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Zitsch BP, Cahoy KM, Urban ND, Buckner BC, Garvin KL. Highly Cross-Linked Polyethylene in Patients 50 Years of Age and Younger: A 20-year Follow-Up Analysis. J Arthroplasty 2024:S0883-5403(24)00267-5. [PMID: 38548239 DOI: 10.1016/j.arth.2024.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) has been an excellent bearing for total hip arthroplasty (THA) due to improved wear characteristics compared to conventional materials. Patients 50 years of age or younger are at high risk for wear-related complications of their THA, and few studies have followed these patients who have HXPLE into the third decade. METHODS In a retrospective review of 88 consecutive THAs performed in 77 patients aged 50 years and younger (mean 41; range, 20 to 50), in which HXLPE was utilized, they were evaluated for their clinical and radiographic results at an average of 20-year follow-up (range, 18 to 24). The current study reports on longer-term follow-up from our previously published series at shorter follow-up times. Patients were categorized by femoral head material: cobalt chrome (n = 14), ceramic (n = 30), and oxidized zirconium (n = 22) and by femoral head size: 26 mm (n = 12), 28 mm (n = 46), and 32 mm (n = 8). Harris Hip Scores were collected preoperatively and at the most recent follow-up. Radiographs were evaluated for linear and volumetric wear, radiolucent lines, and osteolysis. RESULTS Mean Harris Hip Scores improved from 47.1 (standard deviation [SD] 8.8) preoperatively to 92.0 (SD 7.7) (P < .0001) at 20-year follow-up. There was one hip that was revised for recurrent instability, and no hip demonstrated radiographic evidence of loosening or osteolysis. The mean polyethylene linear wear rate was 0.017 (SD 0.012) mm/y, and the mean polyethylene volumetric wear rate was 3.15 (SD 2.8) mm3/year, with no significant differences based on articulation type or head size. CONCLUSIONS Total hip arthroplasty with HXLPE in patients ≤ 50 years of age continues to demonstrate excellent long-term clinical and radiographic outcomes with low wear characteristics at 20-year follow-up, regardless of femoral head material or size.
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Affiliation(s)
- Bradford P Zitsch
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kevin M Cahoy
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nathanael D Urban
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Brandt C Buckner
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kevin L Garvin
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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Anderl C, Johl C, Krüger T, Hubel W, Weigert U, Mittelstaedt H, Ortmaier R. Subsidence after calcar-guided short stem total hip arthroplasty: five-year results of a prospective multicentre study. INTERNATIONAL ORTHOPAEDICS 2024; 48:229-234. [PMID: 37606768 DOI: 10.1007/s00264-023-05934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Calcar-guided short-stem total hip arthroplasty (THA) has shown excellent clinical outcomes. However, the migration pattern of such prostheses and its effect on clinical outcomes are less known. Therefore, we assessed the five-year subsidence after calcar-guided short-stem THA and its implications on clinical outcomes, patient-related factors, and complications. METHODS In this prospective multicentre study, we enrolled 213 patients (224 hips) who underwent calcar-guided short-stem THA mostly for degenerative hip diseases. We examined patients radiographically and clinically after six to 12 weeks, one year, two years, and five years. We evaluated subsidence using Einzel-Bild-Roentgen-Analyse femoral component analysis, assessed clinical outcomes, and systematically recorded all complications. RESULTS Overall, 131 patients (133 hips) were available for final follow-up at a median of 60 months (range, 2 to 72 months). We found a mean subsidence of 0.63 ± 1.22 mm at three months, 1.03 ± 1.60 mm at one year, 1.21 ± 1.91 mm at two years, and 1.54 ± 1.97 mm at five years. Patient-related factors (sex, age, weight, and BMI) did not significantly impact subsidence at five years (P > 0.05). Additionally, the Harris hip score, pain, and satisfaction improved significantly at five years compared to pre-operative values (P < 0.0001). Lastly, five patients underwent revision. CONCLUSION Calcar-guided short-stems revealed the highest subsidence rate within the first three months after THA and stabilisation after one year through the final follow-up examination. Moreover, patient-related factors had no influence on subsidence. Finally, clinical scores and patient satisfaction remained high at five years.
