ABSTRACT
We measured poiyethylene wear radiographically in 85 cementless primary total hip arthroplasties by the modified technique of Livermore et al. All the patients were followed up for at least five years (mean, 6.31 years; range, 5 years-8 years 2 months). The mean extent of linear wear was 0.88mm (range, 0.0083-3.2839mm), and the mean rate of linear wear was 0.14mm/year(range, 0.00-0.47mm /year). The mean volumetric wear was 539.42mm (range, 5.11 2022.09mm), and the mean rate of volumetric wear was 87.69mm/year(range, 0.65-290.12mm/year). The polyethylene wear was correlated inversely with the patients age only, but was not influenced by weight or gender of the patients, Harris hip score, thickness of the polyethylene, the abduction angle of acetahular cup, or the duration of in situ implantation. Osteolysis developed in the femur of 34 hips(40%) and in the acetabulum of 11 hips(12.9%). Radiographic loosening was found in one case in the femur and none in the acetabul pm. The extent of polyethylene wear was significantly correlated with frequencies and sizes of the osteolytic lesion and was not directly associated with radiographic loosening of the prostheses. Calcar resorption was observed in 39 hips(45.9%) and was not associated with polyethylene wear. These results indicated that polyethylene wear of primary total hip arthroplasty should be considered one of major causes of osteolysis and has no direct relationship with prosthesis loosening. To reduce the extent of polyethylene wear, the material characteristics of polyethylene should be improved or new, durable, articulating materials should be researched.
Subject(s)
Humans , Acetabulum , Arthroplasty , Arthroplasty, Replacement, Hip , Femur , Hip , Osteolysis , Polyethylene , Prostheses and Implants , Prosthesis FailureABSTRACT
We evaluated the clinical and radiologic results of 48 cases (31 patients) who had rheumatoid arthritis of the knee joint and were managed with cementless total knee arthroplasty between November 1988 and December 1994. The mean follow-up period was 3.7 years (range, 2 to 7 years). The knee score of the Hospital for Special Surgery improved from an average of 44 points (range, 5 to 77 points) preoperatively to 83 points (range, 50 to 97 points) at the time of the most recent followup examination. In knee score, 85.4% of cases had excellent or good grade (over 75 points). The range of motion improved from an average of 77 degrees to an average of 103 degrees postoperatively. In tibiofemoral angle, 95.8% of cases were between valgus I degree and 10 degrees. The implants were inserted in an optimal position. Continuous radiolucency was not visible beneath any implant and loosening was not found. In one case, heterotopic ossification was removed to improve the range of motion. There was one case of patellar fracture during operation. Even in relatively poor bone quality in rheumatoid arthritis of the knee, the cementless total knee arthroplasty revealed good clinical and radiologic results.
Subject(s)
Arthritis, Rheumatoid , Arthroplasty , Follow-Up Studies , Knee Joint , Knee , Ossification, Heterotopic , Range of Motion, ArticularABSTRACT
Infection in primary total hip arthroplasty may cause catastrophic results and is the major reason for implant failure. The purpose of this study was to evaluate the utility of the hip joint fluid culture as a method of predicting the possibility of a hip joint infection by calculating the sensitivity, specificity and accuracy. We performed 628 primary total hip arthroplasty and aerobic and anaerobic bacterial cultures for hip joint fluid between January 1989 and June 1996. The hip joint fluid culture was routinely performed to evaluate the utility of the femoral head for bone banking. Thirty-two cases out of the 628 hips showed positive intraoperative culture and 596 cases showed negative intraoperative culture. The isolated organisms from 32 positive cultures were 11 for Staphylococcus aureus, eight for Staphylococcus coagulase negative, seven for Enterococcus, three for E.coli and one each for Enterobacter, Acinetobacter and Pseudomonas. Anaerobic culture was negative in all cases. In the positive intraoperative culture cases, none had delayed infection during the follow-up period. But in the negative intraoperative culture cases, one case had acute infection and two cases had delayed infection. In the case with acute infection, Staphylococcus aureus was isolated and on two cases with delayed infection, Enterococcus and Staphylococcus coagulase negative were isolated, respectively. All 32 positive culture cases were fa~lse positive and 595 negative culture cases were true negative and one negative culture case was fa~lse negative. The sensitivity of the hip joint culture was 0%, the specificity was 94.9% and the accuracy was 0%. The specificity of hip joint fluid culture in primary total hip arthroplasty was high, hut the sensitivity score was zero. Therefore, the hip joint fluid culture should not be used for a routine check of infection status in primary total hip arthroplasty. We recommend the hip joint fluid culture in revision arthroplasty or hips in which infection is clinically suspected.
