Results of trabecular metal augments in Paprosky IIIA and IIIB defects

2018 ◽  
Vol 100-B (7) ◽  
pp. 903-908 ◽  
Author(s):  
K. K. Eachempati ◽  
R. Malhotra ◽  
S. Pichai ◽  
A. V. G. Reddy ◽  
A. K. Podhili Subramani ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Bone Defects ◽  
Acetabular Reconstruction ◽  
Revision Total Hip Arthroplasty ◽  
Trabecular Metal ◽  
Intention To Treat ◽  
The Mean ◽  
Mid Term Results ◽  
Treat Analysis

AimsThe advent of trabecular metal (TM) augments has revolutionized the management of severe bone defects during acetabular reconstruction. The purpose of this study was to evaluate patients undergoing revision total hip arthroplasty (THA) with the use of TM augments for reconstruction of Paprosky IIIA and IIIB defects.Patients and MethodsA retrospective study was conducted at four centres between August 2008 and January 2015. Patients treated with TM augments and TM shell for a Paprosky grade IIIA or IIIB defect, in the absence of pelvic discontinuity, and who underwent revision hip arthroplasty with the use of TM augments were included in the study. A total of 41 patients with minimum follow-up of two years were included and evaluated using intention-to-treat analysis.ResultsThere were 36 (87.8%) patients with a Paprosky IIIA defect and five (12.2%) patients with a Paprosky IIIB defect. The mean age was 56.7 years (28 to 94). There were 21 (51.2%) women and 20 (48.8%) men. The mean follow-up was 39.4 months (12 to 96). One (2%) patient died after eight years. No failures were noted in the series. The mean survivorship was 100% at the time of latest follow-up.ConclusionThe results of this multicentre study showed encouraging short- and mid-term results for the use of TM augments in the management of Paprosky grade IIIA and IIIB defects. Cite this article: Bone Joint J 2018;100-B:903–8.

Mid-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head

2018 ◽  
Vol 29 (6) ◽  
pp. 603-608 ◽  
Author(s):  
Yingyong Suksathien ◽  
Jithayut Sueajui
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Stem Revision ◽  
The Mean ◽  
Bone Trabeculae ◽  
Mid Term Results

Purpose: To evaluate the clinical and radiographic mid-term results of short-stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH). Methods: We reviewed 83 cases that underwent Metha stem between November 2010 and November 2012. The appearance of bone trabeculae development and radiolucent line were reviewed and HHS was recorded at 6 months postoperatively then yearly to evaluate the clinical results. Results: The mean age of patients was 43.8 years with the mean follow-up 69.3 (60–84) months. Harris Hip Score improved significantly from 44.7 preoperatively to 99.6 at the last follow-up ( p < 0.0001). There were 4 cases (4.8%) of intraoperative femoral fractures. There was 1 case (1.2%) of distal stem perforation that had stable bone ingrowth and there was 1 case (1.2%) of 5-mm subsidence, which was then stable at 3 months postoperatively. Bone trabecular development was detected at zone 1 (65.1%), 2 (69.9%), 3 (14.4%), 4 (1.2%), 6 (97.6%) and 7 (81.9%). There was 1 case (1.2%) where radiolucent lines were observed in zones 1 and 7. There was 1 femoral stem revision from periprosthetic fracture 4 years after index surgery and 1 cup revision from aseptic loosening. Kaplan-Meier survivorship with the end point of stem revision for any reason was 98.8% and for aseptic loosening it was 100% at 7 years. Conclusions: The mid-term clinical and radiographic results of the Metha stem in patients with ONFH were promising. Its design enables preservation of the bone stock and the bone trabeculae appear to confirm the assumption of proximal force transmission.

Mid-Term Results of Ceramic-on-Ceramic Total Hip Arthroplasty with Sandwich Cup

2006 ◽  
Vol 309-311 ◽  
pp. 1357-1362
Author(s):  
Masahiro Hasegawa ◽  
Akihiro Sudo ◽  
Atsumasa Uchida
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Dislocation ◽  
Clinical Results ◽  
Total Hip ◽  
The Mean ◽  
Acetabular Components ◽  
Mid Term Results ◽  
Ceramic On Ceramic

In ceramic-on-ceramic total hip arthroplasty (THA), modular acetabular component with a sandwich insertion was developed and evaluated mid-term clinical results. 35 hips had undergone cementless ceramic-on-ceramic THA with sandwich cup (Kyocera, Kyoto, Japan). The mean duration of follow-up was 5 years. 6 hips had undergone component revisions. The reasons for revision included infection in 1 hip, dislocation with loosening in 2 hips, alumina liner fractures in 2 hips, and cup dissociation in 1 hip. All femoral and acetabular components showed no loosening in the unrevised hips at the time of the last follow-up. None of the 29 unrevised hips had osteolysis.

