Catastrophic failure of the Accolade I hip arthroplasty stem: a retrieval analysis study

2020 ◽  
Vol 30 (4) ◽  
pp. 481-487
Author(s):  
Christopher W Wylde ◽  
Elizabeth Jenkins ◽  
Moreica Pabbruwe ◽  
Thomas Bucher
Keyword(s):  
Femoral Head ◽  
Femoral Stem ◽  
Time Frame ◽  
Great Success ◽  
Retrieval Analysis ◽  
Wear Pattern ◽  
Bird Beak ◽  
Neck Fracture ◽  
Combination Of Material

Purpose: Modular Morse tapered femoral arthroplasty stems have been used for many years with great success and minimal complications. 1 stem, the Accolade by Stryker is noted to have increased failure when used in combination with LFIT V40 CoCr or the MITCH CoCr femoral heads. The failure has been in the form of corrosion, metallosis, fretting and trunnion fracture. This paper explores 10 cases with trunnion failure. Methods: A retrospective retrieval analysis of ten femoral stems retrieved at four different centres across Western Australia over a 3-year time frame. Inclusion criteria for this analysis included the use of Accolade 1 TMZF femoral stem plus either a MITCH or LFIT modular head. Results: 10 Accolade I (Stryker) stems were retrieved as part of the analysis, 6 with the LFIT V40 36-mm femoral head and 4 with a MITCH TRH femoral head. Average in situ time was 8.9 years. The hips were revised for either trunnion dislocation (6 cases) or trunnion fracture (4 cases). A characteristic destructive wear pattern of the femoral taper (trunnion) a “bird beak” appearance was present in all stems. This wear pattern created excessive movement and loosening resulting in a trunnion/head dislocation or brittle fracture of the trunnion. Conclusions: Catastrophic femoral neck fracture was likely due to a combination of material composition mismatch and mechanically assisted fretting corrosion at the head-neck junction leading to gross metallosis and failure. We suggest a recall on patients with an Accolade 1 stems in combination with a 36-mm or above LFIT or MITCH head, and for these patients to have clinical and radiological review.

scholarly journals A thin, deformable, high-performance supercapacitor implant that can be biodegraded and bioabsorbed within an animal body

2021 ◽  
Vol 7 (2) ◽  
pp. eabe3097
Author(s):  
Hongwei Sheng ◽  
Jingjing Zhou ◽  
Bo Li ◽  
Yuhang He ◽  
Xuetao Zhang ◽  
...  
Keyword(s):  
High Performance ◽  
Electronic Devices ◽  
Form Factors ◽  
Time Frame ◽  
Water Soluble ◽  
Two Dimensional ◽  
Medical Electronics ◽  
Thin Structure ◽  
Shed Light

It has been an outstanding challenge to achieve implantable energy modules that are mechanically soft (compatible with soft organs and tissues), have compact form factors, and are biodegradable (present for a desired time frame to power biodegradable, implantable medical electronics). Here, we present a fully biodegradable and bioabsorbable high-performance supercapacitor implant, which is lightweight and has a thin structure, mechanical flexibility, tunable degradation duration, and biocompatibility. The supercapacitor with a high areal capacitance (112.5 mF cm−2 at 1 mA cm−2) and energy density (15.64 μWh cm−2) uses two-dimensional, amorphous molybdenum oxide (MoOx) flakes as electrodes, which are grown in situ on water-soluble Mo foil using a green electrochemical strategy. Biodegradation behaviors and biocompatibility of the associated materials and the supercapacitor implant are systematically studied. Demonstrations of a supercapacitor implant that powers several electronic devices and that is completely degraded after implantation and absorbed in rat body shed light on its potential uses.

