A comparative study between cemented and un-cemented hemiarthroplasty management of fracture neck of femur in elderly patients

Background: Cementation of prosthesis achieves a good initial fix in an osteoporotic bone, however, arthroplasty using a cemented implant may be associated with increased mortality compared with an arthroplasty using an uncemented implant, as it has the risk of bone marrow and fat embolization with resulting intraoperative hypotension and increased incidence of deep vein thrombosis. This aim of the study wasto evaluate the complications, morbidity, and mortality rates associated with each of the procedures and study the radiographic changes, recovery to physical independence and advantages encountered in each of the procedures, and achieve stable fixation and early mobilization. Methods: Pre-operative and a postoperative assessment was done on patients who underwent Cemented and Uncemented for femoral neck fractures. After the procedure, the frequent follow-up was carried out. Clinical evaluation was done for limblength discrepancy, thigh pain, rotation of the limb, gait pattern, and range of movements.Results:The incidence of postoperative complications was higher in the uncemented group than in the cemented group. The cemented group showed significantly betterresults than the uncemented group regarding walking distance. There was a statistically significant difference between the two groups regarding Harris hip score.Conclusions: For elderly patients with a displaced femoral neck fracture a cemented hemiarthroplasty is favorable compared to an uncemented stem. There was no significant overall difference in mortality rate, cardiovascular and cerebrovascular complications, general complications, local complications, and reoperation rate.

Revisión acetabular primaria: incidencia y mecanismos de utilización del injerto óseo / Primary Acetabular Revision: Incidence and Mechanisms of Bone Graft Use

Introducción: El recambio acetabular primario puede llegar a ser una intervención de gran complejidad en dependencia del defecto óseo existente. Las lesiones pueden ser segmentarias, cavitarias o combinadas. Este último patrón es el que se observa con mayor frecuencia en pérdidas óseas periprotésicas por aflojamiento aséptico. Objetivos: Mostrar la evolución de la cirugía de recambio en la artroplastia de cadera, y orientar al cirujano en la toma de decisiones de modo individualizado, para evitar las complicaciones. Método: Se realizó la investigación basada en el tema de estudio, mediante la revisión de libros de texto de la especialidad, artículos científicos publicados en diferentes bases de datos informáticas: Pubmed/MEDLINE, SciELO, BVS, Scopus, Ebsco, Google Scholar, Cochrane, así como otras consultas en bibliotecas médicas. Análisis de la información: Las prioridades en la planificación de la reconstrucción se establecen para proporcionar un implante estable, restaurar la masa ósea y optimizar la biomecánica de la cadera, aunque son los hallazgos intraoperatorios los que definitivamente indicarán el tipo de intervención a seguir. Las exigencias funcionales de los pacientes y las comorbilidades deben ser consideradas, así como el coste-efectividad de la reconstrucción planificada. Conclusiones: La artroplastia total de cadera ha demostrado mejorar significativamente la calidad de vida en pacientes, con una baja tasa de complicaciones. Para prevenir el aflojamiento aséptico es necesario ser cuidadosos en la técnica de colocación de los componentes protésicos y utilizar el tipo de material más adecuado a la edad, demanda funcional y reserva ósea de cada paciente(AU)

Introduction: Primary acetabular replacement can become a highly complex intervention depending on the existing bone defect. Lesions can be segmental, cavitary, or combined. This last pattern is the one most frequently observed in periprosthetic bone loss due to aseptic loosening. Objectives: To show the evolution of replacement surgery in hip arthroplasty, and to guide the surgeon in making individualized decisions, to avoid complications. Method: A research was carried out on the study topic, by reviewing specialty textbooks, scientific articles published in different databases such as Pubmed/ MEDLINE, SciELO, BVS, Scopus, Ebsco, Google Scholar, Cochrane, as well as other inquiries in medical libraries. Information analysis: Reconstruction planning priorities are established to provide a stable implant, restore bone mass, and optimize hip biomechanics, although it is the intraoperative findings that will definitely indicate the type of intervention to follow. The functional demands of the patients and the comorbidities must be considered, as well as the cost-effectiveness of the planned reconstruction. Conclusions: Total hip arthroplasty has been shown to significantly improve the quality of life in patients, with low rate of complications. To prevent aseptic loosening, it is necessary to be careful in the technique of placement of the prosthetic components and to use the type of material most appropriate to the age, functional demand and bone reserve of each patient(AU)

