Sequelae of the Hip Joint Infection Treated with a Modern Alumina-on-Alumina THA

2007 ◽  
Vol 330-332 ◽  
pp. 1247-1250 ◽  
Author(s):  
Jeong Joon Yoo ◽  
Hee Joong Kim ◽  
Young Min Kim ◽  
Kang Sup Yoon ◽  
Kyung Hoi Koo ◽  
...  
Keyword(s):  
Hip Joint ◽  
Soft Tissues ◽  
Bone Ingrowth ◽  
Joint Infection ◽  
Young Patients ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Attractive Alternative ◽  
Reliable Solution

Total hip arthroplasty (THA) in patients with sequelae of the hip joint infection is a technically challenging procedure. In addition, the majority of such patients are less than fifty years old, so it has been reported that they have higher prevalence of complication and failure of component fixation. Alumina-on-alumina couplings are an attractive alternative and may offer a promising option for such young active patients. We analyzed 33 primary cementless alumina-onalumina THAs (PLASMACUP®SC-BiCONTACT® system incorporating BIOLOX® forte) that had been performed in patients who had sequelae of the hip joint infection. The average age of the patients was 37.8 years (range, 19-68 years) and 26 patients were younger than 50 years old. They were followed-up for more than 5 years (average, 74 months; range, 60-93 months). All hips had no recurrence of hip joint infection. The mean Harris hip score improved from 59.8 points to 93.5 points. All of the implants had radiographic evidence of a bone ingrowth and no radiological loosening was found. During the follow-up period, no cup or stem was revised and no periprosthetic osteolysis was observed. Nonunion of the osteotomized greater trochanter occurred in one hip, but no postoperative infection or ceramic failure was observed. The 5-year minimum follow-up clinical results of modern alumina-on-alumina THAs performed in patients with sequelae of the hip joint infection were encouraging with regard to osteolysis and implant stability. Our findings show that this alternative articulation offers a reliable solution for these young patients with long-standing anatomic abnormalities of the bone and soft tissues.

Noncemented Hip Replacement using a Conical Screw-In Cup and a Straight Press-Fit Stem. A Six to Eight-Year Clinical and Radiological follow-up Study

1998 ◽  
Vol 8 (4) ◽  
pp. 208-218 ◽  
Author(s):  
G. Köster ◽  
S. Leib ◽  
H.-G. Willert
Keyword(s):  
Hip Replacement ◽  
Clinical Symptoms ◽  
Bone Ingrowth ◽  
Control Period ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Radiographic Appearance ◽  
Press Fit ◽  
Bone Atrophy

Noncemented hip replacement using a conical titanium metal-backed screw-in cup to be implanted with precutting of the threads (TITAN-METAL-BACKED, AlloPro, Baar, Switzerland), in combination with a straight conical press-fit stem (Zweymüller-“hochgezogen”, AlloPro, Baar, Switzerland) was evaluated clinically and radiologically in 64 consecutive primary arthroplasties with an average 7.2 year follow-up. The clinical results compare very favourably with other cementless systems. The Harris hip score revealed an improvement from 45 to 84. The Merle d'Aubigné index showed an increase during the case-control period from 16 to 26. Thigh pain was practically absent except in one patient. A radiographic appearance of bone ingrowth around the acetabular component was found in nearly all cases. Only one cup migrated in a patient with a large cystic lesion in the acetabular roof, which was not grafted, with no other signs of loosening. Additionally this patient had chemotherapy. In all other cases there were no signs of cup migration, significant radiolucency, osteolysis or definite cup loosening. Around the stem, primary cortical contact was mainly located in the distal zones. Radiolucent lines appeared only proximally, with few exceptions, and were, except in four cases, always smaller than 2 mm. They were never circumferential and usually combined with sclerotic lines. Only one stem subsided, but the patient remained asymptomatic. There was a high incidence of proximal bone atrophy, distal cortical thickening and endosteal bone formation, not correlating with radiological loosening or clinical symptoms. Signs of femoral osteolysis were absent. No patient had to be revised.

scholarly journals Clinical results of the Metha short hip stem: a perspective for younger patients?

