Bipolar Arthroplasty Research Articles

股関節手術後のけい骨骨密度の変化 臼蓋形成術と人工物置換術との比較

The tibial bone mineral density (BMD) was measured in 10 patients who had undergone hip joint surgery, including 5 pelvic osteotomies (4 rotational acetabular osteotomies and 1 Chiary pelvic osteotomy) and 5 hip replacements (3 total hip arthroplasties and 2 bipolar arthroplasties. Periods of non weight bearing after surgery in all patients were almost the same (56-69 days). The BMD of the tibia on the surgically treated side was measured by periferal quantitative computed tomography (pQCT) system, which provide three different BMD values of the travecular BMD in the distal portion(D50), total BMD in the distal portion (D100) and diaphysis (P100). The measurements were obtaind preoperatively, and at several time points postoperatively, basically 2 weeks, and 1, 2, 3, 6, 9, 12, 15, 18 months. Bone loss was seen in all patients after hip operation, while decreasing pattern did not differ between the pelvic osteotomy group and hip replacement group. Bone loss rate was negatively correlated with BMD in tibia obtained preoperatively in all patients (D50: R=0.58, P=0.026, D100: R=0.89, P=0.0067, M100: R=0.64, P=0.019). The bone loss rate after hip operation was not influenced by the operation method but by preoperative BMD in the tibia. In patients with low BMD bone loss would have been accelerated after hip operation and strength of the bone decreased.

Results of bipolar arthroplasty and THA for osteonecrosis of the femoral head

Results of bipolar arthroplasty and THA for osteonecrosis of the femoral head

Clinical Results of Cemented Bipolar Arthroplasty in Femur Neck Fractures over 70 Years

Clinical Results of Cemented Bipolar Arthroplasty in Femur Neck Fractures over 70 Years

Resurfacing of only the femoral head for osteonecrosis: Long-term follow-up study

Fourteen patients (21 hips) with osteonecrosis of the femoral head with collapse had the femoral head resurfaced with a cemented titanium shell. All of the femoral heads were Ficat stage III or IV. Of the 21 surgeries, 7 were failures. Treatment for all 4 patients with sickle cell disease or trait failed (100%). When the cases of 17 patients who did not have sickle cell disease or trait were reviewed separately, the success rate was 14 of 17 (82%). The follow-up periods (all > 5 years) of the 14 successful patients in this group averaged 6.2 years, and their average Harris hip score was 87 (10 excellent, 4 good). Of the 14 successes, 10 patients had a follow-up period longer than 5 years (average, 7.7 years) and an average Harris hip score of 94 (7 excellent, and 3 good). There was no evidence of loosening and there was no osteolysis. It is concluded that this operation provides an alternative to hemiarthroplasty, total joint arthroplasty surgery, or bipolar arthroplasty. This is a time-buying first-stage operation and, for younger patients, will not last a lifetime. The concept appears prudent because the surgical procedure is directed at the site of primary disease, the femoral head.

Acetabular Osteolysis And Migration In Bipolar Arthroplasty Of The Hip: Five- To 13-year Follow-up Study

We have reviewed 65 bipolar arthroplasties of the hip in 55 patients with osteoarthritis secondary to dysplasia. The mean age at operation was 56 years (42 to 79) and the mean period of follow-up was 7.2 years (5.0 to 13.0). The average Merle d'Aubigné and Postel score before operation was 10.3 and at final follow-up 15.0. There were excellent or good results in 42 hips (65%). Migration of the outer head was observed in 50 hips (77%), most often in the group with a centre-edge angle of less than 0 degrees, an acetabular head index of less than 60%, coverage of the outer head by the original acetabulum of less than +10 degrees and after bone grafting of the acetabulum. This migration was progressive in 31 (62%) of the 50 hips, with massive osteolysis of the acetabulum in eight. The extent and progression of migration were closely associated with this osteolysis. Four hips required revision for extensive migration of the outer head with destruction of the acetabulum or severe acetabular osteolysis, and nine hips are awaiting revision for failure of the bipolar prosthetic head. The overall failure rate was 18%. We report major problems after bipolar hip arthroplasty for osteoarthritis secondary to hip dysplasia with progressive migration of the outer head and massive acetabular osteolysis at five years or more after operation.

