ORCID Profile
0000-0003-1702-3279
Current Organisations
Monash University
,
Royal Adelaide Hospital
,
University of Adelaide
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Publisher: Elsevier BV
Date: 08-2000
Abstract: Osteoclasts are multinucleated bone-resorbing cells that are formed from precursors that circulate in the monocyte fraction. This study has determined the effect of phagocytosis of metal particles on osteoclast formation and bone resorption in vitro. Human peripheral blood monocytes were cocultured for 21 days with osteoblast-like UMR 106 cells, in the presence of 1,25-dihydroxyvitamin D3, dexamethasone, and human macophage colony-stimulating factor. Cobalt-chrome alloy (CoCr), stainless steel (316L-SS), titanium alloy (TiAlV), and commercially pure titanium (cpTi) particles (size range, 0.5-3.0 microm) and 1.0-microm latex particles were added to the cocultures as a single dose at the beginning of each experiment. All 5 types of particles were readily phagocytosed by the monocytes. After 4 days' exposure to high concentrations of all the metal particles, some cell death was found in the cocultures. After 14 days, a reduction in the number of CD14+ cells was seen in cocultures exposed to high concentrations of metal particles, particularly CoCr and 316L-SS particles. Phagocytosis of latex particles by osteoclast precursors did not affect the ability of these cells to undergo osteoclast differentiation. In contrast, exposure to metal wear particle preparations caused a dose-dependent reduction in the number of vitronectin receptor-positive osteoclastic cells formed and a dose-dependent reduction in the bone resorption produced by these cells. This decrease in resorption was greater after exposure to CoCr and 316L-SS particles compared with TiAlV and cpTi particles. This in vitro cell culture system may provide a useful model to compare the effect of different prosthetic materials on human osteoclast formation and bone resorption.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 09-2010
DOI: 10.1302/0301-620X.92B9.23893
Abstract: We dissected 20 cadaver hips in order to investigate the anatomy and excursion of the trochanteric muscles in relation to the posterior approach for total hip replacement. String models of each muscle were created and their excursion measured while the femur was moved between its anatomical position and the dislocated position. The position of the hip was determined by computer navigation. In contrast to previous studies which showed a separate insertion of piriformis and obturator internus, our findings indicated that piriformis inserted onto the superior and anterior margins of the greater trochanter through a conjoint tendon with obturator internus, and had connections to gluteus medius posteriorly. Division of these connections allowed lateral mobilisation of gluteus medius with minimal retraction. Analysis of the excursion of these muscles revealed that positioning the thigh for preparation of the femur through this approach elongated piriformis to a maximum of 182%, obturator internus to 185% and obturator externus to 220% of their resting lengths, which are above the thresholds for rupture of these muscles. Our findings suggested that gluteus medius may be protected from overstretching by release of its connection with the conjoint tendon. In addition, failure to detach piriformis or the obturators during a posterior approach for total hip replacement could potentially produce damage to these muscles because of over-stretching, obturator externus being the most vulnerable.
Publisher: Elsevier BV
Date: 08-1992
DOI: 10.1016/0268-0033(92)90030-8
Abstract: Initial fixation of the femoral components of total hip replacements is related to the mechanical integrity of the bone within the proximal femur. This preliminary study examined the correlations between the mechanical properties, histomorphometry, and radiology of bone core specimens taken from the proximal femora of cadavers and of patients undergoing total hip replacement surgery. Measurements and subjective assessments of the femoral bone from radiographs were shown to have poor correlation with both compressive mechanical properties and bone volume measurements. However, the mechanical properties of the bone core specimens and the histomorphometric measurements correlated well with the bone density measured by single-photon absorptiometry, indicating that this type of imaging technique may be of value in determining bone quality prior to surgery. The prediction of the mechanical properties of the proximal femur by preoperative imaging may have direct bearing on the type of femoral component to be used in total hip replacement. Preoperative assessment of bone quality would allow the surgeon to predict the likely fixation obtainable with different designs.
Publisher: Georg Thieme Verlag KG
Date: 03-2016
Abstract: Objectives: Hemiarthroplasty induces degenerative changes in the hip joint, which are difficult to evaluate in vivo. Radiostereometric analysis (RSA) is a radiographic measurement technique that has recently been used to measure acetabular cartilage wear in vivo. The aim of the study was to measure acetabular cartilage wear, using this technique, in an ovine model during the first 14 weeks post-implantation. Methods: Measurements of three-dimensional femoral head migration, combined with visual assessments at necropsy and safranin O staining for cartilage integrity, were undertaken. Results: Mean femoral head migration during the first six weeks was 0.525 mm in the medial, 0.144 mm in the cranial, and 0.517 mm in the dorsal direction. The majority of this migration was confirmed to be cartilage wear in the medial and dorsal aspects of the acetabulum at necropsy and with subsequent histological evaluation depicting significant cartilage degeneration. Clinical significance: Radiostereometric analysis is the current gold standard technique for in vivo assessment of implant migration following total hip replacement. This study has utilized RSA to quantify the amount of early cartilage wear in vivo, which was supported by ex vivo evaluations. Accurately measuring the amount of cartilage wear will allow future studies to compare component material and design characteristics prior to clinical use.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.ARTH.2011.08.023
Abstract: We investigated the effect several lower limb positions have on muscles that are detached to perform hip arthroplasty through posterior and lateral approaches. We used string models and computer navigation to measure the length changes in these muscles throughout hip movements in the anatomical planes and while simulating several sitting and lying postures. Piriformis and the obturators were shortened by sitting and lying postures when the femur was externally rotated and abducted the clinical implication being that such postures have the potential to best protect their repair after a posterior approach. The anterior part of gluteus medius was lengthened with femoral external rotation. This lengthening was prevented, and therefore, theoretically, the gluteus medius repair protected after a lateral approach, by neutral or internal femoral rotation.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.INJURY.2011.05.012
Abstract: The aim of the study was to investigate the possible outcomes of intracapsular femoral neck fractures managed non-operatively or with a simple form of internal fixation. We reviewed 30 fractures and their post mortem reports from the Galler collection, a modern pathology reference series. Our investigation revealed unusual appearances of the hip following femoral neck fractures that are not usually seen in modern orthopaedic practice, including previously undescribed acetabularisation of the femur and ankyloses of ununited femoral heads. Appreciation of these appearances and an understanding of how these fractures may progress are important in the current diagnosis and management of delayed presentations, neglected or inadequately fixed subcapital fractures of the femoral neck.
Publisher: Elsevier BV
Date: 09-1988
DOI: 10.1016/0142-9612(88)90010-5
Abstract: The tissue response to intra-articular injection into rat knees of similar concentrations of sterile cobalt-chrome (Co-Cr) alloy and aluminium oxide (AL2O3) ceramic prosthesis wear particles was assessed at 1, 4 and 13 wk. A semiquantitative method of histological assessment showed a correlation between the numbers of particles and macrophage response in the tissues, and a difference in the response to different concentrations of Co-Cr particles. At 1 wk, the macrophage response to Co-Cr particles was significantly greater (p less than or equal to 0.01) than that to AL2O3 particles but no difference was detected at 4 and 13 wk. The difference may be due to necrosis of macrophages induced by Co-Cr particles.
