Cementless total hip replacement: past, present, and future.

Cementless total hip replacement (THR) is rapidly being accepted as the surgery for arthritic diseases of the hip joint. The bone-ingrowth rate in porous-type cementless implants was about 90% over 10 years after surgery, showing that biological fixation of cementless THR was well maintained on both the stem and cup sides. As for the stress shielding of the femur operated using a distal fixation-type stem, severe bone resorption was observed. The severe bone resorption group showed continuous progression for more than 10 years after surgery. Stem loosening directly caused by stress shielding has been considered less likely; however, close attention should be paid to bone resorption-associated disorders including femoral fracture. Cementless cups have several specific problems. It is difficult to decide whether a cup should be placed in the physiological position for the case of acetabular dysplasia by bone grafting or at a relatively higher position without bone grafting. The bone-ingrowth rate was lower in the group with en bloc bone grafting, and the reactive line was frequently noted in the bone-grafted region. Although no data indicated that en bloc bone grafting directly led to poor outcomes, such as loosening, cup placement at a higher site without bone grafting is now selected by most operators. The polyethylene liner in a cementless cup is thinned due to the metal cup thickness; however, it has been suggested that the apparent relation between the cup size and the wear rate was absent as long as a cementless cup is used. Comparative study indicated cementless THR was inferior with regard to the yearly polyethylene wear rate and incidence of osteolysis on both the stem and cup sides. Meta-analysis study on the survival rate between cement and cementless THR reported that cemented THR was slightly superior. It should be considered that specific problems for cementless THR, especially with regard to polyethylene wear, do occur.

Power spectrum entropy of acceleration time-series during movement as an indicator of smoothness of movement.

We propose a novel indicator for smoothness of movement, i.e., the power spectrum entropy of the acceleration time-series, and compare it with conventional indices of smoothness. For this purpose, nineteen healthy adults (21.3+/-2.5 years old) performed the task of raising and lowering a beaker between the level of the umbilicus and eye level under the two following conditions: one with the beaker containing water and the other with the beaker containing a weight of the same mass as the water. Moving the beaker up and down when it contained water required extra control to prevent the water from being spilled. This means that movement was not as smooth as when the beaker contained a weight. Under these two conditions, entropy was measured along with a traditional indicator of smoothness of movement, the jerk index. The entropy could distinguish just as well as the jerk index (p<0.01) between when water was used and when the weight was used. The entropy correlated highly with the jerk index, with Spearman's rho at 0.88 (p<0.01). These results showed that the entropy derived from the spectrum of the acceleration time-series during movement is useful as an indicator of the smoothness of that movement.

Joint biomarkers in idiopathic femoral head osteonecrosis: comparison with hip osteoarthritis.

OBJECTIVE: To compare concentrations of joint biomarkers in synovial fluid (SF) between idiopathic osteonecrosis of the femoral head (ION) and osteoarthritis (OA) of the hip joint. METHODS: Levels of the joint biomarkers cartilage oligomeric matrix protein (COMP), antigenic keratan sulfate (AgKS), and hyaluronan (HA) in SF samples from 21 cases of ION and their relationship to disease stage and history of steroid use were assessed and compared to the result of 29 cases of hip OA. RESULTS: In both the ION and hip OA groups, levels of COMP and AgKS in SF showed a significant positive correlation. The ION group had significantly higher levels of AgKS in SF than the hip OA group. In the ION group, stage II patients had significantly higher SF levels of both COMP and AgKS than those in stage III patients. No difference in level of HA in hip joint SF was found between steroid and non-steroid treated ION patients or between the stage II and III subgroups. CONCLUSION: SF levels of COMP and AgKS may serve as useful joint biomarkers that reflect cartilage metabolism not only in hip OA but also in ION.