Calcitropic gene expression suggests a role for the intraplacental yolk sac in maternal-fetal calcium exchange

2002 ◽  
Vol 282 (3) ◽  
pp. E721-E732 ◽  
Author(s):  
Christopher S. Kovacs ◽  
Linda L. Chafe ◽  
Mandy L. Woodland ◽  
Kirsten R. McDonald ◽  
Neva J. Fudge ◽  
...  
Keyword(s):  
Time Frame ◽  
Yolk Sac ◽  
Late Gestation ◽  
Calcium Sensing ◽  
Parathyroid Hormone Related Protein ◽  
Active Calcium ◽  
Calcium Exchange ◽  
Calbindin D ◽  
Pthrp Receptor

The expression of calcitropic genes and proteins was localized within murine placenta during late gestation (the time frame of active calcium transfer) with an analysis of several gene-deletion mouse models by immunohistochemistry and in situ hybridization. Parathyroid hormone-related protein (PTHrP), the PTH/PTHrP receptor, calcium receptor, calbindin-D9k, Ca2+-ATPase, and vitamin D receptor were all highly expressed in a localized structure of the murine placenta, the intraplacental yolk sac, compared with trophoblasts. In the PTHrP gene-deleted or Pthrp-null placenta in which placental calcium transfer is decreased, calbindin-D9k expression was downregulated in the intraplacental yolk sac but not in the trophoblasts. These observations indicated that the intraplacental yolk sac contains calcium transfer and calcium-sensing capability and that it is a probable route of maternal-fetal calcium exchange in the mouse.

scholarly journals Re-Recognition of Garden Index as a Criterion for Evaluating the Quality of Femoral Neck Fracture Reduction: An Imaging Study Based on Cadaver Specimens

2021 ◽  
Author(s):  
Leyi Cai ◽  
Wenjie Li ◽  
Wenhao Zheng ◽  
Jianshun Wang ◽  
Xiaoshan Guo ◽  
...  
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Kirschner Wire ◽  
Imaging Study ◽  
Lateral View ◽  
Healthy Human ◽  
Rotational Displacement ◽  
Significant Difference ◽  
Neck Fracture

Abstract ObjectiveTo investigate whether the Garden index can determine the rotational displacement of femoral neck fracture. MethodsTen healthy human femoral specimens were obtained. A 2.0 mm diameter Kirschner-wire was placed in the center of the femoral head. The osteotomy was perpendicular in the middle of the femoral neck. The distal osteotomy surface was indicated the angle of rotation (pronation and supination to 90°, every 10° was an interval). The X-ray of anterior-posterior and lateral view was taken at different angles according to the mark. The Garden index and other relevant data were analyzed with the PCAS system. Meanwhile, the change of the area of the femoral head fovea at different rotation angles was observed. ResultsThere was no significant difference in the Garden index in 0~30° at pronation and supination position (P>0.05). In range of 40°~90°, there was a statistical difference in the Garden index (P<0.05). With the increase of the pronation angle, the area of the femoral head fovea is gradually reduced; as the angle of the supination increases, the area of the femoral head fovea is gradually increased. ConclusionThe Garden Index cannot accurately determine the rotational displacement of the femoral neck fracture during the pronation or supination range of 0~30°. Changes in the area of the femoral head fovea can help determine the rotational displacement of the femoral neck fracture.Level of EvidenceLevel V.

scholarly journals Caso Clínico: Luxación Controlada de Cadera. Epifisiólisis de Cabeza Femoral

2018 ◽  
Vol 10 (2) ◽  
pp. 175-178
Author(s):  
Christian Romeo Bravo Aguilar ◽  
Franklin Xavier Bravo Aguilar ◽  
Adriana Abigail Guzmán Villa
Keyword(s):  
Femoral Head ◽  
High Body Mass Index ◽  
Long Term Results ◽  
Adequate Treatment ◽  
Surgical Dislocation ◽  
In Situ Fixation ◽  
Lancinating Pain ◽  
The Right ◽  
Dislocation Of The Hip

