Blood metal levels, leucocyte profiles, and cytokine profiles in patients with a modular dual-mobility hip prosthesis

2019 ◽  
Vol 101-B (9) ◽  
pp. 1035-1041 ◽  
Author(s):  
David C. Markel ◽  
Therese Bou-Akl ◽  
Mario D. Rossi ◽  
Natalie Pizzimenti ◽  
Bin Wu ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Short Form ◽  
Harris Hip Score ◽  
Blood Concentrations ◽  
Dual Mobility ◽  
Large Femoral Head ◽  
Serum Cytokines ◽  
Metal Levels ◽  
Leucocyte Profiles

Aims The aim of this study was to evaluate blood metal ion levels, leucocyte profiles, and serum cytokines in patients with a total hip arthroplasty (THA) involving modular dual-mobility components. Patients and Methods A total of 39 patients were recruited, with clinical follow-up of up to two years. Outcome was assessed using the Harris Hip Score (HHS, the 12-Item Short-Form Health Survey (SF-12), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a visual analogue scale (VAS) for pain. Blood concentrations of cobalt (Co), chromium (Cr), and serum cytokines were measured. Subpopulations of leucocytes were analyzed by flow cytometry. Results The clinical performance was good. Blood Co levels (ref 1.0 µg/l) were mildly elevated in seven patients at three months, and two patients at two years’ follow-up. The preoperative Cr levels were normal except for one patient with a detectable Cr (1.2 µg/l). Cr levels were detectable in three patients at three months, two patients at one year, and three patients at two years’ follow-up. No patients had symptoms suggestive of failure. Although flow cytometry showed constant circulating leucocyte profiles, there was a significant reduction of serum interleukin (IL)-4, IL-5, and interferon gamma (IFNγ) postoperatively compared with the preoperative levels (p < 0.05). Conclusion These results suggest that THA using modular dual-mobility components is safe. This allows an opportunity to use a large femoral head and a thick polyethylene bearing surface, which is especially useful in revision procedures or high-risk situations when added stability is required. Cite this article: Bone Joint J 2019;101-B:1035–1041.

Response profiles of circulating leukocytes and metal ions in patients with a modular dual-mobility hip implant

2019 ◽  
pp. 112070001986553
Author(s):  
David Markel ◽  
Theresa Bou-Akl ◽  
Maria Rossi ◽  
Natalie M Pizzimenti ◽  
Bin Wu ◽  
...  
Keyword(s):  
T Cells ◽  
Metal Ion ◽  
Blood Concentrations ◽  
Dual Mobility ◽  
Hip Implant ◽  
Inflammatory Monocytes ◽  
Metal Ion Release ◽  
Metal Levels ◽  
Leukocyte Profiles

Introduction:The purpose of this study was to retrospectively evaluate blood metal ion levels and leukocyte profiles in patients with modular dual-mobility hip implant (MDM) during a postoperative follow-up up to 2 years.Methods:We recruited 49 patients in a retrospective cohort study and had postoperative follow-up up to 2 years. Blood concentrations of chromium (Cr), cobalt (Co) and serum cytokines were measured. Flow cytometry was used to quantify the subpopulations of leukocytes, including CD14+and CD16+monocytes, CD3+T lymphocytes, CD19+B lymphocytes, CD4+Helper T-cells and CD45+RA memory vs. naïve T-cells.Results:Clinical performances of implants were good during 2 years of follow-up. Cr levels were normal in all patients and only detectable in 1 patient (1.4µg/L, ref < 5.0µg/L). Co levels were mildly elevated in 4 patients at 1 year (mean 1.375µg/L, range 1.2–1.7µg/L, ref < 1.0µg/L) and in 2 patients at 2-year follow-up (both 1.2µg/L). Interestingly, Co level observed in 3 patients at 1 year converted to undetectable at their 2-year follow-up. Percentages of B cells, T cells and their subpopulations were within normal levels. There was no increase of CD16+inflammatory monocytes.Discussion:With the recent introduction of MDM systems there is potential for metal ion release from the interface between the acetabular shell and CoCr liner. Clinical results have been good and metal levels undetectable or within acceptable ranges at 1–2 years. There was no evidence of activated immune response, as manifested by constant circulating leukocyte profiles and no increase of CD16+inflammatory monocytes.