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Affiliation(s)
- Conrad Anderl
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Linz, Austria.
| | - Carsten Johl
- Klinikum Dahme-Spreewald GmbH, Lübben (Spreewald), Germany
| | - Thomas Krüger
- Abteilung Für Orthopädie Und Unfallchirurgie, Collm Klinik Oschatz GmbH, Oschatz, Germany
| | - Wilmar Hubel
- Kreiskrankenhaus Stollberg GmbH, Stollberg, Germany
| | - Ulrich Weigert
- Praxis Für Orthopädie Und Unfallchirurgie, Erkner, Germany
| | - Hagen Mittelstaedt
- UKSH Campus Lübeck, Klinik Für Orthopädie und Unfallchirurgie Sektion Orthopädie, Lübeck, Germany
| | - Reinhold Ortmaier
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Linz, Austria
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Blum P, Neugebauer J, Keiler A, Putzer D, Watrinet J, Biermeier S, Dammerer D. Mid-Term Migration Behavior of an Uncemented Proximally Anchored Straight Stem-A Retrospective EBRA Migration Analysis. J Clin Med 2023; 12:4335. [PMID: 37445370 DOI: 10.3390/jcm12134335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Aseptic loosening is one of the most-common causes of the failure of cementless stems. Einzel Bild Röntgen Analyse-Femoral Component Analysis (EBRA-FCA) allows the diagnosis of stem migration, which can be considered a factor in predicting implant survival. The current study aimed to present the migration behavior of a tapered proximally anchored straight stem. METHODS This retrospective study reviewed all consecutive patients who received a cementless CBC straight stem (Mathys AG, Bettlach, Switzerland) between 2005 and 2019. We analyzed the migration pattern using the EBRA-FCA software and reviewed their medical histories. In addition, periprosthetic radiolucency was rated according to the Gruen zones and femoral configuration according to Dorr. RESULTS A total of 333 stems in 332 patients (female 191; male 141) met our inclusion criteria. The mean age at surgery was 63 (range 21-87) years. Migration analysis by EBRA-FCA showed a mean subsidence of 1.6 mm at final follow-up at 96 months with a maximum noted mean subsidence of 2.0 mm at 72 and 84 months. Dorr Type A showed a tendency of less subsidence than did Dorr Type B and was statistically significant at 6 (p = 0.0396) and 72 months (p = 0.0127). The body mass index (BMI) and increased subsidence were not found to correlate (p > 0.05). For this cohort, the overall femoral revision-free rate was 95.2% and the revision-free rate for aseptic loosening was 99.1%. CONCLUSIONS The results showed migration behavior in cementless stems with initial increased migration and subsequent secondary stabilization, suggesting an excellent long-term outcome. Stem migration of this tapered proximally anchored stem might be lower in Dorr Type A than in Dorr Type B femurs without being statistically significant at all time points.
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Affiliation(s)
- Philipp Blum
- Department of Trauma Surgery, BG Trauma Center Murnau, 82418 Murnau, Germany
| | - Johannes Neugebauer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
| | - Alexander Keiler
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Julius Watrinet
- Department of Trauma Surgery, BG Trauma Center Murnau, 82418 Murnau, Germany
| | - Sebastian Biermeier
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
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Hasler J, Flury A, Dimitriou D, Holweg I, Helmy N, Finsterwald M. Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis. J Orthop Surg Res 2021; 16:19. [PMID: 33413463 PMCID: PMC7792117 DOI: 10.1186/s13018-020-02104-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aimed to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA). Methods Ninety-four consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated. Results At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in zone 1 and in 9% in zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions Comparable to other proximally fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-year follow-up.
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Affiliation(s)
- Julian Hasler
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland.
| | - Andreas Flury
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Iris Holweg
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Naeder Helmy
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Michael Finsterwald
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
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Kabelitz M, Fritz Y, Grueninger P, Meier C, Fries P, Dietrich M. Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures. Geriatr Orthop Surg Rehabil 2018; 9:2151459318765381. [PMID: 29623237 PMCID: PMC5881960 DOI: 10.1177/2151459318765381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/28/2018] [Accepted: 02/15/2018] [Indexed: 01/22/2023] Open
Abstract
Background: Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. Methods: We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. Results: We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B2) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B1 and 2 Vancouver AG) were treated conservatively. One periprosthetic femoral fracture (Vancouver B1) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Conclusion: Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level of Evidence: Level III, Therapeutic study.