Publisher: Medical Journals Sweden AB
Date: 14-05-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-11-2018
Abstract: The acetabular components used in revision total hip arthroplasty (THA) to treat severe acetabular bone defects have high rates of re-revision at mid to long-term follow-up. Early translation of acetabular components used in revision THA is a good predictor of later loosening, and radiostereometric analysis (RSA) is the most sensitive method to measure migration. The objectives of the present study were to use RSA to compare the migration of the porous tantalum acetabular components used to treat severe bone defects with the previously established acceptable proximal translation threshold of ≤1 mm within 2 years, and to determine the effect on migration of the addition of inferior screws through the component into the ischium or pubis. RSA was utilized to measure the migration of 55 porous tantalum components used to treat severe acetabular defects (28 Paprosky IIIA, 27 Paprosky IIIB 21 hips with pelvic discontinuity) at a mean follow-up of 4 years (range, 2 to 12 years). Forty-eight of the 55 components migrated less than the threshold that predicts later loosening ( mm) and 50 had not been re-revised at the time of the latest follow-up. Seven components, none of which had inferior screw fixation, exceeded the translation threshold. Of these, 6 were implanted to treat pelvic discontinuity. Of those 6 components, 5 were re-revised for loosening related to patient symptoms. At 2 years, the absolute median proximal translation of components with inferior screw fixation was |0.3| mm (range, |0.1| to |0.9| mm), compared with |0.4| mm (range, |0.03| to |16.4| mm) for those without inferior screws (p = 0.04). As measured with use of RSA, the majority of porous tantalum acetabular components used in a revision THA to treat severe acetabular defects had acceptable early migration. This predicts good long-term survivorship of these components. The use of inferior screws further improved acetabular component fixation. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2015
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.ARTH.2009.08.003
Abstract: Using computed tomography, the volume, location, and number of osteolytic lesions were determined adjacent to 38 Harris-Galante 1 (HG-1) acetabular components fixed with screws and 19 porous-coated anatomic (PCA) acetabular components press-fitted without screws. The median implantation times were 16 and 15 years, respectively. The mean total lesion volumes were similar: 11.1 cm(3) (range, 0.7-49 cm(3)) and 9.8 cm(3) (range, 0.4-52 cm(3)), respectively, for hips with HG-1 and PCA components (P = .32). There was a significant difference in the proportion of rim-related, screw or screw hole-related, and combined lesions between the 2 component designs (P < .0001). HG-1 components had more screw and screw hole-related lesions, and PCA components had more rim-related lesions. Although there are concerns regarding screw and screw hole-associated osteolysis, these findings suggest that peripheral fixation may be well maintained in the long term with the use of multiple-hole acetabular components with screw fixation.
Publisher: Elsevier BV
Date: 07-2000
Publisher: Wiley
Date: 08-1990
DOI: 10.1111/J.1440-1673.1990.TB02634.X
Abstract: The plain films and arthrograms performed on 42 painful cemented hip arthroplasties in 40 patients were reviewed and the radiological findings compared to the surgical assessment of component stability. All radiography, which included Judet views in the plain films, was reviewed without knowledge of the surgical findings and without comparison with previous studies. Criteria for the detection of loosening of cemented femoral and acetabular components were predetermined. The accuracy of plain film assessment of acetabular component stability was increased significantly (p less than 0.05) by including oblique views in the plain film assessment. The accuracy of assessment of acetabular component stability on plain films was 88%, on arthrography 90% and, with both studies combined, was 98%. Femoral component stability was assessed accurately on 90% of plain films and 90% of arthrograms, and this was not improved by combining the studies. The difficulty of detecting low grade infections is discussed with results of pseudocapsule aspiration.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 2014
DOI: 10.1302/0301-620X.96B1.31464
Abstract: We investigated the detailed anatomy of the gluteus maximus, gluteus medius and gluteus minimus and their neurovascular supply in 22 hips in 11 embalmed adult Caucasian human cadavers. This led to the development of a surgical technique for an extended posterior approach to the hip and pelvis that exposes the supra-acetabular ilium and preserves the glutei during revision hip surgery. Proximal to distal mobilisation of the gluteus medius from the posterior gluteal line permits exposure and mobilisation of the superior gluteal neurovascular bundle between the sciatic notch and the entrance to the gluteus medius, enabling a wider exposure of the supra-acetabular ilium. This technique was subsequently used in nine patients undergoing revision total hip replacement involving the reconstruction of nine Paprosky 3B acetabular defects, five of which had pelvic discontinuity. Intra-operative electromyography showed that the innervation of the gluteal muscles was not affected by surgery. Clinical follow-up demonstrated good hip abduction function in all patients. These results were compared with those of a matched cohort treated through a Kocher–Langenbeck approach. Our modified approach maximises the exposure of the ilium above the sciatic notch while protecting the gluteal muscles and their neurovascular bundle. Cite this article: Bone Joint J 2014 -B:48–53.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2007
DOI: 10.2106/JBJS.E.01305
Publisher: Wiley
Date: 12-07-2016
DOI: 10.1002/JOR.23356
Abstract: A number of different software programs are used to investigate the in vivo wear of polyethylene bearings in total hip arthroplasty. With wear rates below 0.1 mm/year now commonly being reported for highly cross-linked polyethylene (XLPE) components, it is important to identify the accuracy of the methods used to measure such small movements. The aims of this study were to compare the accuracy of current software programs used to measure two-dimensional (2D) femoral head penetration (FHP) and to determine whether the accuracy is influenced by larger femoral heads or by different methods of representing the acetabular component within radiostereometric analysis (RSA). A hip phantom was used to compare known movements of the femoral head within a metal-backed acetabular component to FHP measured radiographically using RSA, Hip Analysis Suite (HAS), PolyWare, Ein Bild Roentgen Analyse (EBRA), and Roentgen Monographic Analysis Tool (ROMAN). RSA was significantly more accurate than the HAS, PolyWare, and ROMAN methods when measuring 2D FHP with a 28 mm femoral head. Femoral head size influenced the accuracy of HAS and ROMAN 2D FHP measurements, EBRA proximal measurements, and RSA measurements in the proximal and anterior direction. The use of different acetabular reference segments did not influence accuracy of RSA measurements. The superior accuracy and reduced variability of RSA wear measurements allow much smaller cohorts to be used in RSA clinical wear studies than those utilizing other software programs. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:988-996, 2017.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 04-2017
DOI: 10.1302/0301-620X.99B4.BJJ-2016-0805.R1
Abstract: The purpose of this study was to determine the sensitivity, specificity and predictive values of previously reported thresholds of proximal translation and sagittal rotation of cementless acetabular components used for revision total hip arthroplasty (THA) at various times during early follow-up. Migration of cementless acetabular components was measured retrospectively in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup) in two groups of patients. In Group A, components were recorded as not being loose intra-operatively at re-revision THA (52 components/48 patients) and Group B components were recorded to be loose at re-revision (42 components/36 patients). The mean proximal translation and sagittal rotation were significantly higher in Group B than in Group A from three months onwards (p 0.02). Proximal translation 1.0 mm within 24 months had a positive predictive value (PPV) of 90% and a specificity of 94%, but a sensitivity of 64%. Proximal translation 1.0 mm within the first 24 months correctly identified 76 of 94 (81%) of components to be either loose or not loose. However, ten components in Group B (24%) did not migrate proximally above 1.0 mm within the first 60 months. The high PPV of EBRA-Cup measurements of proximal translation (90%) shows that this can be used in early follow-up to identify patients at risk of aseptic loosening. The absence of proximal translation within the first 60 months indicates a component is not likely to be loose at re-revision THA although it does not exclude late aseptic loosening as a cause of failure. Cite this article: Bone Joint J 2017 -B:465–74.