Acetabular reconstruction using a composite layer of impacted cancellous allograft bone and cement: minimum 5-year follow-up study

2020 ◽  
pp. 112070002094140
Author(s):  
Kanai Garala ◽  
Tarek Boutefnouchet ◽  
Rishanthanan Amblawaner ◽  
Trevor Lawrence
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Grafting ◽  
Composite Layer ◽  
Acetabular Reconstruction ◽  
Total Hip ◽  
Patient Reported ◽  
The Mean ◽  
Composite Bone

Background: Revision total hip arthroplasty (rTHA) is often complex and has a less reliable outcome than primary total hip arthroplasty. Acetabular reconstruction remains a challenge because of the variable amount of bone loss. This study describes and evaluates a novel technique of acetabular reconstruction using composite bone grafting. Patients and methods: Between June 2005 and January 2012, 108 consecutive patients underwent revision hip arthroplasty in which the acetabular component was revised using composite bone grafting. Of these, 24 were lost to follow-up leaving 84 in the study with a minimum 5-year follow-up. There were 54 women and 30 men with a mean age of 70.1 (31–91) years. All patients were assessed clinically and radiologically after a minimum of 5 years. The primary outcome measures were rate of re-revision, patient-reported outcomes and radiological evidence of loosening. Results: The mean follow-up after revision surgery was 6.9 years (5–10). At operation, 60 patients had an acetabular defect of AAOS stage 3 or more. There was no evidence of loosening in 69 revision acetabular components; 12 showed evidence of non-progressive loosening and 3 patients underwent a re-revision procedure (2 for infection, 1 recurrent dislocation). The mean postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) was 89.11/100 (95% CI, 87.8–90.5). Scores were significantly improved in patients with a more extensive preoperative defect ( p  = 0.006). The overall patient satisfaction rate at final follow-up was very high. Conclusions: Composite impaction grafting using a layered cement and bone graft technique can give satisfactory clinical and radiological outcomes in the medium- to long-term.

Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 66-72 ◽  
Author(s):  
Mattia Loppini ◽  
Paolo Schiavi ◽  
Antonello Della Rocca ◽  
Francesco Traverso ◽  
Federico Della Rocca ◽  
...  
Keyword(s):  
Bone Defects ◽  
Acetabular Reconstruction ◽  
Trabecular Metal ◽  
Acetabular Bone ◽  
Pelvic Discontinuity ◽  
Type Iii ◽  
Heterotopic Ossifications ◽  
Radiographic Outcomes ◽  
Acetabular Bone Defects

Introduction: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. Methods: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. Results: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45–81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24–72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. Conclusion: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.

scholarly journals Mid-term outcomes of tantalum cup– a single centre study

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Rajesh Bawale ◽  
Baseem Choudhry ◽  
Srinivasa Samsani
Keyword(s):  
Hip Arthroplasty ◽  
Deep Infection ◽  
Revision Hip Arthroplasty ◽  
Trabecular Metal ◽  
Level Of Evidence ◽  
Porous Tantalum ◽  
Midterm Outcome ◽  
Cementless Cup ◽  
The Mean

Abstract Introduction The cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications. Methods The midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available. Results The mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up. Conclusion The mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments. Level of evidence IV.

scholarly journals High survivorship of highly cross-linked polyethylene in revision Total hip Arthroplasty: a minimum 10-year follow-up study

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Seung-Jae Lim ◽  
Ingwon Yeo ◽  
Chan-Woo Park ◽  
Kyung-Jae Lee ◽  
Byung-Woo Min ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Liner ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Revision Thas ◽  
Total Hip ◽  
The Mean

Abstract Purpose Highly cross-linked polyethylene has been introduced to decrease osteolysis secondary to polyethylene wear debris generation. However, few long-term data on revision total hip arthroplasty (THA) using highly cross-linked polyethylene liners are available. The objective of this study was to determine long-term outcomes of a highly cross-linked polyethylene liner in revision THA. Materials & methods We evaluated 63 revision THAs performed in 63 patients using a highly cross-linked polyethylene liner between April 2000 and February 2005. Of these, nine died and four were lost to follow-up. Thus, the final study cohort consisted of 50 patients (50 hips), including 26 males and 24 females with a mean age of 53 years (range, 27–75 years). Mean follow-up was 11 years (range, 10–14 years). Results The mean Harris hip score improved from 44 points preoperatively to 85 points at the final follow-up. No radiographic evidence of osteolysis was found in any hip. The mean rate of polyethylene liner wear was 0.029 mm/year (range, 0.003 to 0.098 mm/year). A total of 5 hips (10%) required re-revision arthroplasty, including one cup loosening, one recurrent dislocation, and three deep infections. Kaplan-Meier survivorship with an end point of re-revision for any reason was 91.1% and for aseptic cup loosening was 97.9% at 11 years. Conclusion At a minimum of 10 years, the highly cross-linked polyethylene liners showed excellent clinical performance and implant survivorship, and were not associated with osteolysis in our patients with revision THAs.