2013 ◽  
Vol 5 (4) ◽  
pp. 34 ◽  
Author(s):  
Fritz Thorey ◽  
Claudia Hoefer ◽  
Nima Abdi-Tabari ◽  
Matthias Lerch ◽  
Stefan Budde ◽  
...  
Keyword(s):  
Bone Ingrowth ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Femoral Revision ◽  
Term Survival ◽  
Younger Patients ◽  
The Mean ◽  
Short Stems

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

Mid-term Results of Hydroxyapatite-Coated Threaded Cup Implanted without Supplementary Supporting Screws

2009 ◽  
Vol 19 (2) ◽  
pp. 102-108 ◽  
Author(s):  
Stergios J. Trapotsis ◽  
George E. Petsatodis ◽  
Petros D. Antonarakos ◽  
Panagiotis K. Givissis ◽  
Anastasios G. Christodoulou ◽  
...  
Keyword(s):  
Second Generation ◽  
Bone Ingrowth ◽  
Harris Hip Score ◽  
Radiographic Examination ◽  
Acetabular Cup ◽  
Osteolytic Lesions ◽  
The Stability ◽  
Hip Arthroplasties ◽  
Mid Term Results

We retrospectively reviewed the clinical, radiographic, and survivorship outcomes in a series of 180 patients that underwent 204 primary Total Hip Arthroplasties with the use of a second generation threaded hydroxyapatite-coated acetabular cup that was implanted without any supplementary supporting screws. At an average follow-up period of 10.2 (range: 8–14) years, one hundred and seventy-four patients (198 cups) were available for assessment. All patients underwent detailed physical and radiographic examination; their functional status was evaluated according to the Harris Hip Score (HHS). Following their digitization, all radiographs were further reviewed in order to determine the existence of any migration of the acetabular cup. Osteolytic lesions, radiolucent lines or zones of increased bone density were also recorded and classified according to the system of DeLee & Charnley. The modified Engh's criteria were used in order to evaluate the stability of the prosthesis. The patients' mean HHS at their latest follow-up visit (97.24 points) was statistically significantly better than the preoperative mean score of 40.31 points (p<0.001). Radiographic analysis showed “stable with bone ingrowth” fixation (modified Engh's criteria) of all implants with no significant migration of the cup (mean cranial migration: 0.597 mm, mean horizontal migration: 0.607 mm, mean observed difference of the cup's inclination angle: 0.26 degrees). No areas of significant osteolysis were found. The cumulative survival rate of the implants was 97.05%. Our results suggest that second generation hydroxyapatite-coated threaded acetabular cups can be successfully implanted (and achieve excellent results) without the use of any supplementary supporting screws.

scholarly journals Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Jerzy Białecki ◽  
Maciej Kogut ◽  
Sławomir Chaberek ◽  
Paweł Bartosz ◽  
Marcin Obrębski ◽  
...  
Keyword(s):  
Bone Loss ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Two Stage ◽  
Retrospective Assessment ◽  
Severe Bone Loss ◽  
Paprosky Classification

The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

scholarly journals Arthroscopic treatment of internal snapping hip

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0017
Author(s):  
Gonzalo J. Magi ◽  
Juan Pablo Carucci ◽  
Sebastián Bergués
Keyword(s):  
Recurrence Rate ◽  
Clinical Results ◽  
Arthroscopic Treatment ◽  
Harris Hip Score ◽  
Iliopsoas Muscle ◽  
Average Score ◽  
Iliopsoas Tendon ◽  
Snapping Hip ◽  
Endoscopic Release

Introduction: Internal snapping hip syndrome (ISHS) is caused by the iliopsoas tendon snapping over either the iliopectineal ridge or the anterior femoral head. Excellent results are achieved only with activity modification, rest, and stretching the iliopsoas muscle. The literature favors iliopsoas tendon release if conservative therapy fails. There is little evidence about the gold standard of this condition. Objective: Describe clinical results, complicactions and recurrence rate of arthroscopic treatment of ISHS. Methods: We included all patients who failed conservative treatment and were treated with arthroscopy for ISHS between March 2012 and March 2018. Patients with less than 2 years of follow up and previous surgery on the hip were excluded. We performed Ilizariturri´s technique with a transcapsular endoscopic release in central compartment. We registered modified Harris hip score (MHHS), Hip outcome score activity of daily living (EHOSDL), patients satisfaction, recurrence rate and complications. Results: Eight patients were included. Average follow up was 36 months (range 24-60 months). MMHS improved from preoperative average score of 70 (range 62-72) to postoperative average of 93 (range 92 to 96). Average EHOSDL improvement was 30% (from 55% preoperative to 85% postoperative). All patients had excellent results. Average patient satisfaction was 8 (range 7-9). We had no recurrence or complications. Conclusion: Arthroscopic treatment of ISHS allowed us to obtain very good clinical results with no complications or recurrences with a minimum 2 years follow up.