Publisher: Wiley
Date: 12-10-2014
DOI: 10.1111/ANS.12884
Abstract: Revision surgery is currently the recommended treatment for Vancouver B2 femoral periprosthetic fractures, but isolated open reduction and internal fixation (ORIF) might be an effective treatment for these fractures around cemented collarless polished tapered (CCPT) stems, as these stems can re-engage in the cement mantle, regaining stability following internal fixation. The aim of this study was to determine the operative risks, post-operative complications, and radiographic and functional outcomes in two cohorts of Vancouver B2 femoral fractures around CCPT stems treated either by ORIF alone or revision surgery. The results of 12 patients with B2 periprosthetic fractures around a CCPT stems treated by ORIF alone (median follow-up 67 months) were compared with those of nine patients with a similar fracture treated by revision surgery (median follow-up 59 months). All fractures treated by ORIF alone healed and all stems restabilized and remained stable within their original cement mantle. These patients had significantly shorter overall operating room times (P = 0.002), surgical times (P = 0.002) and required fewer units of blood transfusion (P = 0.008) than patients in the revision cohort. In the ORIF cohort, one patient had two dislocations. In the revision cohort, one patient had delayed wound healing, a second patient had delayed wound healing and two dislocations, and a third patient had two dislocations. Although further studies with larger numbers are required, treatment of these fractures with ORIF alone may be a viable alternative to revision surgery as it reduces the operative risks involved.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-08-2012
DOI: 10.2106/JBJS.K.00877
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2010
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/758123
Abstract: Modularity at the head-neck junction of the femoral component in THA became popular as a design feature with advantages of decreasing implant inventory and allowing adjustment of leg length, offset, and soft tissue balancing through different head options. The introduction of a new modular interface to femoral stems that were previously monoblock, or nonmodular, comes with the potential for corrosion at the taper junction through mechanically assisted crevice corrosion. The incidence of revision hip arthroplasty is on the rise and along with improved wear properties of polyethylene and ceramic, use of larger femoral head sizes is becoming increasingly popular. Taper corrosion appears to be related to all of its geometric parameters, material combinations, and femoral head size. This review article discusses the pathogenesis, risk factors, clinical assessment, and management of taper corrosion at the head-neck junction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2012
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.ACTBIO.2012.04.037
Abstract: Wear particle-induced orthopaedic prosthesis loosening is associated with elevated osteoclast activity. The immunoreceptor tyrosine-based activation motif (ITAM)-related molecules OSCAR, FcRγ, TREM2 and DAP12 are important for osteoclast formation. The aim of this study was to determine if these molecules are involved in peri-implant loosening by investigating their expression in peri-implant tissues obtained at revision of joint replacement components containing polyethylene (PE) wear particles, and in osteoclasts formed in vitro in the presence of PE particles. The results showed that there was a marked and statistically significant increase in protein levels of the ITAM-related molecules in the revision tissues. The levels of OSCAR, FcRγ, TREM2 and DAP12 mRNA in the revision tissues were also increased. In vitro PE particles stimulated osteoclast resorption in the presence of 50 ng ml(-1) receptor activator NFκB (RANKL) and significantly elevated the expression of OSCAR, FcRγ, TREM2 and DAP12 during osteoclast formation. These findings suggest that the ITAM signalling molecules and their co-receptors have a role in pathogenic bone loss associated with implant PE wear.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.ARTH.2019.03.003
Abstract: The aim of this study is to assess the outcomes of 52 consecutive Vancouver B2 peri-prosthetic fractures around cemented polished double-tapered stems treated by open reduction and internal fixation in 2 trauma centers in 2 countries. Outcomes included modified Harris Hip Score (mHHS), Harris Pain Score, and return to pre-injury mobility. Fracture healing was assessed implant subsidence measured and complications including re-operations reported. No patient was lost to follow-up. Median patient age at operation was 82 years (range 43-98) Harris pain scores showed minimal pain (median 42, range 10-44) at latest follow-up. Median total subsidence at 1 year was 1.1 mm (range 0-5.4), the majority of which occurred within the cement mantle. No subsequent femoral stem revision was required (median 2.9 years, 0-10) however, there were 3 re-operations: 1 re-operation for pre-existing recurrent dislocation involving head liner exchange and 2 for repeat fixation due to metal fatigue. Two additional fractures occurred below the new plating, requiring further plating whilst still retaining the original stems. Anatomical reduction and open reduction and internal fixation of Vancouver B2 peri-prosthetic fractures should be considered as an appropriate treatment solution for frail elderly patients with a peri-prosthetic fracture around cemented polished double-tapered stems.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Publisher: Springer Science and Business Media LLC
Date: 15-10-2013
DOI: 10.1007/S10787-013-0192-6
Abstract: Periprosthetic osteolysis is a serious complication of total hip replacement (THR) in the medium to long term. Although often asymptomatic, osteolysis can lead to prosthesis loosening and periprosthetic fracture. These complications cause significant morbidity and require complex revision surgery. Here, we review advances in our understanding of the cell and tissue response to particles produced by wear of the articular and non-articular surfaces of prostheses. We discuss the molecular and cellular regulators of osteoclast formation and bone resorptive activity, a better understanding of which may lead to pharmacological treatments for periprosthetic osteolysis. We describe the development of imaging techniques for the detection and measurement of osteolysis around THR prostheses, which enable improved clinical management of patients, provide a means of evaluating outcomes of non-surgical treatments for periprosthetic osteolysis, and assist in pre-operative planning for revision surgery. Finally, there have been advances in the materials used for bearing surfaces to minimise wear, and we review the literature regarding the performance of these new materials to date.
Publisher: ASME International
Date: 24-09-2014
DOI: 10.1115/1.4028522
Abstract: Periprosthetic osteolysis in the retroacetabular region with cancellous bone loss is a recognized phenomenon in the long-term follow-up of total hip replacement. The effects on load transfer in the presence of defects are less well known. A validated, patient-specific, 3D finite element (FE) model of the pelvis was used to assess changes in load transfer associated with periprosthetic osteolysis adjacent to a cementless total hip arthroplasty (THA) component. The presence of a cancellous defect significantly increased (p 0.05) von Mises stress in the cortical bone of the pelvis during walking and a fall onto the side. At loads consistent with single leg stance, this was still less than the predicted yield stress for cortical bone. During higher loads associated with a fall onto the side, highest stress concentrations occurred in the superior and inferior pubic rami and in the anterior column of the acetabulum with larger cancellous defects.