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Affiliation(s)
- Method Kabelitz
- Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland
| | - Yannick Fritz
- Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland
| | | | - Christoph Meier
- Department for Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Patrick Fries
- Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland
| | - Michael Dietrich
- Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland
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Devane PA, Horne JG, Foley G, Stanley J. Measuring the migration of the components and polyethylene wear after total hip arthroplasty: beads and specialised radiographs are not necessary. Bone Joint J 2017; 99-B:1290-1297. [PMID: 28963149 DOI: 10.1302/0301-620x.99b10.bjj-2016-1169.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/13/2017] [Indexed: 01/27/2023]
Abstract
AIMS This paper describes the methodology, validation and reliability of a new computer-assisted method which uses models of the patient's bones and the components to measure their migration and polyethylene wear from radiographs after total hip arthroplasty (THA). MATERIALS AND METHODS Models of the patient's acetabular and femoral component obtained from the manufacturer and models of the patient's pelvis and femur built from a single computed tomography (CT) scan, are used by a computer program to measure the migration of the components and the penetration of the femoral head from anteroposterior and lateral radiographs taken at follow-up visits. The program simulates the radiographic setup and matches the position and orientation of the models to outlines of the pelvis, the acetabular and femoral component, and femur on radiographs. Changes in position and orientation reflect the migration of the components and the penetration of the femoral head. Validation was performed using radiographs of phantoms simulating known migration and penetration, and the clinical feasibility of measuring migration was assessed in two patients. RESULTS Migration of the acetabular and femoral components can be measured with limits of agreement (LOA) of 0.37 mm and 0.33 mm, respectively. Penetration of the femoral head can be measured with LOA of 0.161 mm. CONCLUSION The migration of components and polyethylene wear can be measured without needing specialised radiographs. Accurate measurement may allow earlier prediction of failure after THA. Cite this article: Bone Joint J 2017;99-B:1290-7.
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Affiliation(s)
- P A Devane
- Capital & Coast District Health Board, Private Bag 7902, Wellington South, New Zealand
| | - J G Horne
- Capital & Coast District Health Board, Private Bag 7902, Wellington South, New Zealand
| | - G Foley
- Capital & Coast District Health Board, Private Bag 7902, Wellington South, New Zealand
| | - J Stanley
- University of Otago, Wellington, P O Box 7343, Wellington South, New Zealand
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7
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Grammatopoulos G, Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gill HS, Murray DW. Optimal acetabular orientation for hip resurfacing. ACTA ACUST UNITED AC 2010; 92:1072-8. [DOI: 10.1302/0301-620x.92b8.24194] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pseudotumours are a rare complication of hip resurfacing. They are thought to be a response to metal debris which may be caused by edge loading due to poor orientation of the acetabular component. Our aim was to determine the optimal acetabular orientation to minimise the risk of pseudotumour formation. We matched 31 hip resurfacings revised for pseudotumour formation with 58 controls who had a satisfactory outcome from this procedure. The radiographic inclination and anteversion angles of the acetabular component were measured on anteroposterior radiographs of the pelvis using Einzel-Bild-Roentgen-Analyse software. The mean inclination angle (47°, 10° to 81°) and anteversion angle (14°, 4° to 34°) of the pseudotumour cases were the same (p = 0.8, p = 0.2) as the controls, 46° (29° to 60°) and 16° (4° to 30°) respectively, but the variation was greater. Assuming an accuracy of implantation of ± 10° about a target position, the optimal radiographic position was found to be approximately 45° of inclination and 20° of anteversion. The incidence of pseudotumours inside the zone was four times lower (p = 0.007) than outside the zone. In order to minimise the risk of pseudotumour formation we recommend that surgeons implant the acetabular component at an inclination of 45° (± 10) and anteversion of 20° (± 10) on post-operative radiographs. Because of differences between the radiographic and the operative angles, this may be best achieved by aiming for an inclination of 40° and an anteversion of 25°.
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Affiliation(s)
- G. Grammatopoulos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - H. Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - S. Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - P. McLardy-Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - R. Gundle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - D. Whitwell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - H. S. Gill
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
| | - D. W. Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
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Seehaus F, Emmerich J, Kaptein BL, Windhagen H, Hurschler C. Experimental Analysis of Model-Based Roentgen Stereophotogrammetric Analysis (MBRSA) on Four Typical Prosthesis Components. J Biomech Eng 2009; 131:041004. [DOI: 10.1115/1.3072892] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Classical marker-based roentgen stereophotogrammetric analysis (RSA) is an accurate method of measuring in vivo implant migration. A disadvantage of the method is the necessity of placing tantalum markers on the implant, which constitutes additional manufacturing and certification effort. Model-based RSA (MBRSA) is a method by which pose-estimation of geometric surface-models of the implant is used to detect implant migration. The placement of prosthesis markers is thus no longer necessary. The accuracy of the pose-estimation algorithms used depends on the geometry of the prosthesis as well as the accuracy of the surface models used. The goal of this study was thus to evaluate the experimental accuracy and precision of the MBRSA method for four different, but typical prosthesis geometries, that are commonly implanted. Is there a relationship existing between the accuracy of MBRSA and prosthesis geometries? Four different prosthesis geometries were investigated: one femoral and one tibial total knee arthroplasty (TKA) component and two different femoral stem total hip arthroplasty (THA) components. An experimental phantom model was used to simulate two different implant migration protocols, whereby the implant was moved relative to the surrounding bone (relative prosthesis-bone motion (RM)), or, similar to the double-repeated measures performed to assess accuracy clinically, both the prosthesis and the surrounding bone model (zero relative prosthesis-bone motion (ZRM)) were moved. Motions were performed about three translational and three rotational axes, respectively. The maximum 95% confidence interval (CI) for MBRSA of all four prosthesis investigated was better than −0.034 to 0.107 mm for in-plane and −0.217 to 0.069 mm for out-of-plane translation, and from −0.038 deg to 0.162 deg for in-plane and from −1.316 deg to 0.071 deg for out-of-plane rotation, with no clear differences between the ZRM and RM protocols observed. Accuracy in translation was similar between TKA and THA components, whereas rotational accuracy about the long axis of the hip stem THA components was worse than the TKA components. The data suggest that accuracy and precision of MBRSA seem to be equivalent to the classical marker-based RSA method, at least for the nonsymmetric implant geometries investigated in this study. The model-based method thus allows the accurate measurement of implant migration without requiring prosthesis markers, and thus presents new opportunities for measuring implant migration where financial or geometric considerations of marker placement have thus far been prohibitive factors.
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Affiliation(s)
- Frank Seehaus
- Department of Orthopaedics, Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hannover, Germany
| | - Judith Emmerich
- Department of Orthopaedics, Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hannover, Germany
| | - Bart L. Kaptein
- Department of Orthopaedics and Division of Image Processing, and Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, Netherlands
| | - Henning Windhagen
- Department of Orthopaedics, Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hannover, Germany
| | - Christof Hurschler
- Department of Orthopaedics, Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hannover, Germany
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9
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Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. ACTA ACUST UNITED AC 2005; 87:762-9. [PMID: 15911655 DOI: 10.1302/0301-620x.87b6.14745] [Citation(s) in RCA: 390] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Malposition of the acetabular component is a risk factor for post-operative dislocation after total hip replacement (THR). We have investigated the influence of the orientation of the acetabular component on the probability of dislocation. Radiological anteversion and abduction of the component of 127 hips which dislocated post-operatively were measured by Einzel-Bild-Röentgen-Analysis and compared with those in a control group of 342 patients. In the control group, the mean value of anteversion was 15 degrees and of abduction 44 degrees. Patients with anterior dislocation after primary THR showed significant differences in the mean angle of anteversion (17 degrees), and abduction (48 degrees) as did patients with posterior dislocation (anteversion 11 degrees, abduction 42 degrees). After revision patients with posterior dislocation showed significant differences in anteversion (12 degrees) and abduction (40 degrees). Our results demonstrate the importance of accurate positioning of the acetabular component in order to reduce the frequency of subsequent dislocations. Radiological anteversion of 15 degrees and abduction of 45 degrees are the lowest at-risk values for dislocation.
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Affiliation(s)
- R Biedermann
- Clinical Department of Orthopaedic Surgery, Department of Biostatistics, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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10
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Eingartner C, Ilchmann T, Dieter J, Weise K. Subsidence pattern of a cementless straight titanium alloy femoral stem - A radiographic study with EBRA-FCA. Hip Int 2005; 15:85-91. [PMID: 28224573 DOI: 10.1177/112070000501500204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
EBRA (Ein Bild Roentgen Analyse) is a computer-aided algorithm to assess migration of endoprosthetic components. Stem subsidence is measured in comparable radiographs, as defined by the software. Recent studies showed an improved accuracy of EBRA-FCA as compared to standard methods. For the BiCONTACT cementless femoral component, a prospective follow-up study of 250 cases has provided excellent results, with a survival rate of 97.1% after 11 years. For this migration study 93 hips with a complete radiographic follow-up (> 10 x-rays) over 120 months were included. Seventy-one stems were be measured; in 22 stems the measurement was impossible due to heterotopic ossification. Thirty-two hips (45.1%) showed initial subsidence within the first 24 months but no later, and 11 hips (15.5%) had a late onset of subsidence. In nine hips (12.7%) continuous sinking could be found. Nineteen hips (26.8%) had irregular patterns of migration. In 31.0% the overall migration was between 0.5-1mm after 120 months. Six stems (8.5%) had an absolute amount of subsidence exceeding 2mm after 120 months (one more than 3 mm). The mean subsidence was 0.2mm after three months and six months, 0.3mm after 12 months and reached 0.5mm after 10 years. EBRA-FCA is a practicable method to assess migration of the femoral component. There seems to be initial subsidence for about one half of the stems but further movements are rare, which might be a sign for osseo-integration. The radiographic findings correspond to the excellent clinical performance of this stem in long-term follow-up. (Hip International 2005; 15: 85-91).
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Affiliation(s)
- C Eingartner
- BG Trauma Center, University of Tuebingen, Tuebingen - Germany
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11
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Madanat R, Mäkinen TJ, Moritz N, Mattila KT, Aro HT. Accuracy and precision of radiostereometric analysis in the measurement of three-dimensional micromotion in a fracture model of the distal radius. J Orthop Res 2005; 23:481-8. [PMID: 15734266 DOI: 10.1016/j.orthres.2004.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2004] [Indexed: 02/04/2023]
Abstract
The purpose of the current study was to verify the feasibility of radiostereometric analysis (RSA) in monitoring three-dimensional fracture micromotion in fractures of the distal radius. The experimental set-up consisted of a simulated model of an extra-articular Colles' fracture, including metallic beads inserted into the bone on either side of the fracture site. The model was rigidly fixed to high precision micrometer stages allowing controlled translation in three axes and rotation about the longitudinal and transverse axes. The whole construct was placed inside a RSA calibration cage with two perpendicular radiographic film cassettes. Accuracy was calculated as the 95% prediction intervals from the regression analyses between the micromotion measured by RSA and actual displacements measured by micrometers. Precision was determined as the standard deviation of five repeated measurements of a 200 microm displacement or a 0.5 degrees rotation along a specific axis. Translations from 25 microm to 5mm were measured with an accuracy of +/-6 microm and translations of 200 microm were measured with a precision of 2-6 microm. Rotations ranging from 1/6 degrees to 2 degrees were measured with an accuracy of +/-0.073 degrees and rotations of 1/2 degrees were measured with a precision of 0.025 degrees -0.096 degrees . The number of markers and their configuration had greater impact on the accuracy and precision of rotation than on those of translation. Aside from the unknown rate of clinical marker loosening, the current results favor the use of at least four markers in each bone fragment in distal radius fractures. These results suggest a strong rationale for the use of RSA as an objective tool for comparing different treatment modalities and novel bone graft substitutes aimed at stabilization of fractures of the distal radius.
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Affiliation(s)
- Rami Madanat
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku, FIN-20520 Turku, Finland
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