Radiographic Characteristics of the Femoral Nutrient Artery Canals in Total Hip Arthroplasty using Cementless Femoral Stem

@#Introduction: Accurate diagnosis of undisplaced periprosthetic femoral fracture (PFF) after hip arthroplasty is crucial, as overlooked PFF may affect its treatment and prognosis. The undisplaced PFF is often difficult to distinguish from radiolucent lines of nutrient artery canal (NAC) of the femur present on post-operative radiographs. We aimed to identify the radiographic features of NAC to distinguish them from PFFs. Materials and methods: In this retrospective radiological study, a total of 242 cases in 215 patients with hip arthroplasty were analysed using pre-operative and postoperative anteroposterior (AP) and translateral (TL) radiographs. Interobserver agreement of the measurements was assessed by two independent experienced orthopaedic surgeons. The kappa value ranged from 0.83 to 0.87, indicating strong agreement according to the Landis and Koch criteria. Results: The NACs were found pre-operatively in 94 (39.8%) cases on AP views and in 122 cases (50.4%) on TL views. The radiolucent lines were observed post-operatively in 42 (17.4%) on AP views and 122 (50.4%) on the TL views. three cases (1.2%) had a fracture around the stem that were detected on radiographs. One case with PFF presented simultaneously with NAC on the immediate post-operative radiographs. All patients were treated by conservative measures, and the radiolucent lines did not appear on followup radiographs. Conclusion: It is not easy to differentiate undisplaced PFFs that can occur after hip arthroplasty operation from NACs. However, accurate diagnosis is possible through careful observation and comparison of pre-operative and postoperative radiologic images

Comparison of radiographic and tomographic evaluations for measurement of the Canal Flare Index in dogs / [Comparação entre avaliação radiográfica e tomográfica para mensuração do Canal Flare Index em cães]

The outcome of total hip arthroplasty (THA) in dogs is directly related to surgical planning. Templating of radiographs prior to THA should help the surgeon anticipate prosthesis size and femoral shape allowing canal fill of the proximal metaphysis by the implant ensuring primary stable fixation. The canal flare index (CFI) obtained from radiograph has been used as a measure of risk of complications for the technique in human beings and dogs. However, standard radiographs only provide limited data for the selection of cementless prostheses and the assessment of their fit within the femoral canal, due to factors like radiographic magnification and femoral rotation. Therefore, three-dimensional evaluation based on computed tomography (CT) may be a better tool for CFI measurement. The aim of this study was to compare anatomical measurement with CFI values obtained from craniocaudal radiography and CT. Craniocaudal radiographs using a horizontal radiographic beam (CR), CT, and anatomical macroscopic measurements (A) were obtained from 45 femurs from 23 canine cadavers. The differences between the values of CFI obtained from radiograph (CFI-R), computed tomography on transverse (CFI- TT) and longitudinal axis (CFI-TL) compared to the CFI obtained from macroscopic measurements - gold standard - (CFI-A), and 95% limits of agreement (LOA) between the values, were evaluated by the Bland-Altman method. Dimensions obtained from CT techniques had a greatest mean difference from anatomical and CFI values were also different (P=0.032). Under the experimental conditions, the craniocaudal radiograph, provided the most accurate measurement of the CFI (mean difference: 0.087 ± 0.42).(AU)

