Cemented Total Hip Replacement Research Articles

ESTIMATING THE COSTS, HEALTH-RELATED QUALITY OF LIFE, AND REVISION RISK IN THE YEAR AFTER ELECTIVE PRIMARY AND REVISION HIP ARTHROPLASTY PROCEDURES BY IMPLANT BEARING MATERIALS: AN ANALYSIS OF LINKED DATA FROM THE NATIONAL JOINT REGISTRY (NJR), HOSPITAL EPISODE STATISTICS (HES), AND PATIENT-REPORTED OUTCOME MEASURES (PROMS) FOR ENGLISH PATIENTS

Implants in total hip replacement (THR) are associated with different clinical and cost-effectiveness profiles,. We estimate the costs and outcomes for NHS patients in the year after THR associated with implant bearing materials using linked routinely collected data.We linked NJR primary elective THR patients for osteoarthritis to HES and National PROMs. We estimated health care costs, health-related quality of life indices, and revision risks, in the year after primary and revision THRs overall. We used generalised linear models adjusting for patient and hospital characteristics and estimated 10-year cumulative probability of revision. We imputed utilities using chained equations for half the sample with missing PROMS.We linked 577,973 elective primary THRs and 11,812 subsequent revisions. One year after primary THR, patients with the cemented THRs using cobalt chrome or stainless steel head with HCLPE liner/cup cost the NHS, on average, £13,101 (95%CI £13,080,£13,122), had an average quality-of-life score of 0.788 (95%CI 0.787,0.788), and a 10-year revision probability of 1.9% (95%CI 1.6,2.3). Compared to the reference, patients receiving a cemented THR with delta ceramic head and HCLPE liner/cup, hybrid THR with delta ceramic head and HCLPE liner/cup, and hybrid THR with alumina head and HCLPE liner/cup had lower 1-year costs (-£572 \[95% CI -£775,-£385\], -£346 \[-£501,-£192\], -£371 \[-£574,-£168\] respectively), better quality of life (0.007 \[95% CI 0.003,0.011\], 0.013 \[0.010,0.016\], 0.009 \[0.005,0.013\] respectively), and lower 10-year revision probabilities (1.4% \[1.03,2.0\], 1.5 \[1.3,1.7\], 1.6%\[1.2,2.1\] respectively).Implant bearing materials are associated with varying mean costs and health outcomes after primary THR. Ours is the first study to derive costs and health outcomes from large, linked databases using multiple imputation methods to deal with bias. Our findings are useful for commissioning and procurement decisions and to inform a subsequent cost-effectiveness model with more granular detail on THR implant types.

30-Year Follow-Up of Total Hip Replacement: Longevity of Charnley Cemented Total Hip Replacement in a Young Patient

The gold standard for cemented hip replacement is the Charnley lowfriction hip replacement. Orthopaedic therapies, such as total hip replacement, have a remarkably high success rate. It relieves patients from pain and improves walking ability and the overall quality of life. We report a 30-year follow-up of our case, a total hip replacement done by a senior joint replacement surgeon at our hospital. A 34-year-old patient, teacher by profession, who was a case of bilateral secondary hip arthritis to Ankylosing Spondylitis, was bed-bound and severely disabled and was operated with total hip replacement in 1995. Long-term follow-up based on functional Harris Hip Score, radiographic status and patient-related outcome measures (PROM). We conclude that Charnley’s cemented total hip replacement has given a time-tested long-term result and is a gold standard surgery if it is done following proper technique.

Comparing Intraoperative Blood Loss in Cemented, Uncemented, and Hybrid Total Hip Replacement for Neck of Femur Fractures.

Background As the aging population increases, osteoporotic neck of femur fracture cases will continue to rise. Although hemiarthroplasty or half hip replacement is the treatment of choice in a majority of patients, a small but definite cohort of patients would need a total hip replacement. In these elderly patients who often have comorbidities, the use of cement to fix the prosthesis is often quoted as beneficial in view of perceived lower blood loss compared to uncemented fixation of the prosthesis. However, the cementation of the implant in itself has inherent problems. This study examined three modalities of fixation of a prosthesis for total hip replacement in the neck of femur fractures, namely, cemented, hybrid, and uncemented, and compared their relative intraoperative blood loss. Methodology This is a retrospective study with a follow-up of two years. Patients who presented to a level 1 trauma center in an inner city metropolitan with neck of femur fractures and were treated by total hip replacement were included in the study. Intraoperative blood loss was calculated using Nadler's formula. Results There was no statistical difference in intraoperative blood loss in either of the three groups of patients, namely, cemented, hybrid, or uncemented total hip replacement for neck of femur fractures. Conclusions Intraoperative blood loss should not influence the modality of prosthesis fixation for total hip replacement in neck of femur fractures.