ACETABULAR OSTEOLYSIS AND MIGRATION IN BIPOLAR ARTHROPLASTY OF THE HIP

We have reviewed 65 bipolar arthroplasties of the hip in 55 patients with osteoarthritis secondary to dysplasia. The mean age at operation was 56 years (42 to 79) and the mean period of follow-up was 7.2 years (5.0 to 13.0). The average Merle d’Aubigné and Postel score before operation was 10.3 and at final follow-up 15.0. There were excellent or good results in 42 hips (65%). Migration of the outer head was observed in 50 hips (77%), most often in the group with a centre-edge angle of less than 0°, an acetabular head index of less than 60%, coverage of the outer head by the original acetabulum of less than +10° and after bone grafting of the acetabulum. This migration was progressive in 31 (62%) of the 50 hips, with massive osteolysis of the acetabulum in eight. The extent and progression of migration were closely associated with this osteolysis. Four hips required revision for extensive migration of the outer head with destruction of the acetabulum or severe acetabular osteolysis, and nine hips are awaiting revision for failure of the bipolar prosthetic head. The overall failure rate was 18%. We report major problems after bipolar hip arthroplasty for osteoarthritis secondary to hip dysplasia with progressive migration of the outer head and massive acetabular osteolysis at five years or more after operation.

Bipolar femoral head arthroplasty in osteoarthritis: A prospective study with a minimum 5-year follow-up period

Primary bipolar femoral head arthroplasties performed on 100 osteo-arthritic hips were studied to a minimum of 5 years after surgery. All arthroplasties were performed on physically active patients. At a mean follow-up period of 5.5 years. The Hospital for Special Surgery hip scores were good to excellent in 96 hips. Transient startup soreness constituted the most frequent complaint, occurring in 34 hips. Three hips had more persistent pain localized to the acetabulum, necessitating revision to fixed sockets, which alleviated the symptoms. Four additional hips, in heavy, active men, developed polyethylene fatigue fracture and component disassembly. Acetabular migration of more than 5 mm developed in one hip. Motion, as determined radiologically, occurred primarily at the inner bearing. There were no dislocations or infections in the series. The Bateman bipolar prosthesis provides generally good results in osteoarthritic hips. The shorter operating time and the case of revision are special advantages of bipolar devices. Start-up soreness and stiffness is a shortcoming in approximately one third of cases. Component disassembly in heavy, active men is a problem and the bipolar arthroplasty should be avoided in these patients. Start-up soreness was a significant problem in particular.

Bipolar arthroplasty for painful conditions involving the shoulder

Bipolar arthroplasty for painful conditions involving the shoulder

A bipolar arthroplasty for gross destruction of the shoulder

A bipolar arthroplasty for gross destruction of the shoulder

Bipolar hip arthroplasty in ankylosing spondylitis.

Nineteen severely affected hips in 12 young patients with ankylosing spondylitis were treated with bipolar hip arthroplasty followed by a comprehensive postoperative rehabilitation programme. Additional operative procedures of adductor tenotomy, knee flexion release, supracondylar femoral osteotomy for genu valgum and tendo Achillis lengthening for equinus contracture were required in 13 limbs. After a mean follow-up of 45.8 months, results were good in all cases with respect to relief from pain, and there was significant improvement in posture and function. All the patients resumed employment. The average gain in sum total range of hip movements was 194 deg, and the mean preoperative Harris hip score of 27.8 improved to 82.6 after bipolar arthroplasty. Ectopic ossification did not develop in any case. Bipolar hip arthroplasty appears to be ideally suited for young patients with ankylosing spondylitis.

Fractures de type III : attitudes thérapeutiques, complications, résultats

We reviewed 47 type 3 femoral fractures (below the femoral stem according to the Johansson classification). There were 36 women and 11 men. The average age was 73,4 years, at the time of the fracture.These patients had had a total arthroplasty in 32 cases, a hemi arthroplasty in 10 cases and a bipolar arthroplasty in 5 cases.Of these 47 patients:- 6 underwent an orthopedic treatment (2 trans-tibial traction, and 4 plaster of Paris immobilisations) for a period averaging 60 days. Two (33%) developed pseudoarthritis and 2 (33%) developed bed-sores and decubitus complications.- The remaining, 41 patients underwent a surgical procedure:- 34 osteosynthesis using plates or screw plates brought about : - 4 fractures under the plate; - 4 pseudo-arthrosis; - 4 infections; - 4 plate breakages; - 1 femoral stem loose-ring;- 6 femoral stems were replaced with longer stems going through and extending past the fractures, without any material breakage or local complications (one patient died however, following other complications).- One patient had an Olerud procedure and unfortunately died after 3 months.At last follow up : - 4 patients had died; - consolidation occured in 41 cases over an average period of 130 days (45 to 590); - fractures treated by using osteosynthesis plates, showed a 50% incidence of complication; - on the other hand, when using stem replacement, no mechanical or local complications occured.

