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Hjorth MH, Mechlenburg I, Soballe K, Rømer L, Jakobsen SS, Stilling M. The anatomical location of cystic pseudotumors and muscle atrophy in metal-on-metal resurfacing hip arthroplasty is related to the surgical approach used for implantation. A subgroup analyses of a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:5967-5976. [PMID: 36802238 DOI: 10.1007/s00402-023-04788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pseudotumors and muscle atrophy have been associated with metal-on-metal (MoM) resurfacing hip arthroplasty (RHA). We aimed to investigate the influence of the anterolateral (AntLat) and the posterior (Post) surgical approach on the location, grade and prevalence of pseudotumors and muscle atrophy in MoM RHA. PATIENTS AND METHODS Forty-nine patients were randomized to MoM RHA by the AntLat (n = 25) or the Post (n = 24) approach at Aarhus University Hospital. Patients underwent metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) scans for investigation of location, grade and prevalence of pseudotumors and muscle atrophy. Plain radiographs, metal-ions concentrations and clinical outcome scores were evaluated to compare outcomes of the surgical approaches. RESULTS MRI-detected pseudotumors were seen in 7 of 18 patients (39%) in the AntLat group and in 12 of 22 patients (55%) in the Post group (p = 0.33). Pseudotumors were mainly located anterolaterally to the hip joint in the AntLat group and postero-lateral to the hip joint in the Post group. Higher grades of muscle atrophy of the caudal part of the gluteus medius and minimus (p < 0.004) were seen in the AntLat group, and higher grades of muscle atrophy of the small external rotators were seen in the Post group (p < 0.001). The AntLat group had higher anteversion angles of mean 15.3° (range 6.1-7.5) versus mean 11.5° (range 4.9-22.5) in the Post group (p = 0.02). Metal-ion concentrations and clinical outcome scores were similar between groups (p > 0.08). CONCLUSION Muscle atrophy and pseudotumor location after MoM RHA follow the surgical approach used for implantation. This knowledge may help differentiate between "normal postoperative appearance" and "MoM disease."
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Affiliation(s)
- Mette Holm Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Kjeld Soballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Hanberg P, Bue M, Kabel J, Jørgensen AR, Søballe K, Stilling M. Tourniquet-induced ischemia and reperfusion in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. APMIS 2021; 129:225-231. [PMID: 33496970 DOI: 10.1111/apm.13121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/21/2021] [Indexed: 01/09/2023]
Abstract
This study aimed to evaluated ischemic metabolites in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone before, during, and after tourniquet application in a simultaneous paired comparison of tourniquet-exposed and non-tourniquet-exposed legs. Ten patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed to simultaneously and continuously sample the metabolites glucose, lactate, pyruvate, and glycerol bilaterally for 12 h in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the leg planned for surgery (inflation time: 15 min, mean tourniquet duration time (range): 65 (58;77) min). During tourniquet inflation, a 2- to 3-fold increase of the mean lactate/pyruvate ratio was found for all investigated tissues in the tourniquet-exposed leg compared with the non-tourniquet-exposed leg. The lactate/pyruvate ratio recovery time after tourniquet release was within 30 min for skeletal muscle, 60 min for subcutaneous tissue, and 130 min for calcaneal cancellous bone. Only the tourniquet-exposed skeletal muscles were found to be ischemic during tourniquet inflation, defined by a significant increase of the lactate/pyruvate ratio exceeding the ischemic cutoff level of 25; however, this level decreased below 25 immediately after tourniquet release. The glycerol ratio increased instantly after inflation in the tourniquet-exposed leg in skeletal muscle and subcutaneous tissue, and recovered within 60 (skeletal muscle) and 130 min (subcutaneous tissue) after tourniquet release. These findings suggest that applying tourniquet for approximately 1 h results in limited tissue ischemia and cell damage in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone.