Historia y desarrollo de la artroplastía de cadera: una visión de sus aciertos, fallas y enseñanzas. (Segunda parte) / History and development of hip arthroplasty: a vision of its successes, failures and teachings. (Part two)

Resumen: Ésta es la segunda de dos partes de la Historia y Desarrollo de la Artroplastía de Cadera. En esta parte se hace una revisión histórica del desarrollo de la artroplastía contemporánea de la cadera, dando continuidad a la primera, donde se analizaron los cuatro primeros períodos. Esta quinta etapa corresponde a la revisión de su última etapa que comprende desde 1970 hasta el momento actual. También se hacen comentarios acerca de nuestras actitudes en el presente y la ruta que vislumbramos hacia el futuro.

Abstract: This is the second of two parts of the history and development of hip arthroplasty. In this part, a historical review of the development of contemporary hip alloarthroplasty is made. The purpose of this part is to give continuity to the first one where the first four periods were analyzed. This fifth part corresponds to the revision of its last stage that includes from 1970 to the present time. Comments are also made about our attitudes in the present and the route we envision towards the future.

Assessment of Functional Outcome between Cemented and Uncemented Total Hip Replacement: A Comparative Study

Introduction: Total hip arthroplasty (THA) or total hipreplacement is the most effective, economical surgicalprocedure for femoral neck fractures or hip joint diseasesamong elderly patients. The main purpose is to reduce painas well as reduce joint function. Hence, the aim of the presentstudy was to assess the functional outcome between cementedand uncemented total hip arthroplasty.Material and Methods: The present study was anobservational study which was hospital‑based conductedamong 140 cases divided into two groups with 70 cases ineach group. All the patients of 50–80 years in which THR wasindicated were taken in this study. Patients with neurovasculardeficit and active infection were excluded from this study.In Group 1, cemented THR was done while in Group 2uncemented THR was done. Pain was evaluated using Harriship score.Results: In cemented group, majority of the cases wereavascular necrosis 24(34%) followed by fracture neck offemur 10 (14%), fracture-dislocation of hip 6 (8%) and inuncemented group, maximum cases were avascular necrosis36 (51%) followed by fracture neck of femur 21 (30%) andfracture-dislocation of hip 14 (20%). mean difference amongcemented group was 82.41±7.2 at 6 weeks followed by81.31±7.5 in uncemented group and this difference was foundto be statistically significant at p value 0.001.Conclusion: Cemented implants showed better functionaloutcomes than uncemented in total hip arthroplasty at 6weeks, 3 months and at 6 months.

Evaluation of Outcome of Non-cemented Total Hip Arthroplasty in Avascular Necrosis of Femoral Head in 25 to 40 Years Age Group

Background: The proper treatment of Avascular Necrosis(AVN) of Femoral Head has become a major challengeworldwide in younger age group as they are main effectiveforce of family and society. The patients who are young andsuffer from AVN of femoral head become immovable, worklessand unproductive. Thus they become burden to family andsociety. The Hip Replacement is a better way of treatment forthis type of patients, making them pain free and movable andimproving their everyday activity.Objective: To evaluate outcome of non-cemented total hiparthroplasty in avascular necrosis of femoral head among theactive younger age group of patients.Method: This was a prospective observational study of 30patients and all the patients had done non-cemented total hiparthroplasty (THA) through lateral approach at the NationalInstitute of Traumatology and Orthopaedic Rehabilitation(NITOR), Dhaka.Results: Mean age of the patients was 32 ±5.12 years,patients were diagnosed as Avascular Necrosis of FemoralHead in which 63% were affected at Right sided Hip 37%patients were at Left sided hip. Final outcome after six monthsof operation evaluated with Modified Harris Hip Score revealedthat, there was significant (p<0.005) improvement in functionalability of the patients after THA. Among the 30 studied cases,21 (70%) patients carried slight pain and 63.4% of them wereable to walk unlimitedly. Outcome of supporting functionanalysis indicated 76.7% patients could walk and climb stairswithout support and 100% patients could sit on chair, 66.7%patients among them could walk without limping. On clinicalassessment of deformity, range of motion before and afteroperation, significantly resolved the deformities and increasedthe range of motion (2100-2300). After evaluation with ModifiedHarris Hip Score showed that 60% excellent (HHS 90-100),30% good (HHS 80-89), 10% had fair (HHS 90-100) outcome.Conclusion: The progressive study of the patients of THAshowed that non-cemented THA has resulted in a better wayamong the younger age group of people

