Search

Purpose: Femoral component revision with either cemented or proximally coated stems has been disappointing, but revision with extensively coated stems has been promising. Our purpose was to evaluate the long-term outcome using an extensively hydroxyapatite (HA)-coated stem in femoral revisions surgery.Methods: During 1988-1993 we performed 66 femoral revisions in 65 patients (49 women), mean age 58 (range, 28-86) years. We used a grit-blasted straight stem made of TiAl6V4 designed for press-fit insertion (Landos Corail; Landanger, Chaumont, France). In 48 hips we used primary stems of size 10 in two cases, size 11 in two, size 12 in seven, size 13 in four, size 14 in 12, size 15 in eight, size 16 in 12 and size 18 in one. In 18 cases, we used revision stems of size 12 in four cases, size 14 in seven, size 16 in five and size 18 in two.Results: During follow-up, 21 patients have died. One patient had a traumatic fracture around the stem after six years, and another patient with osteoporosis developed fatigue fracture of the femoral bone after 22 years. In one patient the cup loosened after 23 years. The cup was revised, but deep infection occurred, and the patient underwent a two-stage revision of both components. Then, 12 of the revised stems were followed for more than ten years and 24 for more than 20 years. During this time only one stem was revised due to mechanical failure. This patient had a femoral defect classified to Type IV, and a proximal fracture occurred when the prosthesis was inserted. The fracture was stabilised by wires, but primary stability of the stem could not be obtained. At control examinations no patients suffered from significant thigh pain, and we noticed a low degree of proximal bone loss and a low incidence of distal bone hypertrophy.Conclusions: Our study suggests that a fully HA-coated stem in femoral revision surgery can provide reliable results for up to 27 years. The bone changes confirmed a well-fixed femoral component with a rather physiological transfer of stress from proximal to distal regions with no significant thigh pain. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to establish long-term outcome of the Spitzy shelf-operation and evaluate whether the procedure would delay osteoarthritis.Methods: During 1954-1976, 56 patients (70 hips) underwent Spitzy shelf operation at a mean age of 11.9 years (5 to 22). Indications included residual hip dysplasia or subluxation with Centre-Edge angle < 20°. We used survival analysis with conversion to total hip replacements as end-point. For patients without total hip replacement, information was provided from case records and radiographs. Avascular necrosis was assessed in pre-Spitzy radiographs, when available. Kaplan-Meier product-limit method was used to estimate survival function of the Spitzy shelf operation. Survival was assessed by Cox regression. Univariable Cox regression was performed separately for each variable. Potential predictors (p-value < 0.10) were entered into a multivariable regression model; p-value < 0.05 was considered significant.Results: Mean survival of the shelf procedure was 39.9 years (21 to 53). Survival fell from 83 % 30 years post-operatively, to 22 % at 50 years. Fifty-three hips (76 %) had undergone total hip replacement at mean age of 49.4 years (33 to 64). Seventeen hips had not received total hip replacement, mean survival 47.9 years (39 to 53).Conclusion: The study showed that Spitzy shelf-operation had satisfactory long-term outcome with hip-survival in almost 90 % at patient age 40 years. The results indicate that Spitzy shelf-operation postpone total hip replacement. We consider Spitzy shelf-operation a good alternative in patients above 8 years. In younger children the procedure is not recommended due to increased frequency of graft resorption. [ABSTRACT FROM AUTHOR]

Purpose: Adverse events associated with the use of bone cement for fixation of prostheses is a known complication. Due to inconclusive results in studies of hip fracture patients treated with cemented and uncemented hemiprostheses, this study was initiated. Methods: Our study is based on data reported to the Norwegian Hip Fracture Register on 11,210 cervical hip fractures treated with hemiprostheses (8,674 cemented and 2,536 uncemented). Results: Significantly increased mortality within the first day of surgery was found in the cemented group (relative risk 2.9, 95 % confidence interval 1.6-5.1, p=0.001). The finding was robust giving the same results after adjusting for independent risk factors such as age, sex, cognitive impairment and comorbidity [American Society of Anesthesiologists (ASA) score]. For the first post-operative day the number needed to harm was 116 (one death for every 116 cemented prosthesis). However, in the most comorbid group (ASA worse than 3), the number needed to harm was only 33. Conclusions: We found increased mortality for the cemented hemiprosthesis the first post-operative day compared to uncemented procedures. This increased risk is closely related to patient comorbidity estimated by the patient's ASA score. [ABSTRACT FROM AUTHOR]