Publisher: Wiley
Date: 09-2004
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 09-2014
DOI: 10.1302/0301-620X.96B9.34269
Abstract: Peri-acetabular osteotomy is an established surgical treatment for symptomatic acetabular dysplasia in young adults. An anteroposterior radiograph of the pelvis is commonly used to assess the extent of dysplasia as well as to assess post-operative correction. Radiological prognostic factors include the lateral centre-edge angle, acetabular index, extrusion index and the acetabular version. Standing causes a change in the pelvis tilt which can alter certain radiological measurements relative to the supine position. This article discusses the radiological indices used to assess dysplasia and reviews the effects of patient positioning on these indices with a focus on assessment for a peri-acetabular osteotomy. Intra-operatively, fluoroscopy is commonly used and the implications of using fluoroscopy as a modality to assess the various radiological indices along with the effects of using an anteroposterior or posteroanterior fluoroscopic view are examined. Each of these techniques gives rise to a slightly different image of the pelvis as the final image is sensitive to the position of the pelvis and the projection of the x-ray beam. Cite this article: Bone Joint J 2014 -B:1155–60.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-06-2012
DOI: 10.2106/JBJS.K.00570
Publisher: Elsevier BV
Date: 05-2004
DOI: 10.1016/J.BIOMATERIALS.2003.09.005
Abstract: Tantalum (Ta) is increasingly used in orthopaedics, although there is a paucity of information on the interaction of human osteoblasts with this material. We investigated the ability of Ta to support the growth and function of normal human osteoblast-like cells (NHBC). Cell responses to polished and textured Ta discs were compared with responses to other common orthopaedic metals, titanium and cobalt-chromium alloy, and tissue culture plastic. No consistent differences, that could be attributed to the different metal substrates or to the surface texture, were found in several measured parameters. Attachment of NHBC to each substrate was similar, as was cell morphology, as determined by confocal microscopy. Cell proliferation was slightly faster on plastic than on Ta at 3 days, but by 7 days neither the absolute cell numbers, nor the number of cell isions, was different between Ta and the other substrates. No consistent, substrate-dependent differences were seen in the expression of a number of mRNA species corresponding to the pro-osteoclastic or the osteogenic activity of osteoblasts. No substrate-dependent differences were seen in the extent of in vitro mineralisation by NHBC. These results indicate that Ta is a good substrate for the attachment, growth and differentiated function of human osteoblasts.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Elsevier BV
Date: 06-1990
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.BIOMATERIALS.2009.03.035
Abstract: Polyethylene (PE) wear particles are associated with the osteolysis seen in aseptic loosening that leads to orthopaedic implant failure. While cells of the monocyte/macrophage lineage are implicated, evidence is now emerging that osteoblastic cells may also be affected by PE. In this study we investigated the effect of PE particles on osteoblasts, using a novel in vitro cell culture system that was developed to juxtapose cells and PE particles, replicating the 3-dimensional (3D) environment near implants. This system allowed normal human bone-derived cells (NHBC) to undergo differentiation into a mature osteocyte-like phenotype over a 21-28-day culture period. PE particles induced an increase in mRNA expression of the osteocyte markers E11, DMP-1 and SOST/sclerostin. NHBC responded to PE particles by increasing the mRNA expression of several genes associated with osteoclast formation and activity (RANKL, IL-8 and M-CSF) and decreased the expression of the osteoclast antagonist, OPG. PE also appeared to induce a switch in the RUNX2 control of gene expression from that of promoting matrix production (type I collagen) to inducing the expression of pro-osteoclastogenic genes. These results suggest that PE particles switch mature osteoblastic cells from an anabolic to a more catabolic phenotype. This concept was further supported by the finding that PE-induced expression of RANKL mRNA in the mouse osteocyte cell line, MLO-Y4. Overall, our results suggest that PE particles directly induce a change in the phenotype of mature osteoblasts and osteocytes, consistent with the net loss of bone near orthopaedic implants.
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1016/J.ARTH.2004.09.028
Abstract: Twenty-four cobalt-chrome alloy McKee-Farrar matching acetabular and femoral components were retrieved at revision total hip arthroplasty. The average time in situ was 16 years. Wear and loss of sphericity was very low. Polishing wear (type 1), fine abrasive (type 2), multidirectional dull abrasive (type 3), and unidirectional dull abrasive wear (type 4) of the articulating surfaces were identified. The mean percent area of femoral heads occupied by types 2, 3, and 4 wear was 18%, 5%, and 2%, respectively. There was no association between the type and distribution of wear and the time in situ. Impingement damage was evident on 9 implant pairs. The extent and types of wear described in this paper will be useful when analyzing the patterns of surface damage of newer designs of metal-on-metal articulations.
Publisher: Wiley
Date: 2016
DOI: 10.1111/IMJ.12945
Abstract: An anaemia clinic was established to improve the preoperative management of elective orthopaedic patients scheduled for arthroplasty. This paper is a report on the first 100 patients assessed. To assess the incidence and causes of anaemia in patients on a waiting list for elective arthroplasty in a public hospital and to assess the impact of anaemia detection in this patient population. Patients attending an Anaemia Clinic for elective orthopaedic surgical patients, during March 2010 to June 2013 were studied. Outcome measures included change in haemoglobin preoperative results and perioperative transfusion rates by preoperative haemoglobin. Seventeen per cent of patients scheduled for elective surgery were found to be anaemic. Of the 100 patients who attended, approximately half were found to be iron deficient and the remainder had anaemia of chronic disease. Serum ferritin <30 µg/L alone did not identify iron deficiency in 80% of patients with iron deficiency. Patients with iron deficient anaemia were able to be treated, in all cases, to achieve a significant increase in preoperative haemoglobin. The general unavailability of erythropoietin limited effective intervention for the non-iron-deficient anaemic patients. Seven patients had their surgery cancelled because of the screening programme. Half of the anaemic patients in a joint replacement screening clinic were iron deficient, and treatment was effective in improving the pre-operative haemoglobin and reducing perioperative transfusion rates. This screening process should improve patient outcome. Another important finding in this group of patients is that ferritin levels cannot be reliably used as the sole indicator in the diagnosis of iron deficiency anaemia in this group of patients undergoing elective arthroplasty.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2019