Caracterización de la rehabilitación de implantes protésicos en la Clínica Estomatológica Universitaria de Bayamo, Cuba / Dental implants rehabilitation at the Clinical Dentistry Academy of Bayamo, Cuba

RESUMEN Introducción: la rehabilitación protésica sobre implantes constituye uno de los tratamientos más novedosos aplicados en Granma y en Cuba. Su caracterización contribuye a elevar la calidad del servicio. Objetivo: caracterizar la rehabilitación con implantes dentarios en la Clínica Universitaria de Especialidades Estomatológicas de Bayamo. Método: se realizó un estudio descriptivo-transversal en 144 pacientes que recibieron rehabilitación mediante implantes dentales en la Clínica Universitaria de Especialidades Estomatológicas Manuel Cedeño, de Bayamo, provincia de Granma, durante febrero de 2014 a diciembre de 2017. Resultados: en los pacientes atendidos con implantes predominaron las mujeres, con el 66,67%, y el grupo de edad de 38-47 años (32,64%). Se colocaron mayor cantidad de implantes en el maxilar que en la mandíbula (71,28-28,72%). Los implantes MIS (65,38%) superan en número a los Leader (34,62%). El tipo de tratamiento que más se realizó en el maxilar fue la prótesis unitaria cementada, y en la mandíbula, la prótesis unitaria atornillada. Se logró éxito terapéutico en la mayoría de nuestros pacientes, tanto con la carga inmediata como con la diferida en ambas marcas comerciales. La única complicación en nuestros pacientes radicó en la falla del proceso de osteointegración. Conclusiones: la rehabilitación sobre implantes dentales garantiza el éxito estético y funcional en la mayoría de los pacientes tratados.

ABSTRACT Introduction: dental implants rehabilitation is one of the most novel treatments applied in Granma, Cuba. Its characterization favors service quality. Objective: to characterize dental implants rehabilitation at Clinical Dentistry Academy of Bayamo, Cuba from February 2014 to December 2017. Method: a descriptive and transversal study was carried out, for characterizing dental implants rehabilitation patients, attended at Manuel Cedeño Clinical Dentstry Academy, in Bayamo province, Granma, Cuba, from February 2014 to December 2017. Universe was formed by 144 patients, who attended the stomatological prosthesis consultation within the same period and received dental implants rehabilitation. Results: age group from 38 to 47 (32.64) was the most representative, in which female patients prevailed (66.67%). Implants were placed in the maxilla rather than the mandible up to (71,28-28,72%). The MIS implants (65,38%) outnumbered the Leader (34,62%). Most performed maxilla treatments were the unitary cemented prosthesis and the screwed unitary prosthesis in the jaw. We succeeded in most of our patients, with immediate or delayed loading in both commercial brands. Osseointegration process failure was the only complication. Conclusions: dental implants rehabilitation process, guarantees aesthetic and functional success in most of the patients.

Non-cemented modular prosthetic reconstruction for bone defect after tumor resection in lower extremities / 中国修复重建外科杂志