Outcomes of Hip Arthroscopic Surgery in Adolescents With a Subanalysis on Return to Sport: A Systematic Review

2019 ◽  
Vol 48 (6) ◽  
pp. 1526-1534
Author(s):  
Sarah L. Chen ◽  
David R. Maldonado ◽  
Cammille C. Go ◽  
Cynthia Kyin ◽  
Ajay C. Lall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Short Form ◽  
Adult Population ◽  
Arthroscopic Surgery ◽  
Return To Sport ◽  
Functional Improvement ◽  
Harris Hip Score ◽  
Patient Reported ◽  
The Mean

Background: There is a plethora of literature on outcomes after hip arthroscopic surgery in the adult population; however, outcomes in the adolescent population have not been as widely reported. Additionally, as adolescents represent a very active population, it is imperative to understand their athletic activity and return to sport after hip arthroscopic surgery. Purpose: To analyze patient-reported outcomes (PROs) after hip arthroscopic surgery in adolescents (aged 10-19 years) and present a return-to-sport analysis in the athletic adolescent subgroup. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, Embase, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify articles that reported PROs after hip arthroscopic surgery in adolescents. The standardized mean difference was calculated to compare the effect size of hip arthroscopic surgery on various PROs. For the athletic subgroup, a return-to-sport summary was also provided. Results: Ten studies, with 618 adolescent hips and a collective study period of December 2004 to February 2015, were included in this systematic review. Across all studies, the mean age was 15.8 years (range, 11.0-19.9 years), and female patients composed approximately 56.7% of the entire cohort. The mean follow-up was 34.5 months (range, 12-120 months). The modified Harris Hip Score (mHHS) was reported in 9 studies, and at latest follow-up, scores were excellent in 4 studies (range, 90-95) and good in the remaining 5 studies (range, 82.1-89.6). All adolescents also showed significant improvement on the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL), the HOS–Sport-Specific Subscale (HOS-SSS), the physical component of the 12-Item Short Form Health Survey (SF-12P), a visual analog scale for pain (VAS), and both versions of the International Hip Outcome Tool (iHOT-12 and iHOT-33) at latest follow-up ( P < .05). Further, mean improvements reported in all studies surpassed reported values of the minimal clinically important difference and patient acceptable symptomatic state for the mHHS, HOS-ADL, HOS-SSS, and iHOT-33. Finally, the collective return-to-sport rate among athletic adolescents was 84.9%. Conclusion: In the setting of labral tears and femoroacetabular impingement, hip arthroscopic surgery can safely be performed in adolescents and leads to significant functional improvement. Furthermore, athletic adolescents return to sport at high levels after hip arthroscopic surgery.

scholarly journals Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy

2020 ◽  
Vol 8 (3) ◽  
pp. 232596712090786 ◽  
Author(s):  
Champ L. Baker ◽  
J. Ryan Mahoney
Keyword(s):  
Short Form ◽  
Tendon Repair ◽  
Case Series ◽  
Outpatient Setting ◽  
Harris Hip Score ◽  
Ultrasound Guided ◽  
Level Of Evidence ◽  
Nonsurgical Management ◽  
Gluteal Tendinopathy

Background: Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described. Purpose: To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: A total of 29 patients with gluteal tendinopathy (mean age, 62 years) who did not respond to nonsurgical treatment were enrolled in this prospective study and underwent ultrasound-guided PUT in an outpatient setting. Patients with a history of ipsilateral hip surgery were excluded. All patients initially underwent magnetic resonance imaging or a computed tomography arthrogram demonstrating tendinopathy and/or partial tearing of the gluteus minimus or medius tendon or both tendons. Outcomes were assessed with a visual analog scale (VAS) for pain, the Harris Hip Score evaluation, and the 12-Item Short Form Health Survey (SF-12) before the procedure and at subsequent follow-up visits or by telephone interviews at 3 weeks, 3 months, 6 months, and final follow-up (range, 18-30 months). Results: The mean final follow-up was at 22 months postoperatively. At final follow-up, VAS scores had improved from a preprocedural mean ± SD of 5.86 ± 1.73 to 2.82 ± 2.22 ( P < .01). Harris Hip Scores improved from a preprocedural mean of 60.03 ± 10.86 to 77.47 ± 14.34 ( P < .01). Total SF-12 scores improved from a mean of 29.93 ± 5.39 (51% optimal) to 34.41 ± 4.88 (64% optimal) ( P < .01). No complications were reported. At final follow-up, when asked whether they would have the procedure again, 15 patients replied “yes definitely,” 3 replied “yes probably,” 3 replied “maybe,” 1 replied “likely not,” and 2 replied “definitely not.” There were 3 patients who eventually had hip abductor tendon repair, and their PUT procedures were considered failures. Conclusion: PUT is an effective treatment, with good results for patients with gluteal tendinopathy.

