Is diaphyseal fixation of short neck-retaining stem prostheses related to the size of the implant?

2020 ◽  
pp. 112070002093293
Author(s):  
Miquel Pons-Cabrafiga ◽  
Jorge Arias de la Torre ◽  
Daniel Berlanga-de-Mingo ◽  
Luis Lobo-Escolar
Keyword(s):  
Distal Part ◽  
Stress Shielding ◽  
Radiological Findings ◽  
Hip Prostheses ◽  
Cortical Hypertrophy ◽  
Radiological Changes ◽  
Distal Fixation ◽  
Hip Arthroplasties ◽  
The Relationship ◽  
Pedestal Formation

Introduction: Short-stem hip prostheses present variable proximal femoral bone radiological findings. The aims of this study were to analyse, in our patients with implanted collum femoris-preserving (CFP) stems, cancellous bone remodelling, cortical distal hypertrophy and pedestal formation, and the relationship between those radiological changes that suggest distal fixation with the size of the stem. Methods: From October 2001 to December 2012 a total of 199 consecutive primary total hip arthroplasties in 180 patients were performed at our department using the CFP stem and followed up for a minimum of 5 years until December 2017. Results: Stress shielding was present in 74% of oversized stems cases, but in normal or undersized stems, stress shielding was present in 8.5%. Cortical hyperthrophy was observed in 49% of the oversized stems and in 6% of the normal or undersized ones. Finally, non-statistically significant differences ( p  = 0.089) in pedestal formation were found, present in 16.3% of the oversized stems and in 6% of normal or undersized ones. Conclusions: Oversized stems cause more stress shielding and distal cortical hypertrophy in the distal part of the stem, which indicates distal fixation in bigger sizes of stem.

scholarly journals Numerical investigations of stress shielding in total hip prostheses

2008 ◽  
Vol 222 (5) ◽  
pp. 593-600 ◽  
Author(s):  
B-A Behrens ◽  
C J Wirth ◽  
H Windhagen ◽  
I Nolte ◽  
A Meyer-Lindenberg ◽  
...  
Keyword(s):  
Stress Shielding ◽  
Hip Prostheses ◽  
Numerical Investigations ◽  
Total Hip ◽  
Total Hip Prostheses

scholarly journals Distal Femoral Cortical Hypertrophy after Hip Arthroplasty Using a Cementless Double-Tapered Femoral Stem

2016 ◽  
Vol 24 (3) ◽  
pp. 317-322 ◽  
Author(s):  
Yoon Je Cho ◽  
Young Soo Chun ◽  
Kee Hyung Rhyu ◽  
Jong Hun Baek ◽  
Hu Liang
Keyword(s):  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Stress Shielding ◽  
Femoral Stem ◽  
Visual Analogue Score ◽  
Thigh Pain ◽  
Harris Hip Score ◽  
Cortical Hypertrophy ◽  
Flare Index ◽  
The Mean

Purpose To review 437 hips in 404 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty using the Accolade TMZF stem to determine the incidence and risk factors of distal femoral cortical hypertrophy (DFCH). Methods Records of 437 hips in 169 men and 235 women aged 26 to 100 (mean, 65.7) years who underwent THA (n=293) or hemiarthroplasty (n=144) using the Accolade TMZF femoral stem by 2 senior surgeons and were followed up for a mean of 54.7 months were reviewed. Clinical outcome was assessed using the modified Harris Hip Score and visual analogue score for pain. Proximal femoral geometry and canal flare index were assessed on preoperative radiographs, and DFCH, stem position, subsidence, loosening, and stress shielding were assessed on postoperative radiographs according to the Gruen zone. Results Of 437 hips, 27 (6.2%) developed DFCH and 410 did not. Hips with DFCH had a higher incidence of thigh pain (18.5% vs. 2.2%, p<0.001) and earlier onset of thigh pain (12.3 vs. 20.8 months, p=0.015), compared with those without. Nonetheless, all femoral stems were well-fixed, and no osteolysis or loosening was detected. The 2 groups achieved comparable clinical outcome in terms of Harris Hip Score and pain. The mean canal flare index was higher in hips with than without DFCH (3.706 vs. 3.294, p=0.002). The mean vertical subsidence of the femoral stem was lower in hips with than without DFCH (1.5 vs. 3.4 mm p<0.001). Subsidence negatively correlated with the canal flare index (correlation coefficient= −0.110, p=0.022). The incidence of the DFCH increased with each unit of increment in canal flare index (odds ratio [OR]=1.828, p=0.043) and each year younger in age (OR=0.968, p=0.015). Conclusion The incidence of DFCH in hips with the Accolade TMZF stem was 6.2%. Patients with a higher canal flare index and younger age had a higher incidence of DFCH. Nonetheless, DFCH did not affect clinical outcome or femoral stem stability.