Objective: To report the preliminary clinical results and analyze the prognostic factors of prosthetic failures with non-cemented modular prosthetic reconstruction after tumor resection in lower extremities. Methods: A clinical data of 150 patients with lower extremity tumors treated with MEGASYSTEM-C non-cemented modular prosthetic reconstruction between October 2011 and September 2016 was retrospectively analyzed. There were 88 males and 62 females, aged from 12 to 81 years, with a median age of 24 years. According to World Health Organization (WHO) classification of bone tumors, 120 cases were primary malignant tumors, 27 cases were intermediate tumors, and 3 cases were metastatic tumors. Among them, 134 cases underwent primary operation and 16 cases underwent reoperation after recurrence. Eighty-seven patients with malignant tumors received chemotherapy before and after operation, and no patient received local radiotherapy during perioperative period. Proximal femur was reconstructed in 32 cases, distal femur in 83 cases, and proximal tibia in 35 cases. The postoperative follow-up time, the results of oncology (survival status and tumor recurrence), and prosthesis failure (prosthesis survival rate, reasons for failure, treatment plan after failure) were recorded. The reason of the prosthesis failure was classified into 5 types according to the classification defined by Henderson et al. Kaplan-Meier survival analysis and Log-Rank test were used to analyze patient and prosthesis survival. Lower extremity function was assessed by using the Musculoskeletal Tumor Society (MSTS) scoring system and MSTS scores were compared for patients with different reconstruction sites. Results: All patients were followed up 5-84 months, the median follow-up time was 39 months. During the follow-up period, there were 116 cases of tumor-free survival, 10 cases of tumor-bearing survival, and 24 died of lung metastasis or multiple metastases. The 3-year and 5-year survival rates of 120 patients with primary malignant tumors were 83.1% and 76.6%. There was no significant difference in survival rate between different reconstruction sites ( P=0.851). Seven cases (4.7%) had local recurrence at 7-21 months after operation. The 3-year and 5-year survival rates of the prosthesis in 150 patients were 94.4% and 92.5%. There was no significant difference in survival rate between different reconstruction sites ( P=0.765). There were 26 failures in 24 patients (16.0%) during the follow-up period. There were 9 cases of type 1 failure, 1 case of type 2 failure, 3 cases of type 3 failure, 5 cases of type 4 failure, and 8 cases of type 5 failure. At last follow-up, 120 of the 126 patients survived without prosthetic failure. Except that the influence of different parts of prosthesis on the incidence of type 4 failure ( P=0.029), the influence of chemotherapy on the incidence of type 5 failure ( P=0.002) were significant, the influence of other types of failure on different reconstructed parts of prosthesis, initial operation, and perioperative chemotherapy had no significant difference ( P>0.05). There were 5 cases of amputation (4 cases of type 5 failure, 1 case of type 4 failure), 3 cases of prosthesis removal (1 case of type 2 failure, 1 case of type 3 failure, 1 case of type 4 failure), 3 cases of revision while keeping the original prosthesis (2 cases of type 1 failure, 1 case of type 5 failure). The overall MSTS score was 24±3. The MSTS scores were 24±3, 25±3, and 23±3 in patients whose reconstruction sites located in proximal femur, distal femur, and proximal tibia, respectively, showing no significant difference ( F=3.014, P=0.052). Conclusion: The short-term follow-up showed a lower incidence of complications and good function for MEGASYSTEM-C non-cement modular prosthesis system in treatment of bone defects after lower limb tumor resection. The main factors affecting the early survival of prosthesis were tumor progression and infection.

Investigation of contact dermatitis caused by hard metal dust / 中华劳动卫生职业病杂志

Objective@#To investigate the incidence of contact dermatitis among workers in cemented carbide production enterprises.@*Methods@#From October 1997 to October 2017, an occupational epidemiological survey was conducted on a large-scale cemented carbide production enterprise, and occupational health examinations were conducted for employees. 152 people were exposed to hard metal dust (hard metal raw material dust and alloy dust) . The employees in the work group were contact groups, and 142 employees in the non-dusting operation of the company were in the control group. A detailed retrospective survey of hard metal production workers with contact dermatitis history in the two groups was conducted to analyze the risk factors of contact dermatitis exposure to hard metal dust.@*Results@#The incidence of allergic diseases in the exposed group was significantly higher than that in the control group. The difference was statistically significant (χ2=23.793, P<0.05) . The incidence of contact dermatitis in the exposed group was significantly higher than that in the control group. The difference was statistically significant (χ2=24.659, P<0.05) ; the changes of contact dermatitis in the contact group were mainly allergic contact dermatitis, and some showed irritative contact dermatitis; the operator had respiratory symptoms (including work-related nasal congestion, cough, wheezing) , difficulty breathing may be the influencing factors of contact dermatitis (RR=2.60, 95%CI: 1.10-6.20, P<0.05) .@*Conclusion@#Hard metal alloy enterprises are exposed to hard metal dust. The incidence of contact dermatitis is high in workers, and the occurrence of contact dermatitis may be associated with those with respiratory symptoms.

