritis showed very few technical intraoperative problems, being a useful alternative for femoral reconstruction.

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The Variant rs145204276 of GAS5 is Associated with the Development and Prognosis of Gastric Cancer

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.271.qjl ◽

2018 ◽

Vol 27 (1) ◽

pp. 19-24 ◽

Cited By ~ 7

Author(s):

Qianjun Li ◽

Gang Ma ◽

Huimin Guo ◽

Suhua Sun ◽

Ying Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Cancer Progression ◽

Regulatory Mechanism ◽

Tumor Stage ◽

Kaplan Meier ◽

Non Coding Rna ◽

Early Tumor ◽

Long Non Coding Rna ◽

Clinicopathological Variables

Background & Aims: Down-regulation of the growth arrest specific transcript 5 (GAS5) (long non-coding RNA) is associated with cell proliferation of gastric cancer (GC) and a poor prognosis. We aimed to investigate whether the variant rs145204276 of GAS5 is associated with the prognosis of GC in the Chinese population, and to unveil the regulatory mechanism underlying the GAS5 expression in GC tissues.Method: 1,253 GC patients and 1,354 healthy controls were included. The frequency of the genotype del/del and the allele del of rs145204276 were compared between the patients and the controls and between different subgroups of patients classified by clinicopathological variables. The overall survival rate was analyzed according to the Kaplan-Meier method using the log-rank test.Results: The frequency of genotype del/del was significantly lower in patients than in the controls (7.0% vs. 9.1%, p = 0.001). Kaplan-Meier analysis showed that genotype del/del was significantly associated with a higher survival rate (p = 0.01). Patients with late tumor stage were found to have a significantly lower rate of genotype del/del than those with an early tumor stage (4.9% vs. 8.8%, p = 0.01). Patients with UICC III and IV were found to have a significantly lower rate of genotype del/del than those with UICC I and II (5.3% vs. 8.1%, p = 0.02).Conclusion: The variant rs145204276 of GAS5 is associated with the development and prognosis of GC. The allele del of rs145204276 is associated with a remarkably lower incidence of cancer progression and metastasis.

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Tinospora cordifolia Aqueous Extract Alleviates Cyclophosphamide- Induced Immune Suppression, Toxicity and Systemic Candidiasis in Immunosuppressed Mice: In vivo Study in Comparison to Antifungal Drug Fluconazole

Current Pharmaceutical Biotechnology ◽

10.2174/1389201019666190722151126 ◽

2019 ◽

Vol 20 (12) ◽

pp. 1055-1063 ◽

Cited By ~ 1

Author(s):

Faris Alrumaihi ◽

Khaled S. Allemailem ◽

Ahmad Almatroudi ◽

Mohammed A. Alsahli ◽

Arif Khan ◽

...

Keyword(s):

Survival Rate ◽

Aqueous Extract ◽

Survival Data ◽

Tinospora Cordifolia ◽

Systemic Candidiasis ◽

Organ Index ◽

Tnf Α ◽

Fungal Load ◽

Enhanced Secretion

Objective: The present study was aimed to evaluate the effect of the aqueous extract of Tinospora cordifolia (AETC) against cyclophosphamide-induced immunosuppression and systemic Candida albicans infection in a murine model. Methods: The protective effect of AETC against cyclophosphamide-induced leukopenia was evaluated by quantitative and qualitative analysis of the leukocytes. The immune-stimulating potential of AETC on macrophages was assessed by determining the levels of secreted cytokines. To determine the direct antifungal activity, AETC or fluconazole was administered to C. albicans infected mice. The efficacy of treatment was assessed by determining the survival rate, kidney fungal burden, the organ index and liver inflammation parameters. Results: Cyclophosphamide administration resulted in substantial depletion of leukocytes, whereas AETC treatment induced the recovery of leukocytes in cyclophosphamide-injected mice. Moreover, AETC treatment of macrophages resulted in enhanced secretion of IFN-γ, TNF-α and IL-1β. C. albicans infected mice treated with AETC at the doses of 50 and 100 mg/kg exhibited 40% and 60% survival rate, whereas the mice treated with fluconazole at a dose of 50 mg/kg showed 20% survival rate. Like survival data, the fungal load was found to be the lowest in the kidney tissues of mice treated with AETC at a dose of 100 mg/kg. Interestingly, mice infected with C. albicans demonstrated improvement in the organ indices and liver functioning after AETC treatment. Conclusion: These results suggest that AETC may potentially be used to rejuvenate the weakened immune system and eliminate systemic candidiasis in mice.

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Survival Analysis of Geriatric Patients with Low Digestive Hemorrhage Attending an Emergency Department

Gerontology ◽

10.1159/000513245 ◽

2021 ◽

pp. 1-6

Author(s):

Ana Fernandez-Suárez ◽

Oriol Yuguero Torres

Keyword(s):

Emergency Department ◽

Survival Analysis ◽

Retrospective Study ◽

Survival Rate ◽

Life Expectancy ◽

Antiplatelet Therapy ◽

Geriatric Patients ◽

Digestive Hemorrhage ◽

Kaplan Meier ◽

Number Of Individuals

Background: The increase in life expectancy and low mortality have doubled the number of individuals older than 65 in the last 30 years. Methods: We conducted a retrospective study of 101 patients older than 80 years of age treated by low digestive hemorrhage (LDH) in an emergency department during 2018. Sociodemographic variables were evaluated, as well as comorbidity and survival at 18 months. Survival was assessed by a Kaplan-Meier test. Results: 52.5% of the subjects were women. The average comorbidity of the sample was 1.97. The survival rate per year was 60%. The finding on colonoscopy shows no association with mortality. However, those patients on anticoagulant/antiplatelet therapy have a higher survival rate. Conclusion: Survival per year is high, so urgent colonoscopy for an LDH should be performed after evaluating the patient’s stability and functional status in a scheduled and outpatient manner.

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