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Affiliation(s)
- Pelle Hanberg
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark.,Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Mats Bue
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Jesper Kabel
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Andrea René Jørgensen
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Kjeld Søballe
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Maiken Stilling
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
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Bue M, Hanberg P, Thomassen MB, Tøttrup M, Thillemann TM, Søballe K, Birke-Sørensen H. Microdialysis for the Assessment of Intervertebral Disc and Vertebral Cancellous Bone Metabolism in a Large Porcine Model. In Vivo 2020; 34:527-532. [PMID: 32111750 DOI: 10.21873/invivo.11804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM It remains challenging to evaluate the in vivo pathophysiological biochemical characteristics in spine tissue, due to lack of an applicable model and feasible methods. The aim of this study was to apply microdialysis for the assessment of basic metabolites from the C3-C4 intervertebral disc, C3 vertebral cancellous bone and subcutaneous adipose tissue in a large porcine model. MATERIALS AND METHODS In 7 pigs, glucose, pyruvate, lactate and glycerol concentrations were evaluated in an 8-hour sampling period. RESULTS The mean lactate/pyruvate (L/P) ratios for the intervertebral disc and vertebral cancellous bone were comparable and exceeded the ischemic cut-off value of 25 for the entire sampling interval. For subcutaneous adipose tissue, the L/P ratio was below the ischemic cut-off. CONCLUSION This exploratory study confirms previous findings of ischemia in bone and the intervertebral disc. This encourages new microdialysis study designs in spine tissue employing large porcine models to create new knowledge and a greater understanding of the metabolism and pathogenesis in spine tissue.
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Affiliation(s)
- Mats Bue
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark .,Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Pelle Hanberg
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark.,Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Maja B Thomassen
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel Tøttrup
- Department of Orthopaedic Surgery, Aalborg University Hospital, Farsø, Denmark
| | - Theis M Thillemann
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Bue M, Bergholt NL, Jensen LK, Jensen HE, Søballe K, Stilling M, Hanberg P. Inflammatory proteins in infected bone tissue - An explorative porcine study. Bone Rep 2020; 13:100292. [PMID: 32637468 PMCID: PMC7330156 DOI: 10.1016/j.bonr.2020.100292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To explore the in situ inflammatory proteins in the local extracellular fluid of infected bone tissue. Material and methods Seven pigs went through a two-step surgery performing a traumatically implant-associated Staphylococcus aureus osteomyelitis in the proximal tibia. Five days later, microdialysis catheters (membrane cut off: 20 kDa) were placed in the implant cavity, infected and healthy cancellous bone, and infected and healthy subcutaneous tissue. Plasma samples were collected simultaneously. We employed an antibody-based proximity extension assay (Olink Inflammatory panel) for the measurement of inflammatory molecules within plasma and extracellular fluid of the investigated tissue compartments. Results A higher normalized protein expression in the infected bone tissue in comparison to healthy bone tissue was identified for proteins associated with angiogenesis and bone remodeling: OPG, TGFα, MCP-1, VEGFA, and uPA. Moreover, a parallel detectability of the systemic range of cytokines and chemokines as from the investigated local tissue compartments was demonstrated, indicating the same occurrence of proteins in the local environment as within plasma. Conclusion An angiogenic and osteogenic inflammatory protein composition within the extracellular fluid of infected bone tissue was described. The findings support the current histopathological knowledge and, therefore, microdialysis may represent a valid method for sampling of material for protein investigation of the in vivo inflammatory composition within the extracellular environment in infected bone tissue.