O resultado da artroplastia total do quadril (ATQ) em cães está diretamente relacionado ao planejamento cirúrgico. O templating radiográfico pré-operatório da ATQ deve ajudar o cirurgião a prever o tamanho da prótese e o formato do fêmur, o que permitirá um preenchimento ideal da metáfise proximal pelo implante, garantindo, assim, fixação primária estável. O índice de alargamento do canal (Canal Flare Index - CFI) obtido em radiografias tem sido utilizado como fator de risco de complicações para a técnica em humanos e cães. No entanto, as radiografias podem fornecer apenas dados limitados para a seleção de próteses não cimentadas e a avaliação do seu encaixe no canal femoral, devido a fatores como ampliação radiográfica e rotação femoral. Portanto, a avaliação tridimensional baseada na tomografia computadorizada (TC) pode ser uma ferramenta vantajosa para a mensuração do CFI. O objetivo deste estudo foi comparar a medida anatômica com os valores de CFI obtidos na radiografia craniocaudal e na TC. Radiografias craniocaudais utilizando feixe radiográfico horizontal (CR), tomografia computadorizada e medidas macroscópicas anatômicas (A) foram obtidas de 45 fêmures de 23 cadáveres caninos. As diferenças entre os valores de CFI obtidos na radiografia (CFI-R), na tomografia computadorizada no eixo transversal (CFI-TT) e no eixo longitudinal (CFI-TL), em comparação com os valores de CFI obtidos nas medições macroscópicas - padrão-ouro - (CFI-A) e os limites de concordância de 95% (LOA) entre os valores, foram avaliadas pelo método de Bland-Altman. As dimensões obtidas pelas técnicas de TC apresentaram maior diferença média dos valores anatômicos, e as do CFI também foram diferentes (P=0,032). Nas condições experimentais, a radiografia craniocaudal forneceu a medida mais precisa do CFI (diferença média: 0,087 ± 0,42) para representar o padrão-ouro deste estudo.(AU)

Effects of cementless fixation of implant prosthesis: A finite element study

PURPOSE: A novel retentive type of implant prosthesis that does not require the use of cement or screw holes has been introduced; however, there are few reports examining the biomechanical aspects of this novel implant. This study aimed to evaluate the biomechanical features of cementless fixation (CLF) implant prostheses.MATERIALS AND METHODS: The test groups of three variations of CLF implant prostheses and a control group of conventional cement-retained (CR) prosthesis were designed three-dimensionally for finite element analysis. The test groups were divided according to the abutment shape and the relining strategy on the inner surface of the implant crown as follows; resin-air hole-full (RAF), resin-air hole (RA), and resin-no air hole (RNA). The von Mises stress and principal stress were used to evaluate the stress values and distributions of the implant components. Contact open values were calculated to analyze the gap formation of the contact surfaces at the abutment-resin and abutment-implant interfaces. The micro-strain values were evaluated for the surrounding bone.RESULTS: Values reflecting the maximum stress on the abutment were as follows (in MPa): RAF, 25.6; RA, 23.4; RNA, 20.0; and CR, 15.8. The value of gap formation was measured from 0.88 to 1.19 µm at the abutmentresin interface and 24.4 to 24.7 µm at the abutment-implant interface. The strain distribution was similar in all cases.CONCLUSION: CLF had no disadvantages in terms of the biomechanical features compared with conventional CR implant prosthesis and could be successfully applied for implant prosthesis.

Mid- and long-term effectiveness of total hip arthroplasty with Ribbed femoral stem prosthesis in 354 cases / 中国修复重建外科杂志

Objective: To evaluate the mid- and long-term effectiveness of total hip arthroplasty (THA) with Ribbed femoral stem prosthesis. Methods: A clinical data of 354 patients (384 hips) with hip disease who underwent THA with Ribbed femoral stem prostheses between October 2006 and May 2016 was retrospectively analyzed. There were 171 males and 183 females, with an average age of 53.4 years (range, 20-82 years). There were 324 cases of single hip and 30 cases of bilateral hips. The cause of THA included the avascular necrosis of the femoral head in 151 cases (159 hips), hip osteoarthritis in 134 cases (136 hips), rheumatoid arthritis in 43 cases (43 hips), ankylosing spondylitis in 20 cases (40 hips), and trauma in 6 cases (6 hips). The Harris score of total 354 patients before operation was 42.34±8.89. Harris scores were used to evaluate hip function after operation. X-ray films were used to determine the length of the lower limb, the radiolucent line on the femur side, the stability of the prosthesis, and the occurrence of stress shielding. Results: The incisions healed by first intention. All patients were followed up 2-11 years with an average of 7.4 years. The Harris score at last follow-up was 80.52±7.61, which significantly increased when compared with preoperative score ( t=134.804, P=0.000). Two cases (2 hips) of prosthetic infections, 3 cases (3 hips) of prothesis loosening, and 4 cases (4 hips) of periprosthetic fractures, and 48 cases (48 hips) of mild to moderate thigh pain occurred after operation. X-ray films showed 76 cases (78 hips) with radiolucent lines on the femur side and stress shielding. According to the Engh's method, there were 364 hips of bone ingrowth, 15 hips of fibrosis ingrowth, and 5 hips of prosthesis instability. The femoral stem subsidence occurred in 25 cases (25 hips), and the difference in leg length discrepancy was more than 10 mm in 5 patients. Conclusion: THA with Ribbed femoral stem prosthesis can achieve satisfactory effectiveness with good initial stability and rapid bone growth. The incidence of stress shielding is relatively high, but the stress shielding has no significant impact on the mid- and long-term survival rate and effectiveness of femoral prosthesis.