Long-term Outcomes of Cemented Total Hip Arthroplasty in Patients with Ankylosing Spondylitis at a Minimum Follow-up of 10 Years / 대한고관절학회지

PURPOSE: This study was performed to evaluate long-term clinical and radiologic outcomes of cemented total hip arthroplasty in patients with ankylosing spondylitis. MATERIALS AND METHODS: A retrospective study of 12 patients (16 cases) diagnosed with ankylosing spondylitis undergoing total hip arthroplasty with cemented femoral stem from November 2002 to January 2006 with a minimum follow up of 10 years. Clinical outcomes were assessed using Harris Hip Scores and measures of pain and range of motion. Radiologic outcomes were assessed with serial plain X-ray. Fixation and stability of implant, enthesopathy of ischium and development of heterotopic ossification were also evaluated. RESULTS: Mean Harris Hip Scores significantly improved from pre-operative levels (58 points; range, 39–81 points) to post-operative (92 points; range, 68–100 points). Mean flexion contracture levels decreased from preoperative (13°) to post-operative (5°), and mean post-operative range of motion improved 106° compared to preoperative levels. No newly developed osteolysis lesions or implant loosening were observed in last follow up X-rays. One heterotopic ossification and one greater trochanter fracture were observed. Greater trochanter fracture was treated conservatively, and was resulted in bony union. No patients underwent revisions. CONCLUSION: This study revealed positive long-term clinical and radiologic outcomes following total hip arthroplasty with cemented femoral stems in patients with ankylosing spondylitis patients.

Acetabular Subchondral Bone Decortication and Its Role in the Outcome of Cemented Total Hip Replacement in Young Patients / 대한고관절학회지

PURPOSE: Long-term fixation of cemented acetabular components can be problematic in younger active patients. Our technique is put forward to improve outcomes and maximize implant survivorship in this particular patient population. MATERIALS AND METHODS: We report on a cohort of young adult patients (less than 55 years old) with cemented total hip replacement (THR) using a novel technique in preparing and cementing the acetabulum with a minimum follow-up of 10 years (mean follow-up, 14 years). Retrospectively collected data on clinical and radiological outcomes were reviewed. RESULTS: Sixty-five THRs were performed with the minimum study follow-up period. Average age for patients was 44 years old (range, 19–55 years). The mean Hip Disability and Osteoarthritis Outcome Score for patients at final appointment was 92.7. Radiographs taken at an average of 14 years after operation showed 63 of 65 hips showed no evidence of any radiological loosening. Cup survivorship was 100% at the end of the study period. CONCLUSION: Our technique of preparing the acetabulum in combination with cement fixation is reproducible with excellent results in a cohort of patients prone to early aseptic loosening of the acetabular component.

A retrospective study on the application of cemented polyethylene liner technique in hip revision / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of cemented polyethylene liner technique in hip revision. Methods: Based on inclusion criteria, the clinical data of 26 patients who were undergone hip revision between January 2011 and December 2013, were retrospectively reviewed. Among them, 14 cases were treated with isolated liner exchange (group A) and 12 cases were treated with cemented polyethylene liner technique (group B). There was no significant difference in gender, age, the time from primary total hip arthroplasty to revision, and the preoperative Harris score between 2 groups ( P>0.05). The post-operative Harris score and complications were compared between 2 groups, and X-ray findings of the hip joint were recorded to review the position of hip components. Results: All patients were followed up 4.4-6.4 years (mean, 5.4 years). Except for two femoral fractures during the revision (1 in each group), there was no other complication in 2 groups. The hip pain relieved and the lame gait corrected in 2 groups. The hip's function of 2 groups improved gradually after operation, with a better Harris score at 3 months and the best at the last follow-up, compared with preoperative scores ( P0.05). X-ray films showed no dislocation, aseptic loosening, and other interface related complication. Conclusion: For the cases without the chance to do change liner, cemented polyethylene liner technique has a good effectiveness. But restrict patient selection should be considered before hip revision.