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Affiliation(s)
- Mats Bue
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Natasja Leth Bergholt
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Louise Kruse Jensen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | | | - Kjeld Søballe
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Pelle Hanberg
- Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark
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5
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Alsheri M, Bali K, Railton P, Ponjevic D, Matyas J, Powell J. Anatomic study on the blood supply to the femoral head following hip resurfacing using the posterior approach. Hip Int 2019; 29:558-563. [PMID: 31109180 DOI: 10.1177/1120700019850765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of this study was to investigate femoral head perfusion following cadaveric hip resurfacing using the posterior approach. METHODS This cadaveric study involved injecting Higgins India ink into the common iliac arteries and evaluating the distribution of ink in the resurfaced heads using the modified Spalteholz technique. The study consisted of 2 parts. The 1st part involved utilisation of 22 cadaveric hips for establishing the injection and histological technique. The 2nd part of the study included 4 control cadaveric hips and 12 cadaveric hips with posterior approach hip resurfacing. Each specimen was divided into 15 zones (12 head zones and 3 neck zones) to evaluate detailed geographic distribution of dye-containing blood vessels. RESULTS All 4 controls had good flow of ink to all head zones and the neck region. In all the resurfaced heads, there was good flow to all the neck zones. 6 resurfaced specimens had no dye flow to any of the head zones. In the remaining 6, dye-stained vessels were seen variably in the anterior and middle zones but were consistently absent in the posterior zones of the head. Zones representing the antero-inferior parts of femoral head had the maximum flow of ink, followed by zones representing middle-inferior parts. CONCLUSIONS Posterior approach for hip resurfacing arthroplasty results in vascular insult to the femoral head, with posterior zones more affected than the anterior zones. The persistence of the dye in the intraosseous blood vessels of the neck and in anteroinferior head may be a source of revascularisation of the femoral head after posterior approach hip resurfacing.
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Affiliation(s)
- Mohammed Alsheri
- 1 Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Pamela Railton
- 1 Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Dragana Ponjevic
- 1 Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - John Matyas
- 1 Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - James Powell
- 1 Cumming School of Medicine, University of Calgary, Alberta, Canada
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6
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Gadinsky NE, Klinger CE, Sculco PK, Helfet DL, Lorich DG, Lazaro LE. Femoral Head Vascularity: Implications Following Trauma and Surgery About the Hip. Orthopedics 2019; 42:250-257. [PMID: 31355905 DOI: 10.3928/01477447-20190723-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023]
Abstract
Traumatic injury and surgical intervention about the hip joint place the arterial supply to the femoral head (FH) at risk. Compromised perfusion may lead to FH ischemia, cell death, and osteonecrosis. Progression to FH collapse may lead to pain, functional impairment, and decreased quality of life, especially in younger patients. This review describes the arterial supply to the FH, analyzes the impact of femoral neck fractures on FH vascularity, and explores the vascular implications of various surgical interventions about the hip, offering specific techniques to minimize iatrogenic damage to the vessels supplying the FH. [Orthopedics. 2019; 42(5):250-257.].
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7
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Meertens R, Casanova F, Knapp KM, Thorn C, Strain WD. Use of near-infrared systems for investigations of hemodynamics in human in vivo bone tissue: A systematic review. J Orthop Res 2018; 36:2595-2603. [PMID: 29727022 DOI: 10.1002/jor.24035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
A range of technologies using near infrared (NIR) light have shown promise at providing real time measurements of hemodynamic markers in bone tissue in vivo, an exciting prospect given existing difficulties in measuring hemodynamics in bone tissue. This systematic review aimed to evaluate the evidence for this potential use of NIR systems, establishing their potential as a research tool in this field. Major electronic databases including MEDLINE and EMBASE were searched using pre-planned search strategies with broad scope for any in vivo use of NIR technologies in human bone tissue. Following identification of studies by title and abstract screening, full text inclusion was determined by double blind assessment using predefined criteria. Full text studies for inclusion were data extracted using a predesigned proforma and quality assessed. Narrative synthesis was appropriate given the wide heterogeneity of included studies. Eighty-eight full text studies fulfilled the inclusion criteria, 57 addressing laser Doppler flowmetry (56 intra-operatively), 21 near infrared spectroscopy, and 10 photoplethysmography. The heterogeneity of the methodologies included differing hemodynamic markers, measurement protocols, anatomical locations, and research applications, making meaningful direct comparisons impossible. Further, studies were often limited by small sample sizes with potential selection biases, detection biases, and wide variability in results between participants. Despite promising potential in the use of NIR light to interrogate bone circulation, the application of NIR systems in bone requires rigorous assessment of the reproducibility of potential hemodynamic markers and further validation of these markers against alternative physiologically relevant reference standards. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2595-2603, 2018.
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Affiliation(s)
- Robert Meertens
- Medical Imaging, University of Exeter Medical School, South Cloisters, St Luke's Campus, Heavitree Road, Exeter EX2 1LU, United Kingdom
| | - Francesco Casanova
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
| | - Karen M Knapp
- Medical Imaging, University of Exeter Medical School, South Cloisters, St Luke's Campus, Heavitree Road, Exeter EX2 1LU, United Kingdom
| | - Clare Thorn
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
| | - William David Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
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8
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Tjur M, Pedersen AR, Sloth W, Søballe K, Lorenzen ND, Stilling M. Posterior or anterolateral approach in hip joint arthroplasty - Impact on frontal plane moment. Clin Biomech (Bristol, Avon) 2018; 54:143-150. [PMID: 29587148 DOI: 10.1016/j.clinbiomech.2018.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/12/2018] [Accepted: 03/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterolateral surgical approach in hip joint arthroplasty necessitates division of the hip abductor muscle complex, which may compromise postoperative gait observed in the frontal plane. The aim of the study was to compare frontal plane moment after hip joint arthroplasty by anterolateral or posterior approach and to explore which compensatory strategies patients use to decrease frontal plane moment. METHODS Twenty-eight patients were randomized by sealed envelopes to hip resurfacing arthroplasty surgery by anterolateral (ad modum Watson) or posterior (ad modum Moore) approach, performed by two senior surgeons. Gait analyses were performed using 3D motion capture before surgery, 3, and 12 months after surgery. Peak ground reaction force was extracted for early and late stance and the corresponding frontal plane moment was defined. Measures of lateral trunk inclination, pelvic drop and hip abduction were obtained for the stance phase of the affected leg. FINDINGS An effect of surgical approach on frontal plane moment for the affected leg was found during early stance phase (p = 0.006) where average frontal plane moment in the anterolateral groups was 202.42 N mm/kg in less compared to the posterior group after one year. A similar effect from baseline to 12 months for trunk inclination (p = 0.03) and an overall negative correlation between frontal plane moment and trunk inclination was found (r = -0.66, p = 0.03). INTERPRETATION Frontal plane moment during early stance was less one year after hip joint arthroplasty through anterolateral compared to posterior approach. Patients' primary strategy to reduce frontal plane moment seems to be increased lateral trunk inclination.
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Affiliation(s)
- Marianne Tjur
- Orthopaedic Research Unit, Aarhus University Hospital, Tage Hansensgade 2, Denmark.
| | - Asger R Pedersen
- Hammel Neurorehabilitation and Research Centre, Voldbyvej 15, 8450 Hammel, Denmark
| | - William Sloth
- Hammel Neurorehabilitation and Research Centre, Voldbyvej 15, 8450 Hammel, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Unit, Aarhus University Hospital, Tage Hansensgade 2, Denmark; Department of Clinical Medicine, Aarhus University, Incuba/Skejby, bygning 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Aarhus, Denmark; Department of Orthopaedics, Aarhus University Hospital, Tage Hansens gade 2, 8000 Aarhus C, Denmark
| | - Nina D Lorenzen
- Orthopaedic Research Unit, Aarhus University Hospital, Tage Hansensgade 2, Denmark
| | - Maiken Stilling
- Orthopaedic Research Unit, Aarhus University Hospital, Tage Hansensgade 2, Denmark; Department of Clinical Medicine, Aarhus University, Incuba/Skejby, bygning 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Aarhus, Denmark; Department of Orthopaedics, Aarhus University Hospital, Tage Hansens gade 2, 8000 Aarhus C, Denmark
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9
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Jensen LK, Koch J, Henriksen NL, Bue M, Tøttrup M, Hanberg P, Søballe K, Jensen HE. Suppurative Inflammation and Local Tissue Destruction Reduce the Penetration of Cefuroxime to Infected Bone Implant Cavities. J Comp Pathol 2017; 157:308-316. [PMID: 29169629 DOI: 10.1016/j.jcpa.2017.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/27/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022]
Abstract
Treatment of post-traumatic and implant-associated osteomyelitis (IAO) includes surgical debridement, removal of implants and long-term antibiotic therapy. The success of antibiotic therapy relies not only on activity towards the infecting pathogen, but also on sufficient penetration of the target site. The aim of the present study was to characterize the local pathological changes associated with reduced penetration of cefuroxime to infected bone implant cavities. Previously, reduced penetration of systemically administrated cefuroxime was demonstrated in the implant cavity of 10 pigs with Staphylococcus aureus IAO present for 5 days. In the present study, a comprehensive histopathological characterization of the peri-implant bone tissue was performed and correlated with the reduced penetration of cefuroxime. In two pigs, the levels of oxygen, pyruvate and lactate was estimated in the implant cavity. A peri-implant pathological bone area (PIBA) developed with a width of 1.2 up to 3.8 mm. PIBAs included: (1) suppuration, resulting in destruction of the implant cavity contour, and (2) a non-vascular zone of primarily necrotic bone tissue. A strong negative correlation was seen between PIBA width and cefuroxime area under the concentration time curves (AUC[0-last]) and peak concentration of cefuroxime (Cmax). All metabolic measurements demonstrated hypoxia. In conclusion, subacute suppurative bone inflammation with local tissue destruction can result in decreased penetration of antibiotics and insufficient oxygen supply.
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Affiliation(s)
- L Kruse Jensen
- Department of Veterinary and Animal Science, Ridebanevej 3, 1870 Frederiksberg C, University of Copenhagen, Denmark.
| | - J Koch
- Department of Veterinary and Animal Science, Ridebanevej 3, 1870 Frederiksberg C, University of Copenhagen, Denmark
| | - N Lind Henriksen
- Department of Veterinary and Animal Science, Ridebanevej 3, 1870 Frederiksberg C, University of Copenhagen, Denmark
| | - Mats Bue
- Orthopaedic Research Unit, Building 1A, Nørrebrogade 44, 8000 Aarhus, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Sundvej 30, 8700 Horsens, Horsens Regional Hospital, Denmark
| | - M Tøttrup
- Orthopaedic Research Unit, Building 1A, Nørrebrogade 44, 8000 Aarhus, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Skovlyvej 15, 8930 Randers NØ, Randers Regional Hospital, Denmark
| | - P Hanberg
- Orthopaedic Research Unit, Building 1A, Nørrebrogade 44, 8000 Aarhus, Aarhus University Hospital, Denmark
| | - K Søballe
- Orthopaedic Research Unit, Building 1A, Nørrebrogade 44, 8000 Aarhus, Aarhus University Hospital, Denmark
| | - H Elvang Jensen
- Department of Veterinary and Animal Science, Ridebanevej 3, 1870 Frederiksberg C, University of Copenhagen, Denmark
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Abstract
Hip resurfacing arthroplasty (HRA) is an alternative to conventional, stemmed total hip arthroplasty (THA). The best reported results are young, active patients with good bone stock and a diagnosis of osteoarthritis. Since the 1990s, metal-on-metal (MoM) HRA has achieved excellent outcomes when used in the appropriate patient population. Concerns regarding the metal-on-metal bearing surface including adverse local tissue reaction (ALTR) to metal debris have recently lead to a decline in the use of this construct. The current paper aims to provide an updated review on HRA, including a critical review of the most recent literature on HRA.
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Affiliation(s)
- Robert Sershon
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL, 60612, USA.
| | - Rishi Balkissoon
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL, 60612, USA.
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL, 60612, USA.
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11
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Li M, Cole PA. Anatomical considerations in adult femoral neck fractures: how anatomy influences the treatment issues? Injury 2015; 46:453-8. [PMID: 25549821 DOI: 10.1016/j.injury.2014.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/17/2014] [Indexed: 02/02/2023]
Abstract
Femoral neck fractures in physiologically young adults are relatively uncommon. The reported incidence of avascular necrosis and nonunion rates remain relatively high despite the advancement in understanding and surgical management. Understanding the normal femoral neck anatomy and its relationship to presenting fracture pathology in young adults could help to lessen reported high complication rates to provide better clinical outcomes.
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Affiliation(s)
- Mengnai Li
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, Mailstop 11503L, St Paul, MN 55101, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter A Cole
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, Mailstop 11503L, St Paul, MN 55101, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
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