BACKGROUND: The epiphysiolysis of the femoral head is the displacement of the epiphysis with respect to the metaphysis, in anterosuperior direction; it is etiology is unknown, frequent in adolescents, peripubertal period, and with high body mass index, average age between 12 and 18 years. It is incidence is variable, 0.2 (Japan) to 10 (United States) per 100 000 inhabitants. It is characterized by progressive pain in the hip, with irradiation to the groin or knee, is associated with lameness; with the early detection, an adequate treatment can be established, the most accepted one is the in situ fixation with central screws. CASE REPORT: A 14-year-old female patient with no pathological history attended the Children's Orthopedic Service due to the chronic lancinating pain of the right hip, which increases with walking, it is diagnosed by clinical examination and complementary exams of femoral head epiphysiolysis. Surgical dislocation of the hip and anatomical open reduction with placement of spongy screws was performed. EVOLUTION: On the third day of surgery, hospital discharge is decided; walking with crutches and without support during a postoperative month. The osteosynthesis remained for a year with monthly controls and corresponding physiotherapy; it has been evidenced favorable evolution; hip mobility arches preserved, normal ambulation, without complications CONCLUSIONS: The initial treatment of a patient with epiphysiolysis of stable femoral head depends on the evolution time and is done by fixing with screws or needles with of anatomical dislocation of the hip and osteoplasty of femoral neck remodeling. Most patients do not develop necrosis or chondro- lysis and long-term results with in situ fixation are usually excellent, unlike patients with late diagnosis.

scholarly journals Spontaneous Early Intraprosthetic Dislocation of 22 mm Skirted Femoral Head in Dual Mobility Hip Prosthesis: A Case Report

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Gur Aziz Singh Sidhu ◽  
Amit Kotecha ◽  
Sanjay Mulay ◽  
Neil Ashwood
Keyword(s):  
Case Report ◽  
Femoral Head ◽  
Revision Surgery ◽  
Hip Prosthesis ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Acetabular Cup ◽  
Dual Mobility ◽  
Metal Head ◽  
Intraprosthetic Dislocation

Introduction: There is a trend for increasing use of dual mobility hip designs for both primary and revision hip arthroplasty settings. It provides dual articular surfaces along with increased jump distance to increase the stability of construct. However, this design has some unique complications of its own which surgeons should be aware of especially intraprosthetic dislocation (IPD). Case Report: A 76-year-old lady presented to clinic with painful hip hemiarthroplasty after fracture neck of femur. She underwent revision surgery with dual mobility uncemented acetabular cup and femoral stem was retained as it was well fixed. She was mobilizing well and around 5 weeks post her surgery, developed pain in hip region and difficulty in weight-bearing. Radiographs showed eccentric position of femoral neck in the socket. A diagnosis of IPD was established and revision surgery was planned. Intraoperatively, metal head had dislocated from the polyethylene head and both components were resting in the acetabular socket. No macroscopic erosion of acetabulum was noticed. The polyethylene component and femoral head were retrieved. With previous failed dual mobility, decision was made to achieve stability with larger head size and lipped liner posteriorly. Conclusion: IPD is a rare occurrence and unique complication to dual mobility implants. This report highlights that patients can have IPD without fall or trauma. Keywords: Intraprosthetic dislocation, dual mobility cup, dislocation, total hip replacement.

scholarly journals Current Management of Femoral Neck Fractures (Literature Review)

2021 ◽  
pp. 68-75
Author(s):  
I.M. Zazirnyi ◽  
O.O. Kostrub
Keyword(s):  
Femoral Neck ◽  
Patient Characteristics ◽  
Femoral Neck Fractures ◽  
Classification Systems ◽  
Fracture Characterization ◽  
Orthopedic Surgeons ◽  
Appropriate Treatment ◽  
Neck Fracture ◽  
In Situ Fixation

Summary. Femoral neck fractures are a commonly encountered injury in orthopedic practice and result in significant morbidity and mortality. It is essential that surgeons are able to recognize specific fracture patterns and patient characteristics that indicate the use of particular implants and methods to effectively manage these injuries. The use of the Garden and Pauwels classification systems has remained the practical mainstay of femoral neck fracture characterization that help choosing appropriate treatment. Operative options include in situ fixation, closed or open reduction and internal fixation, hemiarthroplasty, and total hip arthroplasty. Recent reports demonstrate diversity among orthopedic surgeons in regard to the optimal treatment of femoral neck fractures and changing trends in their management.

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