scholarly journals Mid-Term Outcome of Total Hip Arthroplasty Using a Short Stem

2016 ◽  
Vol 24 (3) ◽  
pp. 323-327 ◽  
Author(s):  
Rajesh Malhotra ◽  
Vijay Kumar
Keyword(s):  
Total Hip Arthroplasty ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Term Outcome ◽  
Cortical Hypertrophy ◽  
Short Femoral Stem ◽  
The Mean ◽  
Pedestal Formation

Purpose To review the outcome of total hip arthroplasty (THA) using a short femoral stem in 33 hips. Methods Records of 33 hips in 20 men and 10 women aged 25 to 40 (mean, 30) years who underwent cementless THA using a short femoral stem by a single senior surgeon were reviewed. The diagnosis included avascular necrosis (n=9), ankylosing spondylitis (n=12), rheumatoid arthritis (n=7), post-traumatic arthritis (n=4), and Hurler syndrome (n=1). Clinical outcome was assessed using the Harris Hip Score. Radiological outcome was assessed according to a modified Gruen zoning system. Stem positioning (neutral, varus, valgus) and bone contact were evaluated, as were fixation and early host response as well as subsidence and changes in the calcar region (zone 5). Trabecular response (trabecular attachment), spot welds, cortical hypertrophy, and pedestal formation were determined. Heterotopic ossification was graded by the Brooker classification. Results The mean follow-up period was 6.5 years. The mean Harris Hip Score improved from 40 to 90. All hips achieved immediate postoperative stability. No patient had thigh pain. Four hips had varus placement (5°–7°) of the stem; all were asymptomatic and remained stable without any migration. Evidence of proximal load transfer (endosteal spot welds) between the endosteum and the stem in zones 2 and/or 4 was noted in 12 hips on both sides and in 8 hips on the lateral side only. At one year, all stems showed evidence of osseointegration. None had subsidence or progressive varus migration. There was no radiolucent line or osteolysis around the stem, pedestal formation or buttressing at the prosthesis tip, or cortical hypertrophy. One patient had grade I heterotopic ossification that was not clinically significant. One patient had a 1.5 cm leg lengthening. One patient had a discharging sinus, a loosened acetabular component, and intrapelvic migration at 2 years and underwent implant removal and debridement. One patient developed a crack in the proximal femur even with the smallest stem. The stem was fixed with cerclage wiring and remained stable with no migration. Conclusion A short femoral stem design that transfers load proximally through a prominent lateral flare achieved good short-term outcome in younger patients. Nonetheless, the ease of removal and preservation of bone at the time of revision should guide the choice of the design of the short stem.

Combination of musculoskeletal and wear models to investigate the effect of daily living activities on wear of hip prostheses

2021 ◽  
Vol 235 (12) ◽  
pp. 2675-2687
Author(s):  
Lorenza Mattei ◽  
Matilde Tomasi ◽  
Alessio Artoni ◽  
Enrico Ciulli ◽  
Francesca Di Puccio
Keyword(s):  
Motor Task ◽  
Analysis Data ◽  
Daily Activities ◽  
Wear Depth ◽  
Motor Tasks ◽  
Hip Prostheses ◽  
Wear Modelling ◽  
Sporting Activities ◽  
Joint Prostheses ◽  
Hip Arthroplasties

Abstract Numerical wear predictions are gaining increasing interest in many engineering applications, as they allow to simulate complex operative conditions not easily replicable in the laboratory. As far as hip prostheses are concerned, most of the wear models in the literature are based on the simulation of gait (recommended also in experimental wear tests), since gait is considered the most frequent and important motor task to recover after arthroplasty. However, since joint prostheses have been increasingly implanted in younger people, high loads and potentially severe conditions, e.g. due to sporting activities, should also be considered for a more reliable wear assessment of these implants. In this study, we propose a profitable combination of musculoskeletal and analytical wear modelling for the prediction of wear caused by common daily activities in metal-on-plastic hip arthroplasties. Several motion analysis data available in the literature (walking, fast walking, lunge, squat, stair negotiation) were selected and the effects of such motor tasks on prosthesis wear were investigated, both separately and in combination. Additionally, for comparative purposes, wear prediction for simplified gait conditions prescribed by the ISO 14242 standard, were also considered. Results suggest that this latter case produces lower wear depth and volume with respect to a relatively demanding combination of the selected daily activities. The preliminary results of the present study represent a first step towards the auspicious goal of validating the proposed procedure for in silico trials of hip arthroplasties.

scholarly journals Splenic Infarction and Infectious Diseases in Korea

2020 ◽  
Author(s):  
Jae Hyoung Im ◽  
Moon-Hyun Chung ◽  
Hye-Jin Lee ◽  
Hea Yoon Kwon ◽  
JiHyeon Baek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Immune Cells ◽  
Clinical Presentation ◽  
Scrub Typhus ◽  
Systemic Infection ◽  
Splenic Infarction ◽  
University Hospital ◽  
Radiological Findings ◽  
Epstein Barr ◽  
The Relationship

Abstract Background The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. Methods Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed.Results Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n =12], babesiosis [n =1]); bacteria (scrub typhus [n =5]); viruses (Epstein–Barr [n =1], cytomegalovirus [n =1]); and unidentified pathogen[s] (n =7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. Conclusions In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.