Abstract: We describe 2 cases of nonagenarians with periprosthetic knee fractures that were not amenable to either standard internal fixation nor prosthesis revision because of infected leg ulcers in the same limb. The fractures were internally fixed by percutaneous insertion of medial and lateral plates that spanned the knee. Both patients returned to their baseline level of activity without developing surgical site infections. Percutaneous bridging plates that span the knee are a useful option for treating these difficult cases.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 11-2018
DOI: 10.1302/0301-620X.100B11.BJJ-2018-0092.R2
Abstract: Osteolysis, secondary to local and systemic physiological effects, is a major challenge in total hip arthroplasty (THA). While osteolytic defects are commonly observed in long-term follow-up, how such lesions alter the distribution of stress is unclear. The aim of this study was to quantitatively describe the biomechanical implication of such lesions by performing subject-specific finite-element (FE) analysis on patients with osteolysis after THA. A total of 22 hemipelvis FE models were constructed in order to assess the transfer of load in 11 patients with osteolysis around the acetabular component of a THA during slow walking and a fall onto the side. There were nine men and two women. Their mean age was 69 years (55 to 81) at final follow-up. Changes in peak stress values and loads to fracture in the presence of the osteolytic defects were measured. The von Mises stresses were increased in models of those with and those without defects for both loading scenarios. Although some regions showed increases in stress values of up to 100%, there was only a moderate 11.2% increase in von Mises stress in the series as a whole. The site of fracture changed in some models with lowering of the load to fracture by 500 N. The most common site of fracture was the pubic ramus. This was more frequent in models with larger defects. We conclude that cancellous defects cause increases in stress within cortical structures. However, these are likely to lead to a modest decrease in the load to fracture if the defect is large ( 20cm 3 ) or if the patient is small with thin cortical structures and low bone mineral density. Cite this article: Bone Joint J 2018 -B:1455–62.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-11-2019
DOI: 10.1097/CORR.0000000000000571
Abstract: The Bernese periacetabular osteotomy (PAO) is a complex surgical procedure with a substantial learning curve. Although larger hospital and surgeon procedure volumes have recently been associated with a lower risk of complications, in geographically isolated regions, some complex operations such as PAO will inevitably be performed in low volume. A continuous structured program of distant mentoring may offer benefits when low numbers of PAOs are undertaken, but this has not been tested. We sought to examine a structured, distant-mentorship program of a low-volume surgeon in a geographically remote setting. The purposes of this study were (1) to identify the clinical results of PAO performed in a remote-mentorship program, as determined by patient-reported outcome measures and complications of the surgery (2) to determine radiographic results, specifically postoperative angular corrections, hip congruity, and progression of osteoarthritis and (3) to determine worst-case analysis of PAO survivorship, defined as nonconversion to THA, in a regionally isolated cohort of patients with a high rate of followup. Between August 1992 and August 2016, 85 PAOs were undertaken in 72 patients under a structured, distant-mentorship program. The patients were followed for a median of 5 years (range, 2-25 years). There were 18 males (21 hips) and 54 females (64 hips). The median age of the patients at the time of surgery was 26 years (range, 14-45 years). One patient was lost to followup (two PAOs) and one patient died as a result of an unrelated event. Patient-reported outcome measures and complications were collected through completion of patient and doctor questionnaires and clinical examination. Radiographic assessment of angular correction, joint congruity, and osteoarthritis was undertaken using standard radiology software. PAO survivorship was defined as nonconversion to THA and is presented using worst-case analysis. The loss-to-followup quotient—number of patients lost to followup ided by the number of a patients converted to THA—was calculated to determine quality of followup and reliability of survivorship data. The median preoperative Harris hip scores of 58 (range, 20-96) improved postoperatively to 78 (range, 33-100), 86 (range, 44-100), 87 (range, 55-97), and 80 (range, 41-97) at 1, 5, 10, and 14 years, respectively. Sink Grade III complications at 12 months included four relating to the PAO and one relating to the concomitant femoral procedure. The median lateral center-edge angle correction achieved was 22° (range, 3°-50°) and the median correction of acetabular index was 19° (range, 3°-37°). Osteoarthritis progressed from a preoperative mean Tönnis grade of 0.6 (median, 1 range, 0-2) to a postoperative mean of 0.9 (median, 1 range, 0-3). Six hips underwent conversion to THA: five for progression of osteoarthritis and one for impingement. At 12-year followup, survivorship of PAO was 94% (95% confidence interval [CI], 85%-98%) and survivorship with worst-case analysis was 90% (95% CI, 79%-96%). The loss-to-followup quotient for this study was low, calculated to be 0.3. When PAO is performed using a structured process of mentoring under the guidance of an expert, one low-volume surgeon in a geographically isolated region achieved good patient-reported outcomes, a low incidence of complications at 12 months, satisfactory radiographic outcomes, and high survivorship. A structured distant-mentorship program may be a suitable method for initially learning and continuing to perform low-volume complex surgery in a geographically isolated region. Level IV, therapeutic study.
Publisher: SAGE Publications
Date: 12-1991
DOI: 10.1243/PIME_PROC_1991_205_302_02
Abstract: This paper outlines the main areas of bioengineering research in the Department of Orthopaedic Surgery and Trauma at the Royal Adelaide Hospital, South Australia.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 07-2007
DOI: 10.1302/0301-620X.89B7.18981
Abstract: We investigated 219 revisions of total hip replacement (THR) in 211 patients using a collarless double-taper cemented femoral component. The mean age of the patients was 72 years (30 to 90). The 137 long and 82 standard length stems were analysed separately. The mean follow-up was six years (2 to 18), and no patient was lost to follow-up. Survival of the long stems to re-revision for aseptic loosening at nine years was 98% (95% confidence interval (CI) 94 to 100), and for the standard stems was 93% (95% CI 85 to 100). At five years, one long stem was definitely loose radiologically and one standard stem was probably loose. Pre-operative femoral bone deficiency did not influence the results for the long stems, and corrective femoral osteotomy was avoided, as were significant subsidence, major stress shielding and persistent thigh pain. Because of these reliable results, cemented long collarless double-taper femoral components are recommended for routine revision THR in older patients.