Subject(s)
Acinetobacter , Arthroplasty , Arthroplasty, Replacement, Hip , Bone Banks , Coagulase , Enterobacter , Enterococcus , Follow-Up Studies , Head , Hip Joint , Hip , Pseudomonas , Sensitivity and Specificity , Staphylococcus , Staphylococcus aureusABSTRACT
We analyzed plain radiographs of 591 normal adult hips of various parameters to evaluate the radiological characteristics of the hip joint including the center-edge (CE) angle, acetabular angle, acetabular depth, acetabular roof obliquity and roof angle, and also to verify the rate of acetabular dysplasia. The CE angle was negatively correlated with acetabular angle and acetabular obliquity, but it was positively correlated with acetabular depth and roof angle. The rate of acetabular dysplasia (CE angle<20 degrees) was 1.8%. We concluded that the CE angle and acetabular angle are more useful parameters for the diagnosis of acetabular dysplasia because there was no significant difference with advancing age and gender, as well as relatively small standard deviations.
Subject(s)
Adult , Aged , Female , Humans , Male , Acetabulum/diagnostic imaging , Acetabulum/growth & development , Aging/physiology , Bone Diseases, Developmental/diagnostic imaging , Korea , Middle AgedABSTRACT
Modular designs of hip prostheses have become popular recently. Along with complications inherent in all hip arthroplasty systems, modular systems have the additional potential for dissociation of components. Five male patients underwent total hip arthroplasties, in which all of the acetabular components were Harris-Galante II porous acetabular cups. Many years after the operation, the polyethylene liners were dissociated without any previous trauma or dislocation of the femoral heads, these dissociations and dislodgements were managed with open reduction. This complication can be predicted from clinical symptoms and signs. Roentgenograms must be taken and carefully compared to previous roentgenograms. We postulated two causes for the dissociation. First, the polyethylene liner was not fixed securely within the acetabular metal shell at the time of operation. Second, the locking mechanism of the acetabular metal shell was not strong enough to firmly hold the polyethylene liner within the acetabular metal shell. It does warrant that certain precautions must be taken when implanting modular components. The locking mechanism of the harris-Galante II porous acetabular component is mechanically weak and fails easily, therefore its design must be improved in an attempt to prevent postoperative dissociation of the polyethylene liner.
Subject(s)
Adult , Humans , Male , Acetabulum , Hip Prosthesis/adverse effects , Metals , Middle Aged , Polyethylenes , Prosthesis Design , Prosthesis FailureABSTRACT
The modality of treatment for malignant or benign aggressive tumors in the shoulder includes radical or wide removal of the lesion, accompanied by chemotherapy or radiotherapy. With the introduction of chemotherapy, advance in surgical techniques, and improvements in radiographic imaging studies, the shoulder resection with reconstruction or replantation is a limb-sparing surgical option to be considered for bony and soft-tissue tumors in and around the shoulder, but amputation is used still if inevitable. We treated 16 tumors in or around the shoulder from June 1986 to August 1991: thirteen shoulder resections, two shoulder disarticulations, and one forequarter nine patients, reconstructed with a free fibular graft in two or with a allograft and myocutaneous flap in two. Chemotherapy or radiotherapy were followed if indicated. Function of the hand after the operations should be nearly normal. Mean rating for functional results was 69% (range 43-97%) by criteria of Enneking et al. During the follow-up of the mean 4 years and 1 month, a distant metastasis occurred in one case, leading to death and a local recurrence was noted in another one, indicating the forequarter amputation. Our experience indicates that shoulder resection with reconstruction or replantation can to be used for limb salvage in selected patient with tumors in or around the shoulder.