Introduction: In the elderly, hip fracture is a common injury associated with high early mortality dominated by cardiorespiratory and thromboembolic events. Identification of risk factors that can be modified by treatment has caught attention over the last years. This study was conducted to assess biological markers on perioperative organ dysfunction and its association with early mortality within 3 months after surgery. Method: Blood samples were collected before, during and until 4 days after surgery. Analyses on PaO, alanine aminotransaminase (ALAT), gamma-glutamyl transpeptidase (g-GT) and creatinine were performed and used as markers on lung, liver and kidney functions. Patients: Three hundred and two patients over 75 years of age with acute dislocated hip fracture were consecutively enrolled from two hospitals in Norway. Results: We found a positive correlation between the plasma levels of ALAT, creatinine and death, and an inverse relationship between PaO and death. After controlling for confounding factors such as sex, age and comorbidity, ALAT and creatinine levels were shown to be significantly and independently related to risk for fatal outcome. Conclusion: Our results provide data on clinically important biomarkers in patients undergoing hip fracture surgery. We suggest a stronger emphasis on monitoring and correcting these biomarkers when possible. [ABSTRACT FROM AUTHOR]

Background: Donor site morbidity is a problem after autologous bone transplantation. An injectable CaP bone cement indicates properties similar to bone. Materials and methods: Double osteotomies on rat tibias were performed. The intercalated segments were avascular (10), vascular (10), or avascular with Norian SRS CaP bone cement replacing cancellous bone (10). Controls were non-operated contralateral tibias (15). All osteotomies were stabilised with an intra-medullary nail. After 8 weeks, all rats were killed. The harvested tibias were compared using X-ray, DEXA scanning, microCT scans and a biomechanical torsional test. Results: No difference in healing processes or biomechanical results has been found between the avascular bone graft, vascular bone graft and CaP bone cement groups. Conclusion: The injectable CaP bone cement confirms its similarities to bone, implying that it can be used as an adjunct to secure bone fragments and as a possible alternative to autologous bone transplantation in clinical practice. [ABSTRACT FROM AUTHOR]

Hip fracture, a moderate musculoskeletal trauma, is associated with a high postoperative mortality. Most patients are elderly, with comorbid conditions and often with heart disease. The objective of this study was to find out if clinical parameters and analyses of specific muscle enzymes could predict three month postoperative mortality. A total of 302 patients above 75 years of age with hip fracture were consecutively enrolled. Baseline information on age, sex and comorbidity assessed with the American Society of Anesthesiologists (ASA) score was obtained before surgery. Creatine kinase (CK), myocardium-specific creatine kinase (CK-MB) and troponin T (TnT) were analysed from venous blood, collected the day before surgery (−1) and postoperatively, within 24 hours (0) and on days one (+1) and four (+4). The overall three month mortality was 19.5%. Multivariate analyses showed that age, male sex and comorbidity (ASA) correlated with mortality ( p = 0.027, p = 0.002, p < 0.001, respectively). Surgery induced a two- to threefold increase of CK and CK-MB but without any correlation with mortality. However, high TnT levels >0.04 μg/l correlated significantly with death (days −1, +1 and +4, p = 0.003, p = 0.005 and p = 0.003, respectively). Multivariate analyses, adjusted for age, sex and ASA category, confirmed this correlation (day +4, p = 0.008). Thus, in elderly patients with comorbidities undergoing hip fracture surgery information on sex, age, ASA category and postoperative laboratory analyses on TnT provide the clinicians with useful information on patients at risk of fatal outcome. [ABSTRACT FROM AUTHOR]