Publisher: Medical Journals Sweden AB
Date: 10-10-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
DOI: 10.1097/ALN.0000000000001709
Abstract: Preoperative anemia is a significant predictor of perioperative erythrocyte transfusion in elective arthroplasty patients. However, interactions with other patient and procedure characteristics predicting transfusion requirements have not been well studied. Patients undergoing elective primary total hip arthroplasty or total knee arthroplasty at a tertiary hospital in Adelaide, South Australia, Australia, from January 2010 to June 2014 were used to identify preoperative predictors of perioperative transfusion. A logistic regression model was developed and externally validated with an independent data set from three other hospitals in Adelaide. Altogether, 737 adult patients in the derivation group and 653 patients in the validation group were included. Binary logistic regression modeling identified preoperative hemoglobin (odds ratio, 0.51 95% CI, 0.43 to 0.59 P & 0.001 for each 1 g/dl increase), total hip arthroplasty (odds ratio, 3.56 95% CI, 2.39 to 5.30 P & 0.001), and females 65 yr of age and older (odds ratio, 3.37 95% CI, 1.88 to 6.04 P = 0.01) as predictors of transfusion in the derivation cohort. Using a combination of patient-specific preoperative variables, this validated model can predict transfusion in patients undergoing elective hip and knee arthroplasty. The model may also help to identify patients whose need for transfusion may be decreased through preoperative hemoglobin optimization.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.ARTH.2011.05.007
Abstract: This preclinical in vivo screening study compared bone graft incorporation and stem subsidence in cemented hemiarthroplasty after femoral impaction bone grafting with either morselized allograft bone (n = 5, control group) or a 1:1 mix of allograft and porous hydroxyapatite ceramics (HA) granules (n = 5, HA group). At 14 weeks, there was excellent bone graft incorporation by bone, and the stems were well fixed in both groups. The median subsidence at the cement-bone interface, measured using radiostereometric analysis, was 0.14 and 0.93 mm in the control and HA groups, respectively. The comparable histologic results between groups and good stem fixation in this study support the conduct of a larger scale investigation of the use of porous HA in femoral impaction bone grafting at revision hip arthroplasty.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.ARTH.2005.07.023
Abstract: The wear performance of a polyurethane compliant layer (CL) material formed into an acetabular component and implanted into a sheep model of cemented total hip arthroplasty was assessed at 6, 12, 24, and 48 months. Four (11%) of 36 acetabular components debonded from the cement and one component was slightly loose at the cement-bone interface. There was no macroscopic evidence of fracture, wear, or deformation of the CL material on the articular surface of the acetabular components. Small numbers of polymeric wear particles was found in the hip synovial tissues of 10 sheep, most commonly in the early time groups, and were likely associated with initial wear of surface asperities. The wear performance of the CL was unchanged during a 48-month implantation period.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-11-2016
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1016/J.BIOMATERIALS.2006.05.054
Abstract: This study investigates receptor activator NF-kappaB (RANK), RANK ligand (RANKL) and tumour necrosis factor (TNFalpha), key factors regulating bone turnover, present in the tissues near peri-prosthetic osteolysis. Tissue was obtained from zones of peri-prosthetic osteolysis from 11 patients undergoing revision of total hip prostheses, analysed preoperatively by high-resolution spiral multislice CT using a metal artefact suppression protocol. Synovial tissue from 10 patients with osteoarthritis undergoing primary hip replacement was used as control tissue. Immunohistochemical analysis of formalin fixed tissue sections demonstrated that RANK, RANKL and TNFalpha were strongly expressed by large multinucleated cells containing polyethylene wear debris in revision tissues. Control tissue stained weakly for RANK, RANKL and TNFalpha. A strong statistical correlation (p<0.02) was found between the five parameters, volume of bone loss, polyethylene wear debris, RANK, RANKL and TNFalpha expression. Importantly, in vitro studies revealed that RANKL and TNFalpha synergise to increase the volume of bone resorbed, by more than seven fold, when compared to the effect of either cytokine treatment alone. This suggests that the interaction of TNFalpha and RANKL promotes osteoclast activity associated with polyethylene wear and therapies targeting TNF activity may be useful to treat peri-implant osteolysis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.ARTH.2011.09.012
Abstract: We examined the sensitivity and accuracy of measuring osteolysis around total knee arthroplasty (TKA) on radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) in a cadaver model. Fifty-four simulated osteolytic defects ranging from 0.7 to 14 cm(3) were created in 6 cadaver knees implanted with either a cemented or an uncemented TKA. Three blinded investigators assessed the presence, location, and volume of defects on radiographs and CT and MRI scans with metal reduction protocols. Both CT and MRI had significantly higher sensitivities and specificities than did plain radiographs (P < .005). Overall, there was no difference in the accuracy of defect volume measurements between CT and MRI (P = .574). This study demonstrates the limitations of radiographs and the high sensitivity and specificity of both CT and MRI in assessing osteolysis around TKA.
Publisher: Wiley
Date: 20-02-2020
DOI: 10.1002/JOR.24623
Publisher: SAGE Publications
Date: 16-05-2016
Abstract: The posterior approach to the hip is the most common extensile approach used, however exposure is limited superiorly by the superior gluteal neurovascular bundle (SGNB). The extra-pelvic course of the SGNB demonstrates variability between in iduals, occasionally located only 1 cm from the acetabular rim. In complex acetabular reconstructions where the application of a reinforcement cage maybe required protecting the SGNB is challenging. The flanges of these cages are designed to sit on the ilium superior to the acetabular rim and to receive screws for fixation. The application of such cages may result in iatrogenic injury to the SGNB by way of forceful retraction or entrapment. We describe a technique that involves exposure and release of the SGNB such that the flanges of cage constructs may be safely applied.
Publisher: Springer Science and Business Media LLC
Date: 07-09-2011
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.CLINBIOMECH.2013.07.003
Abstract: A gamma irradiation dose of 15kGy has been shown to adequately sterilise allograft bone, commonly used in femoral impaction bone grafting to treat bone loss at revision hip replacement, without significantly affecting its mechanical properties. The objective of this study was to evaluate whether use of 15kGy irradiated bone affects the initial mechanical stability of the femoral stem prosthesis, as determined by micromotion in a comprehensive testing apparatus, in a clinically relevant time zero in vitro model of revision hip replacement. Morselised ovine bone was nonirradiated (control), or irradiated at 15kGy or 60kGy. For each dose, six ovine femurs were implanted with a cemented polished taper stem following femoral impaction bone grafting. Using testing apparatus that reproduces stem loading, stems were cyclically loaded and triaxial micromotion of the stem relative to the bone was measured at the proximal and distal stem regions using non-contact laser transducers and linear variable differential transformers. There were no significant differences in proximal or distal stem micromotion between groups for all directions (p≤0.80), apart for significantly greater distal stem medial-lateral micromotion in the 60kGy group compared to the 15kGy group (P=0.03), and near-significance in the anterior-posterior direction (P=0.08, power=0.85). Using a clinically relevant model and loading apparatus, irradiation of bone at 15kGy does not affect initial femoral stem stability following femoral impaction bone grafting.
Publisher: Baishideng Publishing Group Inc.
Date: 2011
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.INJURY.2013.04.024
Abstract: Lateral tibial plateau fractures that are located posterolaterally are difficult to reduce through an anterolateral surgical approach because of the lack of direct visualisation of the fracture. This study compared the results of unicondylar posterolateral tibial plateau fractures in two patient cohorts: one treated through a posterolateral direct approach and the other through an anterolateral indirect approach. All nine patients admitted to our hospital, a tertiary care, urban, public hospital in Australia, from 2007 to 2010 with unicondylar posterolateral tibial plateau fractures were treated through a direct posterolateral transfibular approach and prospectively studied. All eight patients admitted from 2004 to 2007 with unicondylar posterolateral tibial plateau fractures were treated through an indirect anterolateral approach and retrospectively reviewed. Fracture reduction and maintenance of reduction were assessed radiographically over 2 years. Knee function was assessed clinically and using the Lysholm score. Fractures managed through a direct posterolateral transfibular approach were reduced with no measurable articular step on standard radiography and had no loss of reduction over time. By contrast, fractures treated through an indirect anterolateral approach had a median postoperative articular step of 5.5mm (interquartile range=4.5). These displacements worsened over time in six of the eight patients. At 2 years, patients treated through a direct approach had significantly better Lysholm scores than those treated through an indirect approach. This study suggests that a direct posterolateral transfibular approach to unicondylar posterolateral tibial plateau fractures results in improved reduction, stabilisation and functional outcomes at early follow-up compared to an indirect anterolateral approach.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2020
DOI: 10.2106/JBJS.RVW.19.00170
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.
