A randomised trial comparing a short and a standard-length metaphyseal engaging cementless femoral stem using radiostereometric analysis

This was a randomised controlled trial studying the safety of a new short metaphyseal fixation (SMF) stem. We hypothesised that it would have similar early clinical results and micromovement to those of a standard-length tapered Synergy metaphyseal fixation stem. Using radiostereometric analysis (RSA) we compared the two stems in 43 patients. A short metaphyseal fixation stem was used in 22 patients and a Synergy stem in 21 patients. No difference was found in the clinical outcomes pre- or post-operatively between groups. RSA showed no significant differences two years post-operatively in mean micromovement between the two stems (except for varus/valgus tilt at p = 0.05) (subsidence 0.94 mm (sd 1.71) vs 0.32 mm (sd 0.45), p = 0.66; rotation 0.96° (sd 1.49) vs 1.41° (sd 2.95), p = 0.88; and total migration 1.09 mm (sd 1.74) vs 0.73 mm (sd 0.72), p = 0.51). A few stems (four SMF and three Synergy) had initial migration > 1.0 mm but stabilised by three to six months, with the exception of one SMF stem which required revision three years post-operatively. For most stems, total micromovement was very low at two years (subsidence < 0.5 mm, rotation < 1.0°, total migration < 0.5 mm), which was consistent with osseous ingrowth. The small sample makes it difficult to confirm the universal applicability of or elucidate the potential contraindications to the use of this particular new design of stem.

Cite this article: Bone Joint J 2015; 97-B:595–602.

Theoretical (in B3LYP/6-3111++G** level), spectroscopic (FT-IR, FT-Raman) and thermogravimetric studies of gentisic acid and sodium, copper(II) and cadmium(II) gentisates

The DFT calculations (B3LYP method with 6-311++G(d,p) mixed with LanL2DZ for transition metals basis sets) for different conformers of 2,5-dihydroxybenzoic acid (gentisic acid), sodium 2,5-dihydroxybenzoate (gentisate) and copper(II) and cadmium(II) gentisates were done. The proposed hydrated structures of transition metal complexes were based on the results of experimental findings. The theoretical geometrical parameters and atomic charge distribution were discussed. Moreover Na, Cu(II) and Cd(II) gentisates were synthesized and the composition of obtained compounds was revealed by means of elemental and thermogravimetric analyses. The FT-IR and FT-Raman spectra of gentisic acid and gentisates were registered and the effect of metals on the electronic charge distribution of ligand was discussed.

Metal ion levels after metal-on-metal total hip arthroplasty: a five-year, prospective randomized trial

BACKGROUND

The U.S. Food and Drug Administration has requested post-market surveillance data, including data on metal ion levels, regarding metal-on-metal total hip arthroplasty. We performed a prospective, randomized study of metal ion levels in erythrocytes, serum, and whole blood at five years after 28 and 36-mm metal-on-metal and 28-mm metal-on-polyethylene total hip arthroplasty.

METHODS

One hundred and five enrolled patients were randomized equally to the three bearing surface options and were blinded with regard to their treatment group. Metal ion measurements and clinical evaluations were performed at regular intervals.

RESULTS

Cobalt and chromium ion levels in all blood sample types at the five-year time point were significantly lower in the metal-on-polyethylene group than in each of the two metal-on-metal groups (p < 0.001) with the exception of chromium in erythrocytes (p = 0.194). Cobalt in serum (p = 0.029) and erythrocytes (p = 0.002) showed significant increases from two to five years in the 36-mm metal-on-metal group; similar increases were not seen in the 28-mm metal-on-metal group. At five years, five patients in the 36-mm metal-on-metal group and none in the 28-mm metal-on-metal group had cobalt or chromium levels of >7 ppb. Correlations among levels in serum, erythrocyte, and whole blood were stronger for cobalt than for chromium. One patient in the 36-mm metal-on-metal group underwent revision because of an adverse local tissue reaction.

CONCLUSIONS

The 36-mm metal-on-metal bearing underperformed the 28-mm metal-on-metal bearing with respect to metal ion levels. The authors are closely following all patients treated with metal-on-metal total hip arthroplasty.

[Psychoorganic and depressive syndrome in severe hepatic diseases]

Authors present the occurrence of the psychopathologic disorders in the group of 33 patients (23 women and 10 men) with severe hepatic disorders (mostly cirrhotic non-alcoholic). Patients in the 20-69 age range were treated in the Medical Academy in Gdańsk in the years 1989-1993. 15 patients were examined twice at intervals from 6 months to 3 years. Using the Hamilton Depression Scale and psychiatric examination, the authors found depression in 5 cases. These patients were treated with thymoleptic. On the basis of the Organic Brain Damage Rating Scale (by Jarema M. and others) and psychiatric examination, the psychoorganic syndrome was confirmed in 4 cases. Correlation between the psychopathologic disorders and changes in some biochemical indicators was not found.

Increase of size and dry mass of human erythrocytes depending on age of donors

The size and dry mass of erythrocytes from the blood of men of various ages were measured by means of microscopic interferometry. The donors age-dependent increase of erythrocytes size and dry mass was found.