scholarly journals Randomised comparison of postpolypectomy surveillance intervals following a two-round baseline colonoscopy: the Japan Polyp Study Workgroup

Gut ◽  
2020 ◽  
pp. gutjnl-2020-321996
Author(s):  
Takahisa Matsuda ◽  
Takahiro Fujii ◽  
Yasushi Sano ◽  
Shin-ei Kudo ◽  
Yasushi Oda ◽  
...  
Keyword(s):  
Protocol Analysis ◽  
Controlled Trial ◽  
Low Grade ◽  
Intention To Treat ◽  
Neoplastic Lesions ◽  
The Mean ◽  
Low Grade Dysplasia ◽  
Randomised Controlled ◽  
Treat Analysis

ObjectiveTo assess whether follow-up colonoscopy after polypectomy at 3 years only, or at 1 and 3 years would effectively detect advanced neoplasia (AN), including nonpolypoid colorectal neoplasms (NP-CRNs).DesignA prospective multicentre randomised controlled trial was conducted in 11 Japanese institutions. The enrolled participants underwent a two-round baseline colonoscopy (interval: 1 year) to remove all neoplastic lesions. Subsequently, they were randomly assigned to undergo follow-up colonoscopy at 1 and 3 years (2-examination group) or at 3 years only (1-examination group). The incidence of AN, defined as lesions with low-grade dysplasia ≥10 mm, high-grade dysplasia or invasive cancer, at follow-up colonoscopy was evaluated.ResultsA total of 3926 patients were enrolled in this study. The mean age was 57.3 (range: 40–69) years, and 2440 (62%) were male. Of these, 2166 patients were assigned to two groups (2-examination: 1087, 1-examination: 1079). Overall, we detected 29 AN in 28 patients at follow-up colonoscopy in both groups. On per-protocol analysis (701 in 2-examination vs 763 in 1-examination group), the incidence of AN was similar between the two groups (1.7% vs 2.1%, p=0.599). The results of the non-inferiority test were significant (p=0.017 in per-protocol, p=0.001 in intention-to-treat analysis). NP-CRNs composed of dominantly of the detected AN (62%, 18/29), and most of them were classified into laterally spreading tumour non-granular type (83%, 15/18).ConclusionAfter a two-round baseline colonoscopy, follow-up colonoscopy at 3 years detected AN, including NP-CRNs, as effectively as follow-up colonoscopies performed after 1 and 3 years.

Revision total hip arthroplasty in patients with femoral bone loss using tapered rectangular femoral stem: a minimum 10 years’ follow-up

2020 ◽  
Vol 30 (5) ◽  
pp. 622-628
Author(s):  
Jian Wang ◽  
Wen-Li Dai ◽  
Ze-Ming Lin ◽  
Zhan-Jun Shi
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Revision Total Hip Arthroplasty ◽  
Femoral Bone ◽  
Revision Tha ◽  
The Mean

Background: Revision total hip arthroplasty (THA) remains a significant challenge when there is severe femoral bone loss. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision THA in patients with femoral bone loss treated with Zweymüller SLR-Plus stem. Methods: A retrospective review of 82 patients who underwent revision THA using tapered rectangular femoral stem between 1997 and 2007 was undertaken. Of the 82 patients, 9 patients were lost to follow-up and were excluded from the study. The most common reason for revision was aseptic loosening (92%), periprosthetic femur fracture (5%), and infection (3%). Bone loss was categorised preoperatively according to the Paprosky classification. The mean clinical follow-up was 14 years (range 10–19 years). Their mean age at the time of index surgery was 54.7 ± 15.3 (range 30–82) years. Results: The mean Harris Hip Score was significantly improved at final follow-up (68.1 ±10.3) compared with that before the revision surgery (30.4 ± 7.7) ( p < 0.0001). Of the 75 stems, 69 (92%) stems were radiographically stable at the last evaluation. Among the 69 stems, 64 hips (85%) had radiographic evidence of bone ingrowth and 5 (5%) had stable fibrous fixation of the stem. Among the 7 hips that were re-revised, 5 hips were re-revised for aseptic loosening, whereas 2 were re-revised for an infection. Kaplan-Meier survivorship analysis, with removal of the stem for any cause as the endpoint, revealed that the 15-year rate of survival of the components was 90% (95% CI, 0.83–0.97). Conclusion: Revision THA in patients with proximal femoral bone loss using Zweymüller SLR-Plus stem led to a high rate of osseointegration of the stem and good clinical results at long-term follow-up.

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