Clinical effect of cemented long stem prosthesis and memory alloy embracing fixator in the treatment of type B2 periprosthetic fractures / 中国综合临床

Objective To study the clinical effect of cemented long stem prosthesis and memory alloy embracing fixator in the treatment of type B2 periprosthetic fractures.Methods Fom April 2014 to April 2016,102 cases of peripheral B2 periprosthetic fractures patients were selected and randomly divided into bone cement long stem prosthesis revision surgery(group A) and revision of cemented long stem prosthesis combined with memory alloy embracing fixator(group B),each group with 51 cases.Clinical efficacy was evaluated according to Beals and Tower criteria,used Harris score to evaluate the hip the joint function,used the Visual Analogue Scale(VAS) score to evaluate the pain,after follow-up of 40 months,the clinical curative effect of 2 groups of patients,fracture healing time,complications and Harris score and VAS score were observed.Results The excellent rate of B group was significantly higher than that of A group,with statistical significance(90.2% vs.72.5%,χ2=5.239,P<0.05).Fracture healing time of group B was shorter than that of group A,with statistically significant ((10.2±2.5) weeks vs.(21.3±8.9) weeks,t=8.575,P<0.05).Harris the score of group B was higher than the group A,with statistically significant((89.9±13.5) points vs.(71.2±18.9) points,t=5.750,P<0.05).VAS score of group B was significantly lower than the group A,with statistically significant((1.23±0.25) points vs.(5.98±1.08) points,t=30.600,P<0.05).There were no complications such as infection,nonunion,loss of reduction and loosening of internal fixation in the 2 groups.Conclusion Revision of cemented long stem prosthesis combined with memory alloy embracing fixator is an ideal methods for the treatment of type B2 periprosthetic femoral fractures,which provides a good initial stability for fracture healing.

Total hip arthroplasty in octogenarians: A local retrospective case series

@#<p>With improving healthcare, the number of Filipino octogenarians is increasing. Projected population of octogenarians as reported by the Philippine National Statistics Office will increase by 28% to 3,227,253 by year 2040 (from 2015: 912,817). This is a multicenter retrospective case series involving 24 patients (1 patient with surgery on 2 hips), with an average age at the time of surgery of 82 years old (range: 80-88 years old) who underwent total hip arthroplasty during the period 2007-2016. Indications for total hip arthroplasty included 12 cases of degenerative osteoarthritis, 8 cases of displaced femoral neck fractures, 4 cases of untreated femoral neck fractures, and 1 case of subtrochanteric fracture with hip arthritis. Of the 24 patients, 21 were females and 3 were males. Of the 25 hips, 19 were treated with cemented total hip, 5 with hybrid implants, and 1 with calcar replacing cemented femoral stem. Average follow-up was 36 months (range: 6-87 months). All patients were able to ambulate and return to premorbid function. There were no intraoperative or postoperative complications encountered. Revision rate was zero percent as of last follow-up. Clinical/functional results were assessed using the Harris Hip Scoring system. The results of this study affirm that primary total hip arthroplasty is a viable treatment option for active octogenarians with end-stage arthritis and hip fractures.</p>

Vástagos cementados en recambios de prótesis total de rodilla en pacientes mayores de 75 años. Análisis clínico y radiológico / Cemented stems in revision total knee arthroplasty on patients older than 75 y/o. Clinical and radiological analysis