Effect of marital status on patient-reported outcomes following total hip arthroplasty: a matched analysis with minimum 2-year follow-up

2019 ◽  
pp. 112070001986401
Author(s):  
Ajay C Lall ◽  
Garrett R Schwarzman ◽  
Muriel R Battaglia ◽  
Sarah L Chen ◽  
David R Maldonado ◽  
...  
Keyword(s):  
Marital Status ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Psychosocial Support ◽  
Short Form ◽  
Harris Hip Score ◽  
Never Married ◽  
Total Hip ◽  
Patient Reported

Introduction: Mental health and patient expectation have been identified as key predictors of recovery following THA; however, there is limited literature examining the effects of social support and marital status on patient-reported outcomes (PROs). Methods: Data were prospectively collected and retrospectively reviewed for patients who underwent THA between July 2008 and January 2016. Patients were included if they underwent primary THA during this period and if they had documented preoperative marital status of married, divorced, or never married. Married patients were group matched to non-married patients (divorced or never married) with similar sex, age, body mass index (BMI), gender distribution, and frequency of surgical approach. Results: There were 414 married patients and 98 non-married patients who were eligible and had minimum 2-year follow-up. Mean PROs were significantly worse in the non-married group than the married group for the following measures: modified Harris Hip Score ( p = 0.002), Harris Hip Score ( p = 0.002), Forgotten Joint Score ( p = 0.04), and the physical portions of the Veterans RAND ( p = 0.025) and Short Form ( p = 0.02) surveys. Conclusions: Our study demonstrated inferior absolute PRO scores at latest follow-up for patients who were non-married compared to married following THA. These results show that while total hip replacement may still yield clinical benefit in all patients, non-married patients may ultimately achieve an inferior functional status, and expectations should be adjusted accordingly. Physicians should assess levels of psychosocial support in their patients prior to undergoing hip arthroplasty in order to optimise results.

Stemless hip arthroplasty versus traditional implants: a comparative observational study at 30 months follow-up

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 21-27 ◽  
Author(s):  
Giandomenico Logroscino ◽  
Fabrizio Donati ◽  
Vincenzo Campana ◽  
Michela Saracco
Keyword(s):  
Short Form ◽  
Stress Shielding ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Harris Hip Score ◽  
Retrospective Case ◽  
Chi Square ◽  
Length Discrepancy ◽  
Short Stems

Introduction: The aim of this retrospective case-control study is to evaluate clinical and radiographic results of short stems compared with traditional hip prostheses. Methods: 46 short stems (SS) and 50 traditional stems (TS) were selected. All the stems were implanted by the same surgeon using posterior approach because of primary osteoarthritis, post-traumatic osteoarthritis and avascular necrosis. All the patients were compared clinically by Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF-12F/M) and radiographically (offset, CD angle, limb length discrepancy, cup inclination, subsidence, osseointegration, heterotopic ossification). Radiographic evaluations were carried out by 3 different blinded surgeons. A statistical analysis was performed (chi-square, t-test, Mann-Whitney). Results: At a mean follow-up of 30 months all the implanted stems were well-positioned and osseointegrated. In both groups there was a marked improvement in pain ( p < 0.001) with a statistically significant advantage in the SS group for WOMAC (90.8 vs. 87.5; p = 0.02) and in part for HHS (93 vs. 91.7; p = 0.18). The radiographic evaluations, with high concordance correlation between the 3 blinded surgeons (ICC consistently >0.80), showed no significant differences in the restoration of the articular geometry, with a reduction of cortical hypertrophy (2% SS vs. 7% TS) and periprosthetic stress-shielding ( p < 0.05) in the SS group. On the other hand, SS were more related to limb length discrepancy (61% vs. 33%; p < 0.05). No major complications were recorded in the 2 groups. Conclusion: Short stems were shown to be comparable or better than traditional implants at short-term follow-up.