Paper #4 The Relationship Between Activity and Ions in Patients with Metal-Metal Bearing Hip Prostheses

2005 ◽  
Vol 20 (2) ◽  
pp. 265 ◽  
Author(s):  
C. Heisel ◽  
M. Silva ◽  
A.K. Skipor ◽  
Joshua J. Jacobs ◽  
Thomas P. Schmalzried
Keyword(s):  
Hip Prostheses ◽  
Metal Metal ◽  
The Relationship

scholarly journals The Relationship Between Endurance Of Periscapular Muscles, Anaerobic Performance And Agility In Professional Athletes

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0008
Author(s):  
Ali Zorlular ◽  
Gamze Çobanoğlu ◽  
Sinem Suner Keklik ◽  
Çağatay Müslim Gökdoğan ◽  
Esedullah Akaras ◽  
...  
Keyword(s):  
Distal Part ◽  
Vertical Jump ◽  
High Energy ◽  
Professional Athletes ◽  
Muscle Endurance ◽  
Anaerobic Performance ◽  
Professional Basketball ◽  
Jump Test ◽  
The Relationship ◽  
Positive Significant Correlation

Objective: The purpose of this study was to identify relationships between endurance of periscapular muscle, anaerobic performance and agility in professional athletes. Methods: 70 professional basketball, volleyball, and handball players (male: 25 female: 45 age 20.41±5.72, BMI: 21.70±2.51) were included to this study. Anaerobic performance was assessed with vertical jump test. Periscapular muscles endurance was evaluated using scapular muscle endurance test and agility was measured hexagonal obstacle test. Statistical analysis was performed using the statistical software SPSS 22. Results: Spearman correlation analysis results showed that there was positive significant correlation between anaerobic performance and endurance of periscapular muscles (p<0.05 r=0.341). A negative significant relationship was demonstrated between anaerobic performance and agility (p<0.05 r=-0.332), and between agility and endurance of periscapular muscles (p<0.05 r=-0.334). Discussion: The scapula acts as an axis, transmitting the power and high energy of the lower extremities and trunk to the upper extremities. The muscles surrounding the scapula provide proximal stability for the upper extremity and act as a fix while the distal part is moving. When weakness of scapular musculature has occurred, normal scapular positioning and mechanics may be altered. Therefore, scapular stabilization failure may lead to poor anaerobic performance. These results indicate that periscapular muscle endurance affects anaerobic and agility performance in sports.

scholarly journals Tumor Necrosis Factor-Alpha in Peripical Tissue Exudates of Teeth with Apical Periodontitis

2007 ◽  
Vol 2007 ◽  
pp. 1-4 ◽  
Author(s):  
Sonja Pezelj-Ribaric ◽  
Karolina Magašic ◽  
Jelena Prpic ◽  
Ivana Miletic ◽  
Zoran Karlovic
Keyword(s):  
Tumor Necrosis Factor ◽  
Tumor Necrosis Factor Alpha ◽  
Tumor Necrosis ◽  
Control Group ◽  
Radiological Findings ◽  
Necrosis Factor Alpha ◽  
Root Canals ◽  
Factor Alpha ◽  
Radiological Changes ◽  
Necrosis Factor

Aim.The aim of this study was to determine tumor necrosis factor-alpha (TNF-α) levels in periapical exudates and to evaluate their relationship with radiological findings.Methodology.Periapical exudates were collected from root canals of 60 single-rooted teeth using absorbent paper points. TNF-αlevels were determined by enzyme-linked immunosorbent assays. The samples were divided into three groups according to the periapical radiolucent area.Results.Nonparametric Kruskal-Wallis test revealed significant differences between TNF-αconcentrations in control group (40,57±28, 15 pg/mL) and group with larger radiolucent areas (2365,79±582, 95 pg/mL), as well as between control and canals with small radiolucent areas (507,66±278, 97) (P<.05).Conclusions.The levels of TNF-αincrease significantly in teeth with periapical pathosis, from smaller to bigger lesions. This research and its results have shown that objective analysis of the TNF-αlevels enables establishment of a relationship between different concentrations of TNF-αand different radiological changes.

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