Disappointing long-term outcome of THA with carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) as acetabular insert liner: a prospective study with a mean follow-up of 14.3 years.

INTRODUCTION: Insert liner wear of the acetabular component is one of the predictive values for survival of total hip arthroplasties (THAs). This prospective single-centre study was designed to evaluate the follow-up of carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) insert liner used as bearing in cementless THAs. METHODS: 29 healthy patients with an indication for cementless THA were selected for a CFR-PEEK insert liner and followed over time. All patients received a cementless THA with a CFR-PEEK insert liner used as bearing. At different follow-up moments patients were routinely examined and were analysed using the Oxford Hip Score (OHS), the modified Merle d'Aubigne-Postel (MAP) score, and radiologically. At the follow up moments the plain radiographics where assessed for loosening, cyst formations and wear of the CFR-PEEK liners. RESULTS: At a mean of 14.3 years follow-up 4 revisions of the acetabular component were performed, resulting in a survival rate of 86.5% (CI 95%, 72.4-96.6). A statistically significant difference in OHS and MAP scores between pre- and postoperative follow-up moments was observed. The acetabular components of the remaining patients showed no radiological abnormalities at 14.3 years follow-up. The overall CFR-PEEK wear was low, with a mean of 0.81 (0.2-1.4) mm wear at 14.3 years follow-up. CONCLUSIONS: In this series we found an aseptic loosening with unclear reasons in 4 well-positioned acetabular components, hence we do not recommend routine use of CFR-PEEK insert liners as bearing in cementless THAs. All the remaining THAs and acetabular components were in situ without abnormalities at 14.3 years follow-up.

Results of Cemented Anatomically Adapted Total Hip Arthroplasty: A Follow-Up Longer Than 10 years.

This retrospective single-center study evaluated the >10-year follow-up (FU) and survival of 2 anatomically adapted cemented total hip arthroplasties (THAs) in a series of 308 patients (323 THAs) with a mean age of 76.2 years at operation. At a mean of 11 years of FU, patient-reported outcome measures, clinical examination, and plain radiography were analyzed. In 6 THAs, the femoral and/or acetabular component was revised. Reasons for revision were aseptic loosening and infection. At >10 years of FU, there was an overall survival for both THAs of 98.1%. Radiographic radiolucent lines were seen in 15 THAs affecting Gruen zone 4 and Delee and Charnley zone II. We conclude that both anatomically adapted cemented THAs have an excellent survival at 11 years of FU.

Efficacy and cost-effectiveness of nutritional intervention in elderly after hip fracture: design of a randomized controlled trial.

BACKGROUND: Hip fracture patients often have an impaired nutritional status at the time of fracture, which can result in a higher complication rate, prolonged rehabilitation time and increased mortality. A study was designed to evaluate the effect of nutritional intervention on nutritional status, functional status, total length of stay, postoperative complications and cost-effectiveness. METHODS: Open-labelled, multi-centre, randomized controlled trial in hip fracture patients aged 55 years and above. The intervention group receives dietetic counselling (by regular home visits and telephone calls) and oral nutritional supplementation for three months after surgery. The control group receives usual dietetic care as provided by the hospital. Outcome assessment is performed at three and six months after hip fracture. DISCUSSION: Patient recruitment has started in July 2007 and has ended in December 2009. First results are expected in 2011. TRIAL REGISTRATION: ClinicalTrials.gov NCT00523575.

Rickets in the Benelux. A case report of two Indian immigrants.

The last decades showed a resurgence of rickets and osteomalacia in the developed countries. In this report, we present two cases of dietary rickets in Indian teenage brothers who migrated to Europe. Supplementation of calcium and vitamin D3 to their diet resulted in rapid relief of musculoskeletal symptoms.

Effect of a distal centralizer on the positioning of an anatomical stem.

Femoral stem centralizers were originally designed for double tapered, straight stems. In a slightly modified configuration, the PMMA centralizer is plugged in a hole in the tip of the ABG II femoral prosthesis. The purpose of this study was to determine the effect of the centralizer on the position of the anatomical ABG II stem. Thirty-nine cemented ABG II stems with a centralizer were compared with thirty-nine stems without a centralizer. We evaluated positioning of the tip of the stem according to a standard selection of criteria, using conventional AP and lateral X-ray imaging. The centralizer supplied with the ABG II was found to have no additional value in guaranteeing optimal varus-valgus positioning. If a stem was not placed neutral, generally it was placed in a slight valgus position. The number of deficient cement mantles was not influenced by the three-fin centralizer. Furthermore, the distal centralizer of the ABG II prosthesis adds a length of 27 mm to the stem, and the distal cement plug found in stems with centralizer was almost twice as long on average. The ABG II centralizer was found in this study to provide insufficient guiding of this anatomical stem and to add excessive length to the distal cement plug.

Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial.

BACKGROUND: Allogeneic blood transfusions are associated with a number of well-recognized risks and complications. Postoperative retransfusion of filtered shed blood is an alternative to (reduce) allogeneic blood transfusion. The objectives of this study were to evaluate the clinical efficacy of retransfusion of filtered shed blood and to evaluate the complications, in particular febrile reactions. STUDY DESIGN AND METHODS: In this clinical trial 160 patients undergoing primary total hip or knee replacement were randomly assigned to receive either a retransfusion system (Bellovac, AstraTech AB) or a regular drain (Abdovac, AstraTech AB). Patients with a preoperative hemoglobin (Hb) level of between 13.0 and 14.6 g per dL were included. The shed blood was returned 6 hours after operation. After surgery the anesthesiologist determined the transfusion trigger. When Hb level dropped below this trigger, an allogeneic blood transfusion was given. The following data were obtained: number of allogeneic blood transfusions, total volume of blood collected in the bag used for retransfusion, perioperative Hb levels, febrile reaction, and other complications. RESULTS: In the control group 19 percent of the patients received at least one allogeneic blood transfusion. In the study group this percentage was 6 percent of the patients (p = 0.015). Comparing total knee and total hip arthroplasty (control vs. study) the percentages were, respectively, 16 percent versus 2 percent (p = 0.040) and 21 percent versus 11 percent (NS). On average 308 mL of filtered shed blood was retransfused in the study group. In the study group 18 percent of patients had febrile reactions compared to 20 percent in the control group. CONCLUSION: Postoperative retransfusion of filtered shed blood is effective for decreasing allogeneic blood transfusions after total hip and knee arthroplasty. There was no relationship between retransfusions and postoperative febrile reactions.

The use of autologous blood to improve exercise capacity after total hip arthroplasty: a preliminary report.

BACKGROUND: Venesection of red blood cells in healthy well-trained subjects decreased the maximum oxygen uptake parallel with the reduction in hemoglobin (Hb) level. Based on the large Hb decrease that is seen after total joint surgery, one could expect a decrease in performance as well. The purpose of this study was to investigate whether autologous blood enhanced performance on a bicycle ergometer in patients after total hip arthroplasty. STUDY DESIGN AND METHODS: Nine patients scheduled for elective total hip arthroplasty in an accelerated stay program participated in a preoperative autologous blood donation (PABD) program. Weeks before the scheduled surgery, patients donated 4 units of blood and received standard erythropoietin treatment. Physical fitness was assessed during exercise test on a bicycle ergometer. Each patient was matched with three previously tested patients. RESULTS: Patients in both groups were 69.0 years old (range, 66-74 years vs. 61-77 years). None of the patients had relevant cardiovascular abnormalities. On average patients received 3.3 units of blood because 3 units were not transfused. The PABD group showed a Hb decrease of 0.5 g per dL (4%) on the fourth postoperative day versus 4.4 g per dL (31%) in the control group. The decline in power output on Day 4 was significantly less in the PABD group compared with the control group (t test, p = 0.026). CONCLUSION: From this pilot study it can be concluded that correction of the postoperative Hb decrease was associated with a lower decrease in maximum power output, compared to the control group. On Days 23 and 39, however, the difference in performance between the PABD group and control group had disappeared.

Souter-Strathclyde total elbow arthroplasty: medium-term results.

The Souter-Strathclyde unconstrained elbow prosthesis was prospectively studied in 36 patients (45 prostheses) with rheumatoid arthritis (Larsen grade 4 and grade 5). The mean age of the patients at the time of operation was 63 years (range: 39 to 75 years). Eight patients (9 prostheses) died within five years of implantation, from causes unrelated to the elbow arthroplasty. One patient was lost to follow-up, leaving 27 patients (35 prostheses) for review. The mean length of follow-up was 98 months (range: 60 to 174 months). At 8.2 years follow-up, the prosthesis showed a probability of survival of 76% (SD 9%) with revision of the humeral component as an end point; the percentage dropped to 67% (SD 9%) when radiographic loosening was taken as an end-point. Survival of the ulnar component was 98%. Loosening of the humeral component seems to be related to both the short humeral stem and a persistent extension deficit.