Background: It has been indicated that, in the long term, the rate of wear and the degree of osteolysis observed with uncemented acetabular components are greater than those associated with cemented cups, but most studies which compare the wear characteristics of cementless with cemented cups have used historical controls. We report a direct comparison of wear of a cemented and an uncemented cup with similar design, polyethylene, and sterilization method. Materials and methods: The study cohort includes 92 patients who were operated in 1997 with primary total hip replacement and have been followed for a period of 9-10 years. All patients were operated by posterolateral approach. In patients 70 years or older we used a cemented cup, in those 60 years or younger we used an uncemented cup, and in patients between 60 and 70 years we used either a cemented or uncemented cup as decided by the surgeon. At follow-up, radiographic imaging was obtained as standard anterioposterior view of the pelvis, and mean wear was determined as described by Livermore et al. Results: The overall wear of the cemented acetabular components was 1.07 ± 0.78 mm, and that of the uncemented cups was 1.18 ± 0.61 mm ( P = 0.529). Wear was significantly associated with male sex ( P = 0.003), younger age ( P = 0.003), and degree of inclination ( P < 0.001), but wear was not significantly associated with cemented versus uncemented cup ( P = 0.437). Conclusion: Our findings in this 9-10-year follow-up study suggest that cementless cups wear no more than cemented cups of similar design. [ABSTRACT FROM AUTHOR]

The immune responses after musculoskeletal trauma are physiological reactions of the organism to restore homeostasis. An imbalance between the early systemic inflammatory response syndrome and the later compensatory anti-inflammatory response syndrome may be responsible for organ dysfunction and increased susceptibility to infections. Cytokines are known to be integral components of the immune response, and the balance or imbalance of the different cytokines partly controls the clinical course in the patients. The major pro-inflammatory cytokines include tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), IL-6, and IL-8. These cytokines are predominantly produced by monocytes and macrophages, they mediate overlapping effects, and their actions can be additive. TNF-α and IL-1β are early regulators of the immune response, and both induce the release of secondary pro-inflammatory cytokines. IL-10 is an anti-inflammatory cytokine which reduces the synthesis of pro-inflammatory mediators. The extent of traumatic damage correlates with the immunological changes and determines a graded depression of leucocytes to express cytokines on edotoxin exposure. Correspondingly, it has become clinically evident that in unstable traumatised patients, the recommendation today is damage control orthopaedics, i.e. initial stabilisation of long bone fractures by external fixation followed by definitive stabilisation at about 1 week. [ABSTRACT FROM AUTHOR]

Dislocation after primary total hip arthroplasty (THA) is a significant complication that occurs in 2–5% of patients. It has been postulated that increasing the femoral head diameter may reduce the risk of dislocation. The purpose of this paper is to report our experiences with a change from a 28 to a 32-mm femoral head. The retrospective cohort study includes 2572 primary THA performed with a 28 or 32 mm diameter femoral head in the period February 2002 to July 2009. All patients were operated with a posterolateral approach, and all except 18 were operated because of osteoarthritis. Cemented stems were used in 1991 cases and uncemented stems in 581 cases. Cemented cups were used in 2,230 cases and uncemented cups in 342 cases. The patients have been routinely followed for 1–8 years in the 28-mm femoral head group and from 0.5–7.5 years in the 32 femoral head group. We defined a dislocation as an event in which the hip required reduction by a physician. Dislocation occurred in 49 hips with a 28-mm femoral head and in 4 hips with a 32-mm femoral head with an odds ratio of 6.06 (95% CI = 2.05–17.8) ( P < 0.001). Otherwise, there were no significant associations between sex, age, diagnosis and type of prosthesis. Multivariate analyses of patients operated at our hospital indicate a significant association between femoral head diameter and dislocation after THA. There were no significant associations between dislocation and sex, age, diagnosis, or type of prosthesis. [ABSTRACT FROM AUTHOR]

Background Venous thrombosis is common in knee surgery, and it has been assumed that vein occlusion by tourniquet in itself may induce thrombogenic and fibrinolytic activity. Prophylactic treatment is used up to 12 h before or after surgery, and recent clinical trials suggest that the timing of initiating prophylaxis significantly influences antithrombotic effectiveness. Materials and methods We studied the time course of coagulation and fibrinolysis locally and systemically during total knee arthroplasty. Specific markers of thrombosis (prothrombin fragment 1.2 (F1.2)) and fibrinolysis (plasmin-antiplasmin (PAP) and D-dimer) were examined in seven female and two male patients. Results There were no systemic activations of either F1.2 ( P = 0.314), PAP ( P = 0.314) or D-dimer ( P = 0.600) during surgery or at 10 min postoperatively ( P = 0.139, 0.139 and 0.128, respectively) as compared to baseline data. At 4 h postoperatively there were significant increments in levels of F1.2 ( P = 0.008), PAP ( P = 0.038) and D-dimer ( P = 0.046). With tourniquet deflation the values of F1.2, PAP and D-dimer were significantly higher in the tourniquet limb than the in the contra lateral limb ( P = 0.025, 0.012 and 0.028, respectively). At 10 min after tourniquet deflation, the differences in F1.2, PAP and D-dimer between the two limbs were not significant. Conclusion The use of tourniquet in total knee arthroplasty causes local thrombogenic and fibrinolytic activity, but without influences in the systemic circulation. Systemic activations in thrombosis and fibrinolysis start when local mediators from the injured limb are released after tourniquet deflation. [ABSTRACT FROM AUTHOR]

Copyright of International Orthopaedics is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This prospective randomized study was designed to evaluate the implication of high preoperative doses of glucocorticoids on the cytokine responses after surgical correction in patients with ankylosing spondylitis. In 20 consecutive patients an extending osteotomy of the lumbar spine was done by a wedge excision. In a random manner, 10 of the patients were given 10 mg/kg of methylprednisolone (“Solum-Medrol”, Pharmacia & Upjohn, Stockholm, Sweden) preoperatively. The control patients received the same amount of saline. Arterial blood was sampled before and at the end of operation and at 4 and 24 h postoperatively and analyzed for pro- and antiinflammatory cytokines. Surgery induced non-significant increases in TNF- α and IL-1- β and significant increases in IL-6, IL-8, IL-10 and sTNF-R1 in both patient groups. Glucocorticoids significantly reduced increases in IL-6 and IL-8. On the other hand, increases in IL-10 and sTNF-R1 were significantly enhanced by corticoids. In both groups CRP was significantly increased at 24 h after surgery, but the increments were significantly reduced by corticoids. This study shows that surgery adds a complexity to cytokine productions in patients with ankylosing spondylitis, and that the balance of these cytokines is significantly influenced by glucocorticoids. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Orthopaedic Surgery & Traumatology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction There are many studies on the short and medium term results of hydroxyapatite (HA) coated acetabular components, but information on survival in the longer run is sparse. In this paper, we report 11 to 16 years follow up results of HA coated threaded versus HA coated hemispherical press Wt cups. Patients and methods During the years 1988-1993, we performed 323 primary total hip replacements in 276 patients with an HA coated acetabular component. In 128 cases we used a HA coated threaded cup, and in 195 cases a HA coated hemispherical press Wt cup was inserted. There were 189 women and 87 men aged 15-79 (mean 48) years. During follow-up, 14 patients died and 21 patients would not come for the follow-up examination as they were doing quite well with their prostheses. These patients were censored at their last control examination. This left 241 patients (287 hips) followed for 11 to 16 (mean 13) years after the operation. Results During the follow-up period 48 press fit cups and 9 threaded cups were revised, none because of infection. Survival analyses indicated a cumulative survival of the threaded HA coated cup of 0.91 (95% CI: 0.86-0.97) at 16 years with one patient at risk. The cumulative survival of the HA coated press Wt cup was 0.74 (0.69-0.80) at 15 years with no patient at risk. The difference is significant (P = 0.0002). Wear and age was significantly associated with revision (P < 0.0001 and 0.0002, respectively), and wear was significantly (P < 0.0001) associated with osteolysis. Conclusion These results indicate that HA coated threaded cups provide satisfactory bony interlock to resist force loads in the long run whereas the HA coated hemispherical press Wt cups do not. [ABSTRACT FROM AUTHOR]

Objective: Pathological rotation of the leg is a well-known problem in paediatric orthopaedics. In this study the normal development of tibial torsion during growth was evaluated by computed tomography (CT).Design: Seventy-eight normal individuals (52 children, 26 adults) aged 3-51 years were examined with CT. In axial scans the angle between a line tangential to the posterior part of the femoral condyles and the intermalleolar line, a line through the centre of the lateral and medial malleolus, was measured. The radiation exposure was evaluated and accepted by The National Department for Radiation and the Regional Committee for Ethics in Science.Results: CT showed that the average lateral torsion of the leg at the age of 4 years was 28 degrees with an individual variation of 20 degrees-37 degrees. Later the increase in tibial torsion was on average 1 degrees/year until 10 years of age and, thereafter, 4 degrees until maturity when the mean lateral torsion was 38 degrees (18 degrees-47 degrees).Conclusion: Tibial torsion in children mainly develops during the first 4 years of life. After this the increase was of less clinical significance. [ABSTRACT FROM AUTHOR]

A direct method of ultrasonographic measurement of the anteversion angle of the femoral neck is presented. Normal values based on measurements in 30 random newborns with vertex presentation correspond well with figures from previous autopsy series. The femoral anteversion in breech presentation was found to be on average 10 degrees greater than in vertex presentation (p < 0.0001). [ABSTRACT FROM AUTHOR]

In this study, the association between increased femoral anteversion and the characteristics of the patellofemoral joint was investigated in adults. In 17 female control patients, the anteversion angle of the femoral neck measured 12 degrees +/- 8 degrees and 11 degrees +/- 9 degrees for the right and left side, respectively. The sulcus angle of the patellofemoral joint was 145 degrees +/- 10 degrees and 146 degrees +/- 11 degrees, the congruence angle 7.2 degrees +/- 14 degrees and 7.8 degrees +/- 15 degrees, and the lateral patellofemoral angle 5.9 degrees +/- 6 degrees and 5.7 degrees +/- 6 degrees, respectively. In 15 female patients who were evaluated for clinical symptoms of increased femoral anteversion, the anteversion angle of the femoral neck was 30 degrees +/- 7 degrees and 31 degrees +/- 8 degrees degrees for the right and left side, respectively. The sulcus angle was 143 degrees +/- 8 degrees and 147 degrees +/- 9 degrees, the congruence angle 7.3 degrees +/- 12 degrees and 7.1 degrees +/- 13 degrees, and the lateral patellofemoral angle 6.4 degrees +/- 8 degrees and 6.1 degrees +/- 7 degrees, respectively. There was no correlation between the degree of femoral anteversion and the indices of the patellofemoral relationships. Thus, this study indicates that there is no association between increased femoral anteversion and abnormal patellofemoral characteristics. [ABSTRACT FROM AUTHOR]

In this study, the association between increased femoral anteversion and external torsion of the leg was investigated by computed tomography in adults. In a control group of 15 women, the anteversion angle of the femoral neck measured 11 degrees +/- 9 degrees and 12 degrees +/- 9 degrees for the right and left sides, respectively. The external torsion of the leg was 40 degrees +/- 8 degrees and 39 degrees +/- 10 degrees, respectively. The patient group consisted of 16 women who were evaluated for clinical symptoms related to increased femoral anteversion. In this group, the femoral anteversion was 31 degrees +/- 7 degrees and 33 degrees +/- 7 degrees for the right and left sides, respectively, and the external torsion of the leg was 35 degrees +/- 10 degrees and 33 degrees +/- 12 degrees, respectively. There were no correlations between the degree of femoral anteversion and the degree of external torsion of the leg. This study indicates that in cases of increased femoral anteversion, compensatory external torsion of the leg does not develop regularly during growth. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Orthopaedic & Traumatic Surgery / Archiv für Orthopädie, Mechanotherapie und Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Orthopaedic & Traumatic Surgery / Archiv für Orthopädie, Mechanotherapie und Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The normal relationships of the patellofemoral joint with the knee in extension were measured with computed tomography (CT) in 43 normal adults. The upper and lower halves of the joint were examined. The range in measurement of the sulcus angle was 115 degrees - 172 degrees, of the congruence angle 43 degrees - 27 degrees, and of the lateral patellofemoral angle 26 degrees - 11 degrees. No significant differences were found between men and women or between the right and left sides. There were some differences between the measurements of the upper and lower halves of the joint. These data may serve as a basis for the evaluation of patients with abnormalities of the patellofemoral joint. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Orthopaedic & Traumatic Surgery / Archiv für Orthopädie, Mechanotherapie und Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Orthopaedic & Traumatic Surgery / Archiv für Orthopädie, Mechanotherapie und Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)