Resumen: Antecedentes: Analizar la evolución funcional y radiológica de los pacientes mayores de 75 años intervenidos de cirugía de revisión de rodilla con vástagos cementados. Material y métodos: Mediante análisis retrospectivo, hemos revisado a 27 individuos mayores de 75 años a quienes se les ha implantado una prótesis total de rodilla de revisión con vástagos cementados en nuestro centro entre 2008-2014. Durante el seguimiento, se realizó un análisis clínico mediante la escala Knee Society Score y de movilidad de la rodilla, un análisis radiológico de la estabilidad de los implantes por medio de la escala radiológica modificada de la Knee Society, el registro de las complicaciones y la supervivencia protésica. Resultados: Con una edad media de los participantes de 82.6 ± 4.4 años y un seguimiento medio de 43 ± 14.4 meses, no hemos observado ningún caso de aflojamiento mecánico de los componentes. La valoración funcional ha sido de 115 ± 32 puntos en la escala total KSS, de los cuales 77 ± 17.5 puntos pertenecen al KSS rodilla y 42 ± 24 puntos al KSS función. El rango medio de movilidad fue de 98o ± 17. A nivel radiológico, 18 sujetos mostraron radiolucencias periprotésicas; según los criterios de la escala radiológica de la Knee Society, solo tres requirieron seguimiento clínico-radiológico estricto. Conclusiones: La cementación de los vástagos en prótesis totales de rodilla de revisión se trata de un buen sistema de fijación en personas mayores de 75 años, con elevada supervivencia del implante, buen resultado funcional y bajo porcentaje de aflojamiento radiológico a pesar de la aparición frecuente de radiolucencias.

Abstract: Background: The purpose of this study was to analyze the clinical and radiological evolution of the total knee revision arthroplasty with cemented stems in patients over 75 years. Material and methods: A retrospective analysis was performed in all the subjects who underwent revision of total knee arthroplasty with cemented stems between 2008 and 2014 in our center. Twenty-seven individuals over 75 years met the inclusion criteria. We assessed the Knee Society Score and range of motion for clinical outcome. We evaluated the implant stability with radiographs through radiolucent lines according to the modified radiological scale of the Knee Society; we registered the complications and prosthetic survival. Results: With an average age of our participants of 82.6 ± 4.4 years and a follow-up of 43 ± 14.4 months, we did not find any mechanical failure of the components. The functional average score was 115 ± 32 in the total KSS, of which 77 ± 17.5 points were in the KSS knee and 42 ± 24 in the KSS function. The average range of motion was 98o ± 17. Radiologically, 18 patients presented radiolucent lines, but only three needed follow-up using the modified Knee Society radiographic scoring system. Conclusions: The results revealed that cemented stems are a good method for fixation in the revision of total knee arthroplasty in people over 75 years. We observed acceptable medium-term clinical results with a low risk of radiological failure, despite the high number of radiolucencies.

Cemented hemiarthroplasty in traumatic displaced femoral neck fractures and deep vein thrombosis: is there really a link?

<p><b>INTRODUCTION</b>Traumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty.</p><p><b>METHODS</b>The data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared.</p><p><b>RESULTS</b>There were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53-99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used.</p><p><b>CONCLUSION</b>Cemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of patients.</p>

Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem / 대한고관절학회지

PURPOSE: To compare and analyze clinical and radiologic outcomes of cemented versus cementless bipolar hemiarthroplasty for treatment of femur neck fractures. MATERIALS AND METHODS: A total of 180 patients aged 65 years and over older who underwent bipolar hemiarthroplasty for treatment of displaced femur neck fractures (Garden stage III, IV) from March 2009 to February 2014 were included in this study. Among the 180 patients, 115 were treated with cemented stems and 65 patients with cementless stems. Clinical outcomes assessed were: i) postoperative ambulatory status, ii) inguinal and thigh pain, and iii) complications. The radiologic outcome was femoral stem subsidence measured using postoperative simple X-ray. RESULTS: The cemented group had significantly lower occurrence of complications (postoperative infection, P=0.04) compared to the cementless group. There was no significant difference in postoperative ambulatory status, inguinal and thigh pain, and femoral stem subsidence. CONCLUSION: For patients undergoing bipolar hemiarthroplasty, other than complications, there was no statistically significant difference in clinical or radiologic outcomes in our study. Selective use of cemented stem in bipolar hemiarthroplasty may be a desirable treatment method for patients with poor bone quality and higher risk of infections.