Publisher: Wiley
Date: 09-1999
Abstract: Periprosthetic bone loss is an important contributory factor for aseptic loosening of total joint replacements. It has recently been shown that osteoclast precursor cells are present in the wear particle-associated macrophage infiltrate found in the membrane surrounding loose implants and that these cells are capable of differentiating into osteoclastic bone-resorbing cells. Long-term co-culture of arthroplasty-derived macrophages and the rat osteoblast-like cell line, UMR-106, in the presence of 1,25(OH)2D3 results in the formation of numerous multinucleated cells that are positive for tartrate-resistant acid phosphatase and vitronectin receptor and capable of extensive lacunar bone resorption. The aim of this study was to determine the effect of cytokines/growth factors, known to be present in the arthroplasty membrane, on this process of osteoclast differentiation. During osteoclast formation, increased levels of macrophage colony-stimulating factor, interleukin-6, and to a lesser extent, interleukin-1beta, but not tumour necrosis factor alpha, were detected in the co-culture supernatants. Addition of neutralising antibodies to human interleukin-1beta or tumour necrosis factor alpha to the co-culture system did not inhibit osteoclast formation. In contrast, co-cultures to which neutralising antibodies to human macrophage colony-stimulating factor or interleukin-6 were added contained fewer cells positive for tartrate-resistant acid phosphatase and vitronectin receptor and formed significantly fewer resorption pits. Time-course studies showed that macrophage colony-stimulating factor and interleukin-6 increase osteoclast formation mainly in the early stages of osteoclast differentiation. These results indicate that the release of macrophage colony-stimulating factor and interleukin-6 by activated cells in the arthroplasty membrane is likely to contribute to pathological bone resorption associated with aseptic loosening by stimulating differentiation of mononuclear phagocyte osteoclast precursors into mature bone-resorbing cells.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 06-2011
DOI: 10.1302/0301-620X.93B6.26122
Abstract: We investigated the stability of seven Schatzker type II fractures of the lateral tibial plateau treated by subchondral screws and a buttress plate followed by immediate partial weight-bearing. In order to assess the stability of the fracture, weight-bearing inducible displacements of the fracture fragments and their migration over a one-year period were measured by differentially loaded radiostereometric analysis and standard radiostereometric analysis, respectively. The mean inducible craniocaudal fracture fragment displacements measured −0.30 mm (−0.73 to 0.02) at two weeks and 0.00 mm (−0.12 to 0.15) at 52 weeks. All inducible displacements were elastic in nature under all loads at each examination during follow-up. At one year, the mean craniocaudal migration of the fracture fragments was −0.34 mm (−1.64 to 1.51). Using radiostereometric methods, this case series has shown that in the Schatzker type II fractures investigated, internal fixation with subchondral screws and a buttress plate provided adequate stability to allow immediate post-operative partial weight-bearing, without harmful consequences.
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.ARTH.2009.04.007
Abstract: The long-term survival of 270 Wagner resurfacing hip arthroplasties was determined. Two patients were lost to follow-up. Eleven hips remained unrevised at 15 to 22 years. Survival at 5, 10, and 16 years was 74%, 35%, and 17%, respectively. Survival in patients older than 55 years was better after 5 years than that for patients 55 years or younger (P = .0067). Femoral neck fracture occurred in 2% of the total cohort. Femoral component failure was an early and midterm complication. Acetabular component loosening was the most common reason for revision. The proportion of cases revised for acetabular component failure increased with time. These long-term data in this large series provide important historical results against which the relative benefits of contemporary designs may be evaluated.
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.ARTH.2013.08.014
Abstract: The aims of this were to examine the effect of acetabular liner exchange and intra-operative bone grafting surgery on peri-prosthetic osteolysis. Seven patients with well-fixed Harris-Galante-1 acetabular components received cemented exchange liners for worn liners associated with pre-operatively CT-quantified osteolysis. During surgery, accessible osteolytic lesions were debrided and bone-grafted. Except for one patient with recurrent dislocation and acetabular component revision, the other patients had CT scans at a median of 4 months and at approximately 4 years after surgery. None of the pre-operative lesions increased in volume during the post-operative reporting period and no new lesions were detected. These results show that cemented liner exchange surgery can halt the progression of osteolysis and that bone grafting has the potential to restore bone.
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.ARTH.2013.08.015
Abstract: This study investigated the variability of os coxae's volume and linear morphometry in 50 dry adult bones. There was a wide variability, with coefficients of variation exceeding 30%, of the bones' volumes (mean 142 ml, range 80 to 300 ml) and distances between the acetabular rim and the horizontal plane through the sciatic notch (mean 10.6 mm, range -7 to 19 mm). The smallest width of the ilium ranged between 3 and 9 mm at a level between 1.5 and 4 cm above the acetabulum. The volume of os coxae correlated with the acetabular diameter (r = 0.79), the height of os coxae (r = 0.88) and antero-posterior length of the ilium at mid-acetabular level (r = 0.70). Knowledge of the variability of os coxae may be useful during preoperative planning in primary and revision hip arthroplasty.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.ARTH.2016.11.031
Abstract: The risk of revision following primary total hip arthroplasty (THA) is increased in young patients who undergo THA for pathologies other than primary osteoarthritis. We report the results of primary THA performed with cemented polished stems in patients aged 40 years and younger for pathologies other than primary osteoarthritis. We investigated 52 patients (65 hips) who underwent primary THA for secondary osteoarthritis with a cemented tapered polished stem between 1990 and 2007. Clinical and radiographic outcomes, available in 46 patients (57 hips), included the Harris Hip Scores, Societe Internationale de Chirurgie Orthopedique et de Traumatologie activity, patient satisfaction, stem survival and reoperations, and assessment of prosthesis-cement-bone radiolucencies, osteolysis, and femoral bone deficiencies. Median patient age was 34 years (16-40) and follow-up was 14 years (mean 13, range 5-22). Stem survival to the endpoint revision for loosening was 100% and to the endpoint revision for any reason, excluding infection was 88% (95% confidence interval 78-98) at 16 years. No stem was revised for aseptic loosening. Nine stems were revised for other reasons. Radiographically, one stem was definitely loose at 16 years. The median patient Harris pain score improved from marked pain to no pain at latest follow-up. Patient activity level improved, albeit minimally, for 8 years after surgery. At latest follow-up, 98% of the patients remained satisfied with their surgery. Primary THA with a cemented polished stem shows excellent results in young patients with pathology other than primary osteoarthritis. In addition, the stem design facilitates cement within cement exchange and therefore preservation of proximal femoral bone stock at revision surgery.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 04-2017
DOI: 10.1302/0301-620X.99B4.BJJ-2016-0804.R1
Abstract: This study aimed to determine the diagnostic performance of radiographic criteria to detect aseptic acetabular loosening after revision total hip arthroplasty (THA). Secondary aims were to determine the predictive values of different thresholds of migration and to determine the predictive values of radiolucency criteria. Acetabular component migration to re-revision was measured retrospectively using Ein-Bild-Rontgen-Analyse (EBRA-Cup) and manual measurements (Sutherland method) in two groups: Group A, 52 components (48 patients) found not loose at re-revision and Group B, 42 components (36 patients) found loose at re-revision between 1980 and 2015. The presence and extent of radiolucent lines was also assessed. Using EBRA, both proximal translation and sagittal rotation were excellent diagnostic tests for detecting aseptic loosening. The area under the receiver operating characteristic (ROC) curves was 0.94 and 0.93, respectively. The thresholds of 2.5 mm proximal translation or 2° sagittal rotation (EBRA) in combination with radiolucency criteria had a sensitivity of 93% and specificity of 88% to detect aseptic loosening. The sensitivity, specificity, positive predictive value and negative predictive value (NPV) of radiolucency criteria were 41%, 100%, 100% and 68% respectively. Manual measurements of both proximal translation and sagittal rotation were very good diagnostic tests. The area under the ROC curve was 0.86 and 0.92 respectively. However, manual measurements had a decreased specificity compared with EBRA. Radiolucency criteria had a poor sensitivity and NPV of 41% and 68% respectively. This study shows that EBRA and manual migration measurements can be used as accurate diagnostic tools to detect aseptic loosening of cementless acetabular components used at revision THA. Radiolucency criteria should not be used in isolation to exclude loosening of cementless acetabular components used at revision THA given their poor sensitivity and NPV. Cite this article: Bone Joint J 2017 -B:458–64.