Analysis of the Factors that Predispose to Wear with a 32mm Femoral Head at 5–15 Year follow-up: Clinical and Radiographic Assessment of the Harris-Galante cup at 5–15 Year follow-up

2003 ◽  
Vol 13 (2) ◽  
pp. 65-73
Author(s):  
M. Katsimihas ◽  
G. Katsimihas ◽  
M.B Lee ◽  
I. D. Learmonth
Keyword(s):  
Wear Rate ◽  
Polyethylene Wear ◽  
Young Patients ◽  
Harris Hip Score ◽  
Linear Wear ◽  
Outer Diameter ◽  
Linear Wear Rate ◽  
Total Hip Replacements ◽  
Hip Replacements

The clinical and radiographic features of 109 consecutive hybrid total hip replacements performed between 1986 and 1992 in 96 patients were retrospectively reviewed. A cementless Harris-Galante (HGP1) cup and a 32mm monobloc straight Muller stem were used in all cases. At an average 10.11 (range 5 to 15) years following surgery, the excellent durability of fixation of the Harris-Galante cup has been demonstrated with only one cup (0.9%) revised for periacetabular osteolysis and aseptic loosening. The prevalence of polyethylene wear was 27.4%. The mean annual linear wear rate was 0.063mm (range 0.00–0.53mm). There was a significantly increased wear of polyethylene inserts with an outer diameter < 52mm (<10mm polyethylene thickness), (ANOVA Test). However, there was no association found between acetabular liner wear and the following factors: underlying diagnosis, Charnley grade, age, weight and sex of the patient. The Harris Hip Score ranged between 5 and 54 pre-operatively and the average HHS was more than 80 post-operatively with more than 70% of patients pain-free. A liner with a thickness of 10mm or greater may prove beneficial in the prevention and reduction of wear rate particularly in young patients. It is recommended that all patients with this cup design, in which a polyethylene insert that is less than 10mm thick is coupled with a 32mm head, should continue to be regularly followed up.

scholarly journals Arthroscopic Lift, Drill, Fill and Fix (LDFF) for Talar OCDs Stands the Test of Time: Mean 5 year Follow-Up Results in 25 Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Kaj Lambers ◽  
Nienke Altink ◽  
Jari Dahmen ◽  
Sjoerd Stufkens ◽  
Gino Kerkhoffs
Keyword(s):  
Rating Scales ◽  
Bone Ingrowth ◽  
Distal Tibia ◽  
Clinical Results ◽  
Long Term Results ◽  
Arthroscopic Fixation ◽  
Pain Symptoms ◽  
Pain At Rest

Category: Ankle, Arthroscopy Introduction/Purpose: The purpose of this study was to describe the long-term clinical and radiological outcome of a new arthroscopic fixation technique for primary osteochondral talar defects: Lift, Drill, Fill and Fix (LDFF). Methods: Twenty-five patients underwent an arthroscopic LDFF surgery for osteochondral talar defects. Two of these patients underwent surgery on both ankles. During the LDFF technique, the OCD was identified after which an osteochondral flap was created and lifted (lift-phase). The bone flake of the OCD as well as the osteosclerotic area of the bed was drilled (drill phase). Cancellous bone was harvested from the distal tibia and transported into the defect until there was sufficient substantial filling (fill phase). Finally, the osteochondral flap was fixed with an absorbable biocompression screw (fix phase). The mean follow-up was 63 months (SD 9.2). Pre- and postoperative clinical assessment included the Foot and Ankle Outcome Score (FAOS) and the numeric rating scales (NRS) of pain at rest and during walking. Remodeling and bone ingrowth after LDFF were analyzed on computed tomography scans during follow-up at one year after the surgery. Results: All patients were available for final follow-up. At final follow-up, LDFF led to a significant improvement of the NRS of pain during rest and the NRS of pain during walking in all patients. The FAOS significantly improved on all 5 subscales: pain, symptoms, activities of daily living, sport and recreation and quality of life. The NRS of pain at rest significantly improved from 2.3 to 1.0 (p = 0.01), and pain with walking significantly improved from 5.7 to 1.6 (p < 0.001). In total 24 out of 25 patients, and 26 out of 27 ankles, showed remodeling and bone ingrowth on CT scans 1 year after the arthroscopic fixation procedure. No complications occurred. Conclusion: Arthroscopic LDFF of an osteochondral talar defect shows good long-term results at 5 year follow-up after surgery. Although the radiological results at 1-year follow-up and the long-term clinical results are encouraging, more patients and long- term radiological follow-up is necessary in order to identify prognostic factors on outcomes.