Good mid-term clinical results of a cemented dual mobility cup: a single-centre experience

2017 ◽  
Vol 28 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Gregor Kavčič ◽  
Pika Mirt ◽  
Klemen Bedenčič
Keyword(s):  
Final Analysis ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Single Centre Experience ◽  
The Mean ◽  
Hip Arthroplasties

Introduction and methods: From January 2004 to December 2008, 188 total hip arthroplasties were performed using a cemented dual mobility cup. 174 patients were available for final analysis. Their mean age was 76.8 (range 54-98 years). The mean follow-up was 7.7 years (range 5-10 years). Results: There were no dislocations. Survivorship rates of the femoral and acetabular components were 100% at a minimum of 5 years. At the latest follow-up, the mean Harris Hip Score significantly increased from 31.6 (only arthritic patients) points preoperatively to 84.5 points. No patients had progressive osteolysis, component migration, or loosening on radiographs. 2 patients presented with periprosthetic fractures treated conservatively. 2 patients presented with infection treated without implant removal and 1 patient presented with transient femoral palsy. Conclusions: The results of this consecutive series confirmed the good performance of the cemented dual mobility cup at mean 7.7 years follow-up with no revision and no dislocations.

scholarly journals Reconstruction of Paprosky III defects with double-trabecular metal cups in acetabular revision at five-year follow-up

2020 ◽  
Author(s):  
Xianghong Zhang ◽  
Jia Wan ◽  
Wanchun Wang ◽  
Fuming Li ◽  
Libiao Qiu ◽  
...  
Keyword(s):  
Los Angeles ◽  
Bone Grafting ◽  
Short Form ◽  
Limb Length Discrepancy ◽  
Acetabular Revision ◽  
Harris Hip Score ◽  
Trabecular Metal ◽  
Modified Harris Hip Score ◽  
Acetabular Defects

Abstract Background: Acetabular revision is often difficult to manage because of severe bone loss, especially for Paprosky type Ⅲ defects. Our present study aimed to assess the strategy of double-trabecular metal cups in acetabular revision.Methods: Fifteen patients (15 hips) underwent acetabular revision using double-cup technique alone or in combination with impacting bone grafting between January 2008 and May 2015. Preoperative and the latest follow-up clinical and radiographic scores were recorded and compared.Results: No patients were lost to follow up, and no patients underwent re-revision for loosening or any other reasons at the mean follow-up duration of 66 (range 55-105) months. We discovered 3 patients (3/15) with the early dislocation within the first year after the surgery and 2 patients (2/15) with delayed wound healing. The comparison between preoperative and the latest follow-up results showed the records of modified Harris Hip Score, University of California, Los Angeles activity score, Short Form 36, limb-length discrepancy and hip center of rotation were significantly improved.Conclusions: The application of double-cup technique alone or in combination with impacting bone grafting is an effective and reliable treatment option for Paprosky type Ⅲ acetabular defects without pelvic discontinuity.

scholarly journals Total hip arthroplasty after hip joint gunshot injury

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987311 ◽  
Author(s):  
Ozhan Pazarci ◽  
Seyran Kilinc ◽  
Yalkin Camurcu ◽  
Okay Bulut
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Short Form ◽  
Gunshot Injury ◽  
Harris Hip Score ◽  
Joint Region ◽  
Total Hip ◽  
The Mean

Background: Gunshot injury of the hip joint was reported to constitute 2–17% of all extremity firearm injuries. However, there are few studies in the literature related to gunshot injuries of the hip joint. The aim of the current study was to present the results of 10 cases treated with arthroplasty following a gunshot injury to the hip joint together with the recommended treatment algorithm. Methods: Patients with a previous medical history of hip joint region gunshot injury who underwent total hip arthroplasty were retrospectively evaluated. Those with incomplete medical records or who were lost to follow-up were excluded. Patients were classified according to the severity of the previous gunshot injury to the hip joint region. Harris hip score (HHS) and Short Form-12 quality of life score were the main outcome measurements. Postoperative complications encountered during follow-up were recorded. Results: The mean age of the patients at the time of surgery was 29.9 years. The mean preoperative HHS was 25.2 points and it was 65.8 at the final follow-up. Patients with bullet fragments in the hip joint, classified as group 1, had better HHS, whereas those with contaminated hip joint with intestinal flora, classified as group 3, had worst HHS. Conclusion: Hip arthroplasty after hip joint gunshot injury is a good treatment choice in young patients to reduce pain and regain functions. However, very high infection rates can be seen in patients with accompanying intestinal injury.