Hip arthroplasty in hemophilic arthropathy.

As hemophilic arthropathy infrequently affects the hip joint, we performed a multicenter retrospective study to determine the results of hip arthroplasty in hemophilic patients. Thirty-four hip arthroplasties were performed in twenty-seven male patients at four major hemophilia centers from October 1972 through September 1990. Twenty-six patients had classic hemophilia and one had factor-IX deficiency. The mean age of the patients at the time of the operation was thirty-eight years (range, fifteen to seventy-three years). The mean duration of follow-up was eight years, with a minimum of two years for all patients who were still alive at the time of this review. Four patients were seropositive for the human immunodeficiency virus at the time of the operation, and sixteen patients were seropositive at the time of the most recent follow-up examination. Nine patients (33 per cent) died before the time of this review; seven had been seropositive for the human immunodeficiency virus. There were twenty-six total hip arthroplasties performed with cement, six total hip arthroplasties performed without cement, one total hip arthroplasty in which the femoral component was inserted with cement and the acetabular component was inserted without it (so-called hybrid arthroplasty), and one bipolar arthroplasty performed with cement. There were no early infections after these thirty-four primary arthroplasties. There were three late infections around prostheses inserted with cement, and all led to a resection arthroplasty. Six (21 per cent) of the twenty-eight cemented femoral components and six (23 per cent) of the twenty-six cemented acetabular components were revised because of aseptic loosening.(ABSTRACT TRUNCATED AT 250 WORDS)

Prosthetic reconstruction of the proximal femur after resection for bone tumors

Thirty-one cases of endoprosthetic proximal femoral reconstruction after resection for bone tumors are reported. The minimum follow-up period was 2 years (average, 63 months). There were two local recurrences, two deaths from pulmonary metastases, two postoperative infections (1 superficial and 1 deep), both responding to therapy, one postoperative dislocation of a bipolar endoprosthesis, and two cases of loosening of acetabular cups on the same patient. Clinical results (Enneking grade) showed 27% E, 56% G, 14% F, and 3% P. Diaphyseal remodeling results (Rizzoli grade) were 29% A, 6% B, 49% C, 10% D, and 6% E. Anchorage (International Society of Limb Salvage grade) was assessed as 97% E and 3% F, whereas interface (International Society of Limb Salvage grade) was 100% E. Hip (bipolar) articulation was graded as 30% E, 56% G, 11% F, and 3% P. Initial rigid stabilization of the stem with cross-fixation screws allows for excellent bone ingrowth, but presents the problem of proximal cortical atrophy. Bipolar hip components are easy to insert and offer greater inherent stability and so are to be recommended for use in tumor surgery. The results suggest good medium- to long-term results with respect to wear. A new radiographic grading system is presented for bipolar arthroplasty. Survivorship of the femoral component in this series is 100% at a maximum follow-up period of 8 years.

Ｂｉｐｏｌａｒ型人工骨頭置換術後のｏｕｔｅｒ ｈｅａｄの移動に関する検討

Radiographic assessment was done to investigate outer head migration after bipolar arthroplasty in 44 osteoarthritic hips (35 patients). Bone graft was performed on the lateral edge of the acetabulum using resected femoral heads in 19 cases who had dysplastic acetabulae.There was a significant correlation at six months between CE angle and medial migration (r=-0.43, p 6mm) is significantly greater than that in the shallower reaming group (<5mm).Thickness of the grafted bone correlated strongly with superior migration at 12 months (r=0.93, coefficient for slope=0.85). This result shows that the grafted bone did not act as a brake on the superior migration of the outer head.