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.ARTH.2007.06.001
Abstract: The clinical and radiographic outcomes of the cement-within-cement femoral stem exchange technique at revision hip arthroplasty were determined. Twenty-three revisions with a collarless polished double-taper stem design were prospectively monitored at up to 12 years. The most common indications for revision were recurrent dislocation and acetabular revision. Radiographic stem subsidence was measured by the Ein Bild Röentgen Analyse method. There was no stem re-revision and no radiographic loosening. Stem within cement subsidence, an intentional design feature of this stem, averaged 0.8 mm (range, 0-2 mm). The average subsidence was similar to that in primary hip arthroplasty. The excellent long-term results of cemented collarless polished taper stems for primary and revision hip arthroplasty can be extended even further by cement-within-cement exchange, which preserves the femur.
Publisher: Wiley
Date: 10-2008
DOI: 10.1002/CA.20697
Abstract: Pelvic external fixators have a high rate of reported complications, most of which relate to pin placement. In this descriptive study, we analyzed the morphology of the ilium in cadaveric specimens and compared these with the measures obtained from normal human pelvic computer tomograph scans, and how these related to each of the three basic configurations of pin positioning for the external fixation of a pelvis: anterosuperior (Slätis type), anteroinferior (supra-acetabular), and subcristal. The irregular shape and size of the iliac wing and the abdominal wall overlying the pin's insertion site could hinder accurate placement of anterosuperior pins. Potential disadvantages of the use of anteroinferior pins was found related to the deep location of the anterior inferior iliac spine, interference with the hip flexion area, risk of hip joint penetration, and the variable obliquity of the ilium. As subcristal pins are positioned between two superficial bony landmarks of the iliac crest, our findings suggest that they are more likely to have a correct placement and avoid complications.
Publisher: Wiley
Date: 16-07-2007
DOI: 10.1002/JBM.A.31336
Abstract: Porous tantalum (Ta) has found application in orthopedics, although the interaction of human osteoblasts (HOB) with this material has not been reported. The aim of this study was to investigate the interaction of primary HOB with porous tantalum, using 5-mm thick discs of porous tantalum. Comparison was made with discs of solid tantalum and tissue culture plastic. Confocal microscopy was used to investigate the attachment and growth of cells on porous Ta, and showed that HOB attached successfully to the metal "trabeculae," underwent extensive cell ision, and penetrated into the Ta pores. The maturation of HOB on porous Ta was determined in terms of cell expression of the osteoblast phenotypic markers, STRO-1, and alkaline phosphatase. Despite some donor-dependent variation in STRO-1/AlkPhos expression, growth of cells grown on porous Ta either promoted, or did not impede, the maturation of HOB. In addition, the expression of key osteoblastic genes was investigated after 14 days of culture. The relative levels of mRNA encoding osteocalcin, osteopontin and receptor activator of NFkappaB ligand (RANKL) was not different between porous or solid Ta or plastic, although these genes were expressed differently by cells of different donors. However, bone sialoprotein and type I collagen mRNA species showed a decreased expression on porous Ta compared with expression on plastic. No substrate-dependent differences were seen in the extent of in vitro mineralization by HOB. These results indicate that porous Ta is a good substrate for the attachment, growth, and differentiated function of HOB.
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.ARTH.2006.12.051
Abstract: We present 14 cases of fracture of modern, high-nitrogen, stainless steel stems. Our clinical and radiological data suggest that heavy patients with small stems and poor proximal support are at risk for fracturing their implants. "Ch agne-glass" canals can lead to the use of smaller stems often placed in varus, which can lead to cantilever bending and fatigue failure in the distal half of the stem. Metallurgical assessment of the retrieved high-nitrogen, stainless steel stems reveals microstructural inconsistencies that may contribute to their failure. Based on our findings, careful consideration and attention to technique is required when using stainless steel stems in patients with high body mass index or high weight. Technique is particularly important in femurs with ch agne-glass canals.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 08-2015
DOI: 10.1302/0301-620X.97B8.34632
Abstract: The outcome of 219 revision total hip arthroplasties (THAs) in 98 male and 121 female patients, using 137 long length and 82 standard length cemented collarless double-taper femoral stems in 211 patients, with a mean age of 72 years (30 to 90) and mean follow-up of six years (two to 18) have been described previously. We have extended the follow-up to a mean of 13 years (8 to 20) in this cohort of patients in which the pre-operative bone deficiency Paprosky grading was IIIA or worse in 79% and 73% of femurs with long and standard stems, respectively. For the long stem revision group, survival to re-revision for aseptic loosening at 14 years was 97% (95% confidence interval (CI) 91 to 100) and in patients aged 70 years, survival was 100%. Two patients (two revisions) were lost to follow-up and 86 patients with 88 revisions had died. Worst-case analysis for survival to re-revision for aseptic loosening at 14 years was 95% (95% CI 89 to 100) and 99% (95% CI 96 to 100) for patients aged 70 years. One additional long stem was classified as loose radiographically but not revised. For the standard stem revision group, survival to re-revision for aseptic loosening at 14 years was 91% (95% CI 83 to 99). No patients were lost to follow-up and 49 patients with 51 hips had died. No additional stems were classified as loose radiographically. Femoral revision using a cemented collarless double-taper stem, particularly with a long length stem, and in patients aged 70 years, continues to yield excellent results up to 20 years post-operatively, including in hips with considerable femoral metaphyseal bone loss. Cite this article: Bone Joint J 2015 -B:1038–45.
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1016/J.OCL.2004.12.001
Abstract: This article describes a randomized clinical trial in young patients, comparing metal-on-metal cemented resurfacing hip replacement with cemented total hip replacement. The trial was stopped early, mainly because of a high incidence of failure of the cemented resurfacing acetabular component. The results reinforce the importance of clinical trials for evaluating the safety and efficacy of prosthesis designs before being used in a large cohort of patients. Although there may be advantages of resurfacing hip replacement, trials are also required to demonstrate it has a midterm success that reasonably approaches that of total hip replacement.
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