Direct anterior approach versus posterior approach in primary total hip replacement: comparison of minimum 2-year outcomes

2019 ◽  
pp. 112070001988193 ◽  
Author(s):  
David R Maldonado ◽  
Cynthia Kyin ◽  
Rafael Walker-Santiago ◽  
Philip J Rosinsky ◽  
Jacob Shapira ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Propensity Score ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Short Form ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Life Outcomes ◽  
Total Hip

Introduction: The direct anterior approach (DAA) has gained popularity in recent years for total hip arthroplasty (THA). Several authors reported significantly better early outcomes when compared to the posterior approach (PA). Nevertheless, controversy exists regarding longer-term benefits of the DAA. Methods: Data was prospectively collected and retrospectively reviewed for primary THAs conducted between July 2008 and July 2016. Patients who underwent DAA and PA with minimum 2-year follow-up for Harris Hip Score (HHS), Forgotten Joint Score-12 (FJS-12), Veteran RAND 12 Mental (VR-12 Mental), Veteran RAND 12 Physical (VR-12 Physical), 12-Item Short Form Survey Mental (SF-12 Mental), 12-Item Short Form Survey Physical (SF-12 Physical), visual analogue scale, and patient satisfaction were included. Propensity score matching was performed on the DAA and PA cohorts (1:1) based on the following variables: age, sex, body mass index, and laterality. Results: 205 DAA hips were satisfactorily matched to 205 PA hips. The DAA group had higher scores at final follow-up for VR-12 Mental ( p = 0.0145), VR-12 Physical ( p = 0.0236), SF-12 Mental ( p = 0.0393), and SF-12 Physical ( p = 0.0391). The DAA and PA groups had comparable HHS ( p = 0.0737) and FJS-12 ( p = 0.2900). Conclusions: Although the DAA and PA groups had different follow-up periods, both the DAA and PA groups reported favourable outcomes at minimum 2-year follow-up. While both groups achieved comparable scores for the majority of PROs including VAS and patient satisfaction, the DAA group achieved superior quality of life outcomes when compared with a propensity score matched group of PA surgeries.

The Modified Dunn Osteotomy for SCFE: Clinical and Radiographical Results at 3 Years Follow-Up

2017 ◽  
Vol 01 (04) ◽  
pp. 173-179
Author(s):  
Oliver Eberhardt ◽  
Thomas Wirth ◽  
Michele Surace ◽  
Francisco Fernandez ◽  
Nicola Guindani
Keyword(s):  
Short Form ◽  
Slipped Capital Femoral Epiphysis ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Slip Angle ◽  
Clinical Consequence ◽  
Retrospective Clinical Study ◽  
Outcome Scores ◽  
The Mean

AbstractThe modified Dunn osteotomy (MDO) gained popularity for the treatment of moderate-to-severe SCFE over the past years, even though both indications and outcomes are currently debated. The aim of this study is to evaluate results and complications of MDO consecutively performed at a single institution for severe slipped capital femoral epiphysis (SCFE) (slip angle ≥ 60°). In this retrospective clinical study, 23 hips (22 patients) were treated with MDO (2009–2015). SCFE was classified according to stability, slip angle, and as chronic/acute. Clinical assessment was performed with clinical examination and nonarthritic hip score (NAHS), modified Harris hip score (mHHS), and short form 12 (SF-12) outcome scores. Residual deformity, avascular necrosis (AVN), and osteoarthrosis (OA) were measured on plain radiographs. The mean slip angle was 70° (range 60–90); 17 of 23(74%) patients had a chronic SCFE, 6 of 23(26%) had acute-on-chronic SCFE, and 1 of 23(4%) had an unstable SCFE. The mean age at surgery was 14 years (range 11–17). At 3 years follow-up (range 1–7), 4 of 23(17%) patients had an AVN or AVN progression, one of these needing a hip arthroplasty. All the cases of AVN or AVN progression were diagnosed within the first year after surgery and there was an association between AVN and operation date (with more AVN among patients operated earlier). Out of 23 patients, 2 (9%) had an implant mobilization or failure and needed a revision surgery without further complications, 1 (4%) developed an asymptomatic heterotopic calcification, and another a partial implant removal without clinical consequence. At follow-up, the slip angle was 9° (range 1–15) and outcome scores were improved. MDO is a demanding technique which allows a near anatomical correction of SCFE and the overall complication rate is not negligible. With actual data, the authors only recommend this procedure for specialized centers, performed by experienced high-volume surgeons, and for severe displaced SCFE (≥50°). The long-term results must be closely monitored and compared with the natural history and other treatment options. This study was a Level IV retrospective study in a case series.

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