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1.
Article in English | WPRIM (Western Pacific) | ID: wpr-101621

ABSTRACT

Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed as early as 1985 by the senior author (PH). We undertook a systematic review of the medical literature to examine the progress in cell therapy during the last 30 years for the treatment of early stage osteonecrosis.


Subject(s)
Humans , Cell- and Tissue-Based Therapy , Femur Head/surgery , Femur Head Necrosis/surgery , Mesenchymal Stem Cell Transplantation , Tissue Engineering
2.
Int Orthop ; 39(4): 639-44, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25231573

ABSTRACT

PURPOSE: Long, cementless, femoral stem revisions are being used with increasing frequency. There is a relative lack of studies of late fractures after cementless implants, particularly in those patients who had a previous stem revision and are at higher risk for periprosthetic fracture after revision. In this paper, we review risk factors for periprosthetic fracture and revisions of long, cementless, locked stems and report implant survival compared with conventional, cemented, long-stem hip revision arthroplasties in such a group of patients. METHODS: We used data recorded in our institution. Between 1996 and 2002, 85 cementless femoral stem Aura™ (distal locked stem) prostheses were implanted in 85 patients. Of the 85 revisions with long, cementless stems, 32 were performed after one stem revision, 20 after two stem revisions and 12 after three stem revisions. Between 2003 and 2010, 124 femoral revision stems were performed in 124 patients using an extensively long, titanium femoral stem (Ceraver Osteal™). Kaplan-Meier analysis was used to determine implant survival. The Cox regression model was used to study risk factors for reoperation and revision. RESULTS: The increase in stem length corresponded to a mean of 4.5 ± 2.1 femoral canal diameters and was not significantly different (p = 0.02) between the two groups. Cardiopulmonary distress, intraoperative or postoperative complications were not significantly different between the two groups. There was an overall increased risk of pain, periprosthetic fractures and revision for the cementless prostheses compared with the cemented stems. With regard to thigh pain at the last follow-up, most patients (95 %) reported no pain in the cemented group, while 15 % of the cementless group experienced thigh pain under stress and 6 % had incapacitating pain. In the cemented group, stem re-revision was not required in any hip; there was no periprosthetic fracture; five stems had radiological loosening but in the absence of pain were not revised. Among patients of the cementless group, 21 % sustained failure or revision of their interlocked stem with periprosthetic fractures observed in 15 cases; factors which contributed significantly to a higher risk of fracture included the number of previous revisions; the average time between surgery and failure was 3.2 years after one revision, 2.8 years after two revisions, and 1.6 years after three revisions. CONCLUSIONS: The long, cementless, locked stem showed more early complications compared with recementing of long-stem prosthesis. We therefore recommend the use of cemented long stems in patients with severe bone loss and previous revision.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Bone Cements/therapeutic use , Femur/surgery , Hip Prosthesis/adverse effects , Periprosthetic Fractures/epidemiology , Postoperative Complications/etiology , Reoperation/statistics & numerical data , Titanium/therapeutic use , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Bone Cements/adverse effects , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Periprosthetic Fractures/etiology , Prosthesis Design , Prosthesis Failure , Risk Factors , Titanium/adverse effects
3.
Int Orthop ; 38(2): 437-42, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24190590

ABSTRACT

PURPOSE: Recently, increased interest has developed for patellofemoral arthroplasty as treatment for isolated patellofemoral arthritis. However, there are very few reports of the experience with the modern generation of patellofemoral arthroplasties. The new patellofemoral arthroplasty Hermes design is described. The design and technique of insertion are detailed. METHODS: The indications were isolated patellofemoral disease with advanced arthritic damage. Ten-year followup is available for treatment of 70 knees. Postoperative radiographs of patients were assessed for Oxford deterioration and maltracking of the patella. Tracking was categorised as follows: normal tracking, patellar subluxation, patellar dislocation. RESULTS: There were no late complications attributable to the arthroplasty. Disease progression in the tibiofemoral joint occurred in five patients requiring revision in three of these patients. Persistent anterior knee pain was recorded in four knees. The long-term results using this new design were better than those in the literature that described earlier designs, especially concerning malalignment. Only four knees in four patients had slight lateral patellar subluxation. CONCLUSIONS: This implant offers a reasonable alternative to total knee replacement in patients with isolated patellofemoral disease.


Subject(s)
Arthritis/surgery , Arthroplasty, Replacement/instrumentation , Arthroplasty, Replacement/methods , Joint Prosthesis , Patellofemoral Joint/surgery , Prosthesis Design , Aged , Disease Progression , Female , Follow-Up Studies , Humans , Incidence , Longitudinal Studies , Male , Postoperative Complications/epidemiology , Reoperation , Treatment Outcome
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