Hip Arthroplasty Using the Bencox® Hip System: An Evaluation of a Consecutive Series of One Thousand Cases / 대한고관절학회지

PURPOSE: This is a report on the outcomes associated with a consecutive series of 1,000 cementless hip arthroplasties utilizing the Bencox® hip stem–the first Korean-developed hip prosthesis. MATERIALS AND METHODS: A consecutive series of 1,000 hip arthroplasties using the Bencox® hip stem were analyzed, starting from its initial release (September 2006) until June 2014. Patients in this consecutive series underwent surgery for fractures (n=552), arthritis (n=155), avascular necrosis (n=209), and revisions (n=84). Of these 1,000 cases, patients with a minimum follow-up of at least 1 year (n=616) were retrospectively analyzed for radiographic and clinical outcomes (i.e., Harris hip score). The stability of the prosthesis was evaluated by examining subsidence. RESULTS: During the follow-up period (mean follow-up period of 54.8 months), there were 2 cases requiring revision of the femoral stem–both were caused by periprosthetic fractures and neither involved stem loosening. The mean Harris hip score during follow-up was 95.5. Bone ongrowth occurred in 95% of patients; no cases of subsidence or aseptic loosening of the stem were detected, and no cases of postoperative complications such as ceramic breakage were observed. CONCLUSION: Clinical and radiographic evaluations of hip arthroplasty using the Bencox® hip stem revealed excellent outcomes with an average of 54.8 month follow-up in a consecutive series of 1,000 cases.

Cementless Total Hip Arthroplasty Using the COREN Hip System: A Minimum Five-Year Follow-up Study / 대한고관절학회지

PURPOSE: This study presents the clinical and radiological outcomes of cementless total hip arthroplasty using the COREN hip system after a minimum duration of follow-up of 5 years. MATERIALS AND METHODS: We evaluated the results of a consecutive series of the first 200 primary total hip arthroplasties that had been performed in our hospital in 169 patients between February 2007 and April 2011. Six patients (6 hips) had died within 5 years, and 12 patients (13 hips) had been lost to follow-up, leaving a total of 151 patients (181 hips) available for the study. All patients were evaluated clinically and radiologically with special attention to thigh pain, implant fixation, radiolucent line and osteolysis around implants. RESULTS: The mean Harris hip score improved from 59.4 preoperatively to 97.2 postoperatively. No patient complained of thigh pain. All implants demonstrated radiographic evidence of stable fixation by bone ingrowth without any change in position. No implant was loose radiographically or was revised. Eleven hips (7.7%) had a radiolucent line around the femoral stem. Focal osteolytic area was detected in 3 cases (2.1%). An osteolytic lesion was stabilized in 1 case and further observation was needed in 2 cases in which the lesions were detected several years after surgery. Stress shielding was observed in 80.3% of cases (first degree, 35.9%; second degree, 44.4%); there were no cases of third or fourth degree stress shielding. One case was complicated by bacterial infection and repeated dislocation. CONCLUSION: Mid-term results of total hip arthroplasty using the COREN hip system are very encouraging clinically and radiologically.

Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty / 中国修复重建外科杂志

Objective: To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment of avascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection. Methods: The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treated with cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips) without HIV infection, who were treated with cementless THA during the same period, were collected as control (negative group). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between 2 groups ( P0.05). The operation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization time were recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the position of the prosthesis. Results: The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25 months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than that of positive group ( t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate of blood transfusion, and hospitalization time between 2 groups ( P>0.05). There was no significant difference in Harris score between 2 groups before operation and at 1, 3, 6, and 12 months after operation ( P>0.05). There were 2 cases of superficial infection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficial infection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening and sinking of the prosthesis occurred in both groups during follow-up. Conclusion: Cementless THA is a safe and effective method for ANFH in patients with HIV infection.

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>

Influence of tibolone on postoperative effect of osteoporosis patients with bone cementless type artificial total hip replacement / 中国基层医药

Objective To discuss the influence of tibolone on near and long-term postoperative effect of osteoporosis patients with bone cementless type artificial total hip replacement effect.Methods 136 patients with hip fracture by bone cementless type artificial total hip replacement were selected.According to the situation of osteoporosis,all patients were divided into osteoporosis group and control group.The osteoporosis group received tibolone treatment,followed up for 12 weeks.The intraoperative blood loss,operating time were analyzed.Enzyme-linked immunosorbent assay was used to determine serum bone alkaline phosphatase(sBAP),osteocalcin(sOC),C-terminal peptide collagen cross-linking Ⅰ type(sCTx).Harris hip score was applicated to evaluate hip function.Before and after treatment,lumbar vertebra bone mineral density(BMD) was detected by dual-energy X-ray absorption metry method.Results The intraoperative blood loss,operating time between the two groups had no significant differences(all P>0.05).The serum sBAP and sOC levels of the osteoporosis group were (28.41±6.13)U/L,(22.74±5.87)g/L,which were significantly lower than those of the control group[(35.18±7.21) U/L,(27.42±6.38)g/L],the serum sCTx level[(0.56±0.21)ng/mL]was higher than that of the control group[(0.42±0.11)ng/mL].The differences were statistically significant(tsBAP=5.36,tsOC=6.62,tsCTx=6.71,all P0.05).Conclusion The type of bone cement after total hip arthroplasty patients with osteoporosis bone metabolism and bone mineral density in osteoporosis patients are poor in the hip joint function recovery is poorer,postoperatively for drug resistance to osteoporosis treatment can effectively avoid further loss of bone mass,it is worthy of further clinical promotion.

Cementless Total Hip Arthroplasty Using Dual Offset Titanium Tapered Stem: At Least 7-Year Follow-Up / 대한정형외과학회잡지

PURPOSE: The purpose of current study is to evaluate the midterm results of cementless primary total hip arthroplasty (THA) using a dual offset titanium tapered stem. MATERIALS AND METHODS: A retrospective analysis of 102 cases (84 patients), with a minimum of 7-year clinical follow-up, was performed. All of the cases consisted of patients who underwent primary cementless THA, using a dual offset titanium tapered stem in The Catholic University of Korea, Bucheon St. Mary's Hospital between July 2004 and May 2009. Clinical results were analyzed via the Harris hip score, level of thigh pain, squeaking around hip joint, and complication rate. Radiologic results were examined with stability and location of inserted prosthesis, hypertrophy of femoral cortex, and osteolysis. RESULTS: Out of the 102 cases (84 patients; 47 males and 37 females), with the mean age of 55.9 years (range, 27–79 years) and mean follow-up period of 99.2 months (range, 84–132 months). The mean Harris hip score was 53.8 preoperatively (range, 26–75) and improved to 93.5 postoperatively (range, 74–100) (p=0.000). All of the cases gained stable bony fixation on the final follow-up, including 2 cases of intra-operative proximal femur fracture. Calcar remodeling was observed in 94 cases, however, they were irrelevant with stem stability. Cortical hypertrophy of femur was seen in 12 cases and thigh pain in 4 cases; nonetheless, they were not relevant (p=0.067). There was 1 case of squeaking sound during joint movement. Hip dislocation occurred in 1 case early after the procedure, but the event was due to excessive anteversion of the acetabular cup, in which a revisional replacement procedure of the acetabular cup was conducted. No sign of ceramic breakage was observed. There were 2 cases of heterotrophic ossification. CONCLUSION: Results from a 7-year follow-up of cementless THA using dual offset titanium tapered stem were encouraging in both clinical and radiologic evaluations.

Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring / 대한고관절학회지

PURPOSE: Bipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture. MATERIALS AND METHODS: We reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81.7 years. During the arthroplasty, trochanteric fracture fragments were fixed using 1 or 2 vertical wires and transverse wires. We evaluated the clinical outcomes such as abductor power, ambulatory ability and wire-related complications, and radiologic outcomes including the union of the trochanteric fragment and subsidence of stem. RESULTS: Sixty-two patients were followed for a minimum of 2 years (mean, 59 months) postoperatively. The mean abductor power and Koval category was 4.1 (range, 3 to 5) and 4.6 (range, 1 to 6). The wire was broken in 3 hips (4.8%) and the nonunion of the greater trochanter occurred in 1 hips (1.6%). Two stems subsided by 3 mm and 8 mm, respectively, during postoperative 6 weeks, after which the subsidence was not progressive. CONCLUSION: Cerclage wiring of the trochanter using monofilament wire leads to acceptable outcome in cementless HA for senile patients with unstable intertrochanteric fracture. Cerclage wiring using a monofilament wire is recommended for the fixation of trochanteric fragments.

Comparative Study of Peripheral Rim Fixation Using Jumbo Cup in Revisional Hip Arthroplasty / 대한고관절학회지

PURPOSE: It is challenging procedure to revise acetabular component in acetabulum with severe bone defect or deformity. The jumbo cup is good option for revisional arthroplasty in large bone defect. The purpose of this study is to compare the prognosis of revisional total hip arthroplasty using jumbo cup with peripheral rim fixation and no rim fixation. MATERIALS AND METHODS: We included the patients who had performed acetabular revisional total hip arthroplasty from January 2002 to March 2015 in our institute. Total of 51 hips (51 patients) were included. The mean follow up period was 51 months (range, 12 to 154 months) and mean age was 60.7 years (range, 30 to 81 years). We divided into two groups (peripheral rim fixation group and no rim fixation group) by anteroposterior and lateral plain radiograph. We compared survival rate, hip center change and clinical outcomes between two groups. RESULTS: There were 37 patients in peripheral rim fixation group and 14 patients in no rim fixation group. There was one patient who had aseptic loosening necessary to re-revision in rim fixation group and 3 patients in no rim fixation group. And one patient had superficial infection in rim fixation group and one patient had periprosthetic fracture in no rim fixation group. Survival rate was higher in the peripheral rim fixation group (97.3%) than no rim fixation group (78.6%, P=0.028) CONCLUSION: Based on our findings, peripheral rim fixation might be recommended to improve short-term outcome after revision total hip arthroplasty using jumbo cup.

Tratamiento de las fracturas periprotesicas de cadera de tipos B2 y B3 con tallos no cementados de fijacion distal / Treatment of type B2 and B3 periprosthetic hip fractures with distal fixation cementless stem