Bipolar arthroplasty for painful conditions involving the shoulder a preliminary report

Bipolar arthroplasty for painful conditions involving the shoulder a preliminary report

Fatal marrow embolization following a porous-coated bipolar hip endoprosthesis

Fat embolization syndrome is a well-known complication associated with total hip arthroplasty. It is believed to be caused by high intramedullary pressures that occur during cement pressurization and femoral stem placement. Fat embolization syndrome has also been reported with intramedullary reaming and placement of an intramedullary alignment guide during total knee arthroplasty. To our knowledge, there have not been previous reports of fatal fat emboli as a result of uncemented hip arthroplasty. The purpose of this case report is to describe a fatality due to fat embolization following a noncemented bipolar arthroplasty.

Progressive Migration in Bipolar Arthroplasty for Osteoarthritis of the Hip Secondary to Congenital Dislocation

Seventy-one hips with osteoarthritis secondary to congenital dislocation underwent bipolar arthroplasty with autologous bone grafting (grafted group) or without bone grafting (ungrafted group). Clinical and radiographic followup was performed; the average followup was 5.7 years (range, 3-11.3 years). At followup, the mean Merle d'Aubigné and Postel score was 14.3 points. Excellent or good results were achieved in only 50% of all cases. The mean extent of prosthetic head migration was 6.5 mm in the grafted group and 4.7 mm in the ungrafted group. Progressive migration occurred in 68% of the grafted group and in 43% of the ungrafted group. There was a significant negative correlation between the extent of migration of the outer head and the coverage of the outer head by the original acetabulum (R = 0.53). In the grafted group, the revision rate for failure of the outer head of the prosthesis was 60% at 6 years postoperatively. In the grafted group, progressive migration was more extensive and more frequently than in the ungrafted group. Extensive migration was also observed when there was adequate coverage of the outer head by host bone in the ungrafted group. In conclusion, bipolar arthroplasty is not recommended for osteoarthritis secondary to congenital hip dislocation because of the poor clinical outcome, high risk of significant progressive migration, and high revision rate.

COMPONENT MOTION IN BIPOLAR HIP ARTHROPLASTY: AN EVALUATION OF REAMED AND NON-REAMED ACETABULA

Sixty-four patients with 67 bipolar arthroplasties of the hip were reviewed for a mean follow up of 3.1 years. The study group consisted of 46 hemiarthroplasties secondary to primary osteoarthritis of the hip and 21 hemiarthroplasties secondary to displaced subcapital hip fractures. Reaming of the acetabulum was performed in 47 of the hips studied. The Harris hip scores were not significantly affected by acetabular reaming. Total motion decreased when hips were loaded in the standing position. Reaming of the acetabulum resulted in a decrease in percent outer component motion and an increase in percent inner component motion. The non-reamed acetabula had the largest percent inner motion decrease when taken from the supine to the standing position. The reamed acetabula had significantly higher average percentage of inner component motion in both standing and supine positions. There was no patient with postoperative acetabular protrusion.

変形性股関節症に対するｂｉｐｏｌａｒ型人工骨頭置換術 臼蓋及び移植骨のＸ線学的変化

We performed bipolar hip arthroplasty combined with bone grafting acetabuloplasty on 26 hips since 1986 and reviewed them clinically and roentgenographically in this study.The average follow-up period was 4.5 years (range 3-6.3 years). Clinical results using JOA score were excellent in all cases with marked relief of pain; preoperative total average score of 52.7 points was improved to 85.8 points postoperatively. Outer head migration was frequently detected in cases which had insufficient post-operative coverage of the original acetabulum and a significant relationship was found between the post-operative CE angle by the original acetabulum and outer head migration (p<0.01), however, no relationship was found between post-operative CE angle involved with grafted bone and outer head migration. These results appeared to show that acetabular bone grafting did not prevent migration and outer head migration was stopped with the appearance of a sclerotic line in the acetabulum.These results suggest that special care should be paid to the operative indications of bipolar arthroplasty for osteoarthritis with acetabular dysplasia.

Posterior allograft bone-block for recurrent dislocation of the hip after hemiarthroplasty in noncompliant patients with neuromuscular disease

Two mentally retarded patients with cerebral palsy developed recurrent dislocation of the hip after hemiarthroplasty. Instability had persisted despite release of contracted soft tissues, conversion to a bipolar arthroplasty, and cast immobilization in one patient and repeated closed reductions with abduction splinting and bed rest in the other. Both patients were treated with a posterior femoral head allograft bone-block that resulted in restoration of hip function and control of recurrent dislocations.