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 Sports Activity and Patient-Related Outcomes after Cementless Total Hip Arthroplasty in Patients Younger than 40 Years

2021 ◽  
Vol 10 (20) ◽  
pp. 4644
Author(s):  
Luis Navas ◽  
Jasmin Faller ◽  
Sebastian Schmidt ◽  
Marcus Streit ◽  
Matthias Hauschild ◽  
...  
Keyword(s):  
Los Angeles ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Young Patients ◽  
Activity Level ◽  
Harris Hip Score ◽  
Return To Sports ◽  
Sports Activity ◽  
Total Hip

Background: The management of degenerative hip diseases in young patients remains a challenge. Despite the improvement of hip-preserving procedures, total hip arthroplasty (THA) may be required in some instances. In addition, young patients undergoing THA have high expectations concerning their postoperative level of activity. Purpose: (1) to define the sports activity level and the return to sports after THA, (2) to describe the modification or initiation of new sports disciplines, and (3) to report the clinically meaningful outcomes after THA in patients younger than 40 years. Methods: A total of 36 patients (40 hips) were prospectively analyzed at a midterm follow-up of 3.9 years. The modified Harris Hip Score (mHHS); the Visual Analog Scale (VAS) for pain; the University of California, Los Angeles (UCLA) activity scale; and sports and recreational activity levels were assessed via questionnaire. The minimal clinically important difference (MCID) was determined by calculating half of the standard deviation, and the substantial clinical benefit (SCB) as well as patient acceptable symptomatic state (PASS), were calculated by the anchor method for the mHHS. Results: At the final follow-up, there was a significant improvement in mHHS (34.1 to 92.6; p < 0.0001), UCLA (3.2 to 7.6; p < 0.0001), and VAS for pain (8 to 1; p < 0.0001). More patients were active in sports at follow-up than before surgery (44% to 92%, p < 0.0001). In addition, the duration and frequency of sports activities showed a significant increase (p < 0.0001). The MCID, SCB and PASS for mHHS were 89% and 58%, respectively. No revision surgery had to be performed. Conclusion: This study showed that a large proportion of patients under 40 years of age who underwent THA increased their physical activity. Eighty-six percent of the patients were highly active, with a UCLA score ≥ 7. Furthermore, the reported MCID, SCB, and PASS for mHHS were achieved by more than 80% of patients.

scholarly journals Debridement, antibiotics, irrigation, and retention of the prosthesis with antibiotic-impregnated calcium hydroxyapatite in periprosthetic hip joint infection

2021 ◽  
Author(s):  
Hiroki Wakabayashi ◽  
Masahiro Hasegawa ◽  
Yohei Naito ◽  
Shine Tone ◽  
Akihiro Sudo
Keyword(s):  
Joint Infection ◽  
Calcium Hydroxyapatite ◽  
Clinical Results ◽  
Prosthetic Joint ◽  
Component Revision ◽  
Rate Of Success ◽  
Lost To Follow Up ◽  
Surrounding Bone ◽  
Antibiotic Delivery

Abstract Background We have developed antibiotic-impregnated calcium hydroxyapatite (CHA) as a novel antibiotic delivery system. Here, we assessed the clinical results of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) with antibiotic-impregnated CHA for the treatment of prosthetic joint-associated infection (PJI) after total hip arthroplasty (THA). Methods Twelve patients (13 hips) treated with DAIR for PJI after THA at our institution between 1997 and 2017 were retrospectively evaluated. The study group included four men (five hips) and eight women, with an average age of 66.1 (range, 56–90) years. Four patients (five hips) had symptoms of infection within less than 3 weeks; however, eight patients had symptoms of infection over 3 weeks. All patients received DAIR with antibiotic-impregnated CHA in the surrounding bone. In one patient, the cup component revision was performed with one-stage re-implantation because of loosening, but the stem component was retained. In nine patients (10 hips), vancomycin hydrochloride was impregnated in the CHA. Results The average duration of follow-up was 8.3 (range, 2.9–18.6) years. No patients were lost to follow-up. Four patients included in this study died of other causes, with an average follow-up of 6.7 (range, 4.0–12.5) years. Intra-operative cultures were positive in 12 hips. Ten of 12 patients (11 of 13 hips) were successfully treated, and no signs of infection were observed at the latest follow-up. In two of 12 patients (two of 13 hips) for whom treatment failed, infection was successfully treated with two-stage re-implantation. Both patients had diabetes mellitus and symptoms of infection over 3 weeks. Eighty-five percent of patients were successfully treated by DAIR with antibiotic-impregnated CHA. No complications were observed with this antibiotic-impregnated CHA. Conclusions DAIR treatment with antibiotic-impregnated CHA produce a higher rate of success in patients with PJI after THA.

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