Bipolar Hemiarthroplasty for Unstable Intertrochanteric Femur Fracture in Patients over the Age of 80 Years: Comparative Analysis between Cementless and Cemented Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the effectiveness of bipolar hemiarthroplasty for unstable intertrochanteric fracture in patients over the age of 80 years. MATERIALS AND METHODS: Sixty-two patients (62 cases) who had unstable comminuted intertrochanteric fractures between January 2007 and February 2012 were evaluated. All patients were over 80 years old at the time of the diagnosis, and were followed-up for at least 12 months. Patients were divided into two groups: those who received cementless stems (group 1, n=32) and those who received cemented stems (group 2, n=30). Functional results including Harris hip score, thigh pain, Koval's ambulatory classification, postoperative mortality rate, operation time, and the amount of blood loss were evaluated. RESULTS: The operation time and the amount of blood loss were significantly lower in group 1 compared to group 2. The Harris hip score was 82.1+/-8.6 points for group 1 and 83.4+/-7.5 points for group 2 at the final follow-up. One patient with poor cement press-fit level in group 2 experienced thigh pain. Twenty-seven patients (84.4%) in group 1 and 25 patients (83.3%) in group 2 recovered pre-injury ambulatory status. During the follow-up period, overall, 6 patients (18.8%) in group 1 and 8 patients (26.7%) in group 2 died. No significant differences in follow-up mortality rates were observed between the two groups. CONCLUSION: Considering the satisfactory clinical results, cementless bipolar hemiarthroplasty may be a good treatment option for patients over 80 years old with unstable intertrochanteric fracture.

Application of uncemented acetabular cup in revision arthroplasty with cemented acetabular prosthesis / 医学研究生学报

Objective Uncemented prothesis has become the preference of first hip arthroplasty, but there is a little study on its application in cemented acetabular revision arthroplasty.This paper aimed to evaluate the clinical effects of uncemented acetabular cup in cemented acetabular prosthesis revision arthroplasty. Methods A retrospective analysis was made on the clinical data of 31 patients(31 hips) who underwent revision arthroplasty using uncemented acetabular prosthesis from January 2012 to March 2015.Har-ris hip score( HSS) was applied to measure the hip function and visual analogue score( VAS) was preformed to assess the pain degree of knee joint preoperatively and postoperatively(3 months, 6 months and 1 year).All the patients were followed up for a mean of 22 months ranging from 3 to 42 months. Result The mean HSS increased from preoperative points (53.19 ±9.12) to postoperative points([77.71 ±5.75]at 3 months,[80.61 ±5.74] at 6 months,[82.94 ±5.80] at 1 year ).The mean VAS score decreased from preoperativepoints (6.23 ±1.23) to postoperative points(0.26 ±0.27).No lossening, infection or deep vein thrombosis were found in the patients′prostheses. Conclusion For patients with PaproskyI-Ⅱ acetabular defects, uncemented acetabular prosthesis has satisfactory short-term clinical results in revision arthroplasty with cemented acetabular prosthesis, however, long-term clinical results remain to be further observed.

Comparison of Perioperative Blood Loss in Primary Non-cemented Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis and Osteonecrosis of the Femoral Head / 대한고관절학회지

PURPOSE: The purpose of this study is to compare the perioperative blood loss in primary non-cemented total hip arthroplasty (THA) performed for rapidly destructive coxarthrosis (RDC) with the perioperative blood loss in primary non-cemented THA for typical osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: From January 2000 to December 2013, 19 patients were diagnosed with RDC (group 1) and 40 patients were diagnosed typical Ficat stage IV ONFH (group 2), comparison of perioperative blood loss between group 1 and group 2 in primary noncemented THA was done. Patients with preoperative usage of steroid or anticoagulants medication and with hemodynamic abnormal blood test results were excluded. The blood loss was measured up to the fifth post operation day and calculated with formula proposed by Mercuriali, Inghilleri and Nadler. RESULTS: Non-compensated blood loss calculated in milliliters of red blood cells was 362 mL (standard deviation [SD], 187; range, 77-675) in group 1 and 180 mL (SD, 145; range, 53-519) in group 2. Compensated blood loss was 630 mL (SD, 180; range, 380-760) in group 1 and 503 mL (SD, 260; range, 190-1, 505) in group 2. The total blood loss after primary non-cemented THA is greater when surgery is performed for RDC than for ONFH, with the volume of 992 mL (SD, 300; range, 457-1, 434) in group 1 and 683 mL (SD, 360; range, 226-1, 975) in group 2 respectively. CONCLUSION: Total perioperative blood loss was significantly greater in RDC than in ONFH in primary non-cemented THA.