Introducción: La fractura periprotésica es la tercera causa más frecuente de revisión de cadera por detrás del aflojamiento aséptico y la infección. Aquellas que se presentan asociadas a un tallo flojo (B2) o a un déficit de capital óseo (B3) deben ser tratadas con la revisión femoral. Materiales y Métodos: Se estudiaron retrospectivamente 38 pacientes con fracturas periprotésicas de fémur de tipos B2 y B3 tratadas con tallos no cementados de fijación distal sin injerto óseo ni placas de osteosíntesis. El tiempo de seguimiento promedio fue de 2.5 años (rango 1.5-10). Resultados: El puntaje promedio en el Harris Hip Score fue 69 (rango 57-91). En todos los casos, se logró la consolidación ósea. La supervivencia libre de revisión fue del 94,8%. Las complicaciones fueron: un (2,6%) hundimiento del tallo >5 mm, una (2,6%) luxación, dos (5,2%) infecciones y un (2,6%) hematoma de la herida. Conclusión: La técnica de revisión con tallos no cementados de fijación distal sin el aporte de injerto óseo ha demostrado ser un método eficaz para tratar las fracturas periprotésicas de cadera de tipos B2 y B3.

Introduction: Periprosthetic hip fracture is the third most common cause of hip revision, behind aseptic loosening and infection. Fractures presenting in combination with a loose stem (B2) or poor bone stock (B3) should be revised. Methods: We retrospectively evaluated 38 patients with type B2 and B3 periprosthetic hip fractures that had been treated with distal fixation cementless stem without bone graft or a plate. Follow-up averaged 2.5 years (range 1.5-10). Results: The mean postoperative Harris Hip Score was 69 points (range 57-91). Fracture consolidation was achieved in all patients. Implant survival at last follow-up was 94.8%. Complications were: one (2.6%) stem subsidence, one (2.6%) dislocation, two (5.2%) infections and one (2.6%) hematoma. Conclusion: Hip revision in the set of type B2 and B3 periprosthetic fracture with distal fixation cementless stem without bone graft is an effective technique.

Implant Design in Cementless Hip Arthroplasty / 대한고관절학회지

When performing cementless hip arthroplasty, it is critical to achieve firm primary mechanical stability followed by biological fixation. In order to achieve this, it is essential to fully understand characteristics of implant design. In this review, the authors review fixation principles for a variety of implants used for cementless hip replacement and considerations for making an optimal selection.

The Short-term Clinical Outcome of Total Hip Arthroplasty Using Short Metaphyseal Loading Femoral Stem / 대한고관절학회지

PURPOSE: The purpose of this study was to retrospectively evaluate the short-term clinical and radiological outcomes of total hip arthroplasty (THA) with short metaphyseal loading femoral stem. MATERIALS AND METHODS: We retrospectively reviewed the records of 56 cases in 47 patients who had undergone THA with short metaphyseal loading femoral stem from April 2010 to December 2011. There were 20 males and 27 females. The mean age was 54 years (range, 26-77 years). The average follow up period was 4.6 years. Clinical results were evaluated by Harris hip scores (HHS) before the operation and at the last follow-up. Radiographic analysis was done by evaluating osteolysis, loosening, stress shielding, and alignement. RESULTS: The mean HHS significantly improved from 45 (range, 15-58) preoperatively to 98 (range, 85-100) at the last follow-up. In radiographic analyses, there was no evidence of osteolysis or loosening around the stems and the acetabuluar components. All cases showed rounding off of the calcar, grade 1 bone resorption of the proximal femur. With regard to implant alignment, 51 femoral component (91.1%) were in neutral position, and 5 (8.9%) were in varus position. There was 1 intraoperative fracture treated by cerclage wiring and no case was revised during follow-up period. CONCLUSION: Although longer follow-up is needed to confirm the durability of the short metaphyseal loading femoral stem, this short stem might provide stable fixation without diaphyseal fixation and demonstrated good clinical result at mean 4.6 year short term follow-up.

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.

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.

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.

Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty / 대한고관절학회지

PURPOSE: We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA). MATERIALS AND METHODS: From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up. RESULTS: Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture. CONCLUSION: Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type.

Fracture of Fully-coated Femoral Stem after Primary Total Hip Arthroplasty for Nonunion of Intertrochanteric Fracture: A Case Report / 대한고관절학회지

Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture.