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Stigbrand H, Brown K, Olivecrona H, Ullmark G. Implant migration and bone mineral density measured simultaneously by low-dose CT scans: a 2-year study on 17 acetabular revisions with impaction bone grafting. Acta Orthop 2020; 91:571-575. [PMID: 32452289 PMCID: PMC8023911 DOI: 10.1080/17453674.2020.1769295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Early postoperative implant migration predicts failure of joint replacements. Bone mineral density reflects bone quality and bone-graft incorporation. Implant migration and bone densitometry analysis usually require special equipment. We investigated cup migration and bone mineral density changes simultaneously with low-dose CT scans after acetabular revision hip arthroplasty using impaction bone grafting.Patients and methods - We performed a low-dose CT postoperatively, after 6 weeks, and after 2 years in 17 patients, all revised using impaction bone grafting and a graft-compressing titanium shell in the acetabulum. 6 patients had combined segmental and cavitary acetabular defects. Cup migration was analyzed using CT-based micromotion analysis (CTMA). Bone mineral density was determined in the graft and in surrounding native bone using volumetric quantitative computed tomography (QCT). The bone graft volume was calculated from 3D reconstructions.Results - At 2 years, the translations were 1.5 (95% CI 0.4-2.6) mm in proximal direction, -0.6 (CI -1.6 to 0.4) in the medial direction and 0.3 (CI 0.0-0.6) in the anterior direction. The mean volume of impacted bone graft was 40 cm³ (CI 28-52). In the graft bone mineral density increased 14% after 6 weeks and 23% after 2 years. There was 1 mechanical failure.Interpretation - Proximal migration of the acetabular component was low and comparable to previous reports. There was a rapid increase of bone mineral density in the bone graft. Low-dose CT scans make migration analysis and bone densitometry measurements possible in the same setting, offering great diagnostic potential for hip arthroplasty patients.
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Affiliation(s)
- Hampus Stigbrand
- Department of Orthopedics Gävle Hospital, Center for Research & Development, Uppsala University/County Council of Gävleborg, Sweden; ,Department of Surgical Sciences/Orthopedics, Uppsala University, Sweden; ,Correspondence:
| | | | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Gösta Ullmark
- Department of Orthopedics Gävle Hospital, Center for Research & Development, Uppsala University/County Council of Gävleborg, Sweden; ,Department of Surgical Sciences/Orthopedics, Uppsala University, Sweden;
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Abrahams JM, Callary SA, Munn Z, Jang SW, Huang Q, Howie DW, Solomon LB. Acetabular Component Migration Measured Using Radiostereometric Analysis Following Revision Total Hip Arthroplasty: A Scoping Review. JBJS Rev 2020; 8:e0170. [PMID: 32304493 DOI: 10.2106/jbjs.rvw.19.00170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
* Radiostereometric analysis (RSA) studies of acetabular component migration following revision total hip arthroplasty (THA) have a large variation in their methodology and reporting of results, and, therefore, they may not be directly comparable. Standardization of RSA reporting is recommended.
* In our review of RSA studies, there was a trend for cemented acetabular components to have larger amounts of early proximal migration than uncemented acetabular components. Results regarding cemented and uncemented components should be reported separately. * Cohorts that addressed larger acetabular defects were associated with a larger amount of early migration. * Reporting the migration result at 1 and 2 years postoperatively may enable earlier identification of poorly performing implants.
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Affiliation(s)
- John M Abrahams
- Centre for Orthopaedic and Trauma Research (J.M.A., S.A.C., S.W.J., Q.H., D.W.H., and L.B.S.) and the Joanna Briggs Institute (Z.M.), The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research (J.M.A., S.A.C., S.W.J., Q.H., D.W.H., and L.B.S.) and the Joanna Briggs Institute (Z.M.), The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Zachary Munn
- Centre for Orthopaedic and Trauma Research (J.M.A., S.A.C., S.W.J., Q.H., D.W.H., and L.B.S.) and the Joanna Briggs Institute (Z.M.), The University of Adelaide, Adelaide, South Australia, Australia
| | - Sung Won Jang
- Centre for Orthopaedic and Trauma Research (J.M.A., S.A.C., S.W.J., Q.H., D.W.H., and L.B.S.) and the Joanna Briggs Institute (Z.M.), The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedic Surgery, Pohang SeMyeong Christianity Hospital, Pohang-si, Republic of Korea
| | - Qiang Huang
- Centre for Orthopaedic and Trauma Research (J.M.A., S.A.C., S.W.J., Q.H., D.W.H., and L.B.S.) and the Joanna Briggs Institute (Z.M.), The University of Adelaide, Adelaide, South Australia, Australia.,Orthopedic Department of West China Hospital, Sichuan University, Chengdu City, China
| | - Donald W Howie
- Centre for Orthopaedic and Trauma Research (J.M.A., S.A.C., S.W.J., Q.H., D.W.H., and L.B.S.) and the Joanna Briggs Institute (Z.M.), The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lucian Bogdan Solomon
- Centre for Orthopaedic and Trauma Research (J.M.A., S.A.C., S.W.J., Q.H., D.W.H., and L.B.S.) and the Joanna Briggs Institute (Z.M.), The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Qayoom I, Raina DB, Širka A, Tarasevičius Š, Tägil M, Kumar A, Lidgren L. Anabolic and antiresorptive actions of locally delivered bisphosphonates for bone repair: A review. Bone Joint Res 2018; 7:548-560. [PMID: 30464835 PMCID: PMC6215244 DOI: 10.1302/2046-3758.710.bjr-2018-0015.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
During the last decades, several research groups have used bisphosphonates for local application to counteract secondary bone resorption after bone grafting, to improve implant fixation or to control bone resorption caused by bone morphogenetic proteins (BMPs). We focused on zoledronate (a bisphosphonate) due to its greater antiresorptive potential over other bisphosphonates. Recently, it has become obvious that the carrier is of importance to modulate the concentration and elution profile of the zoledronic acid locally. Incorporating one fifth of the recommended systemic dose of zoledronate with different apatite matrices and types of bone defects has been shown to enhance bone regeneration significantly in vivo. We expect the local delivery of zoledronate to overcome the limitations and side effects associated with systemic usage; however, we need to know more about the bioavailability and the biological effects. The local use of BMP-2 and zoledronate as a combination has a proven additional effect on bone regeneration. This review focuses primarily on the local use of zoledronate alone, or in combination with bone anabolic factors, in various preclinical models mimicking different orthopaedic conditions. Cite this article: I. Qayoom, D. B. Raina, A. Širka, Š. Tarasevičius, M. Tägil, A. Kumar, L. Lidgren. Anabolic and antiresorptive actions of locally delivered bisphosphonates for bone repair: A review. Bone Joint Res 2018;7:548–560. DOI: 10.1302/2046-3758.710.BJR-2018-0015.R2.
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Affiliation(s)
- I Qayoom
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology, Kanpur, India
| | - D B Raina
- Department of Orthopedics, The Medical Faculty, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - A Širka
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Š Tarasevičius
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - M Tägil
- Department of Orthopedics, The Medical Faculty, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - A Kumar
- Department of Biological Sciences and Bioengineering; Centre for Environmental Sciences and Engineering; Centre for Nanosciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - L Lidgren
- Department of Orthopedics, The Medical Faculty, Clinical Sciences Lund, Lund University, Lund, Sweden
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Kuiper BW, Graybill S, Tate JM, Kaufman N, Bersabe D. After the fall: improving osteoporosis treatment following hip fracture. Osteoporos Int 2018; 29:1295-1301. [PMID: 29464276 DOI: 10.1007/s00198-018-4416-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Osteoporotic hip fractures can be life changing and can increase mortality. Treatment of osteoporosis following hip fracture is often delayed. We began offering osteoporosis medication during hospitalization for hip fracture, dramatically increasing the number of patients meeting standard of care. INTRODUCTION Osteoporotic hip fracture is a debilitating condition with major morbidity and mortality implications. Osteoporosis medication given within 90 days of hip fracture improves mortality and reduces risk of future fractures. The aim of this project was to improve rates of timely osteoporosis treatment following fragility hip fracture. METHODS This was a two-step intervention utilizing the Plan-Do-Study-Act cycle, beginning with resident-focused education in cycle 1. In cycle 2, we offered osteoporosis medication to inpatients for hip fracture with help from a new electronic order set. RESULTS Prior to this intervention, 32% of patients received osteoporosis medication within 90 days of fragility hip fracture; this improved to 81% after intervention. CONCLUSIONS Resident education and an electronic order set dramatically improved the percentage of patients meeting standard of care with osteoporosis pharmacotherapy following fragility fracture.
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Affiliation(s)
- B W Kuiper
- Department of Internal Medicine Residency, SAUSHEC, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, San Antonio, TX, USA.
| | - S Graybill
- Department of Endocrinology, SAUSHEC, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, San Antonio, TX, USA
| | - J M Tate
- Department of Endocrinology, SAUSHEC, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, San Antonio, TX, USA
| | - N Kaufman
- Department of Internal Medicine Residency, SAUSHEC, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, San Antonio, TX, USA
| | - D Bersabe
- Department of Internal Medicine, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland Air Force Base, San Antonio, TX, USA
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