DISTAL CEMENT MANTLE THICKNESS AND POSITION OF STEM TIP ARE PREDICTORS OF PERIPROSTHETIC FRACTURES IN CEMENTED TAPERED FEMORAL STEMS

Periprosthetic femoral fractures are increasingly seen in recent years, adding considerable burden to the National Health Service. These require complex revision or fixation and prolonged post-operative care, with significant morbidity with associated costs. The purpose of this study was to assess whether the size of femoral cement mantle is associated with periprosthetic femoral fractures (PPF).This retrospective study was carried out on a cohort of 49 patients (Fracture Group - FG) who previously had a revision procedure following a proximal PPF between 2010 and 2021. Inclusion criteria – all primary cemented total hip replacements (THR). Exclusion criteria – complex primary THR, any implant malposition that required early revision surgery or any pre-fracture stem loosening. The antero-posterior (AP) radiographs from this cohort of patients were assessed and compared to an age, sex, time since THR-matched control group of 49 patients without PPF (Control Group - CG). Distal cement mantle area (DCMA) was calculated on an AP radiograph of hip; the position of the femoral stem tip prior to fracture was also recorded: valgus, varus or central. Limitations: AP radiographs only. Statistical analyses were performed using Microsoft® Excel.Chi-square test demonstrated statistically significant difference in DCMA between FG and CG. DCMA of 700 to 900 mm² appeared to be protective when compared to DCMA of 0 to 300 mm². Also, a valgus position observed in 23% in FG Vs 4 % in CG increased the risk, with a smaller area of DCMA.This study demonstrates and recommends that a size of 700 – 900 mm² of the DCMA is protective against periprosthetic fractures, which are further influenced by the positioning of the distal stem tip. This could be due to the gradual decrease in the stiffness gradient from proximal to distal around the stem tip than steep changes, thereby decreasing possibility of a stress riser just distal to the cement mantle or restrictor. Further biomechanical research specific to this finding may be helpful to validate the observation, progressing to suggest a safe standardised surgical technique.

Re-revision hip replacement in peri prosthesis shaft femur fracture in operated case of cemented total hip replacement

Introduction: Revision surgery differs from original total hip replacement surgery, which is a lengthier and more difficult process. To get a satisfactory result, substantial preparation is required, as well as the use of specialised implants and instruments. Periprosthetic fractures are most commonly caused by a fall and frequently necessitate revision surgery. Most modifications will include the use of customised implants intended to compensate for compromised bone and soft tissue. Case Report: 68-year-old male with bilateral cemented total hip replacement presents with peri prosthetic shaft femur fracture in left side without DNVD which was van-couver type B2 managed with ORIF + Platting + TBW loop which eventually failed, impairing the patient's routine activity, so he came to SMIMER hospital. Management: We performed implant removal + revision total hip replacement with long stem femoral component, which failed post-operatively, therefore the patient underwent Re-revision surgery with inter locking nail femoral long stem component. During repeated follow-ups, the patient expressed satisfaction with his everyday activities. Discussion: Complication are common in revision surgery. Early management is key to rectify intra operative and post-operative complication. Periprosthetic femoral fractures after total hip replacement is a rare but feared complication. Peri prosthetic fracture is managed based on fracture pattern and stem and bone stock. Conclusion: Surgical treatment of periprosthetic fractures, thanks to the introduction of new implants for osteosynthesis and development of new stems for revision endoprostheses, helps achieve ever better results. Of major importance for choosing the treatment method is correct classification of fracture and stem stability.

Implant survival of cemented arthroplasty following failed fixation of proximal femoral fractures in patients aged 30–60 years: a retrospective study with a median follow-up of 10 years

BackgroundGiven the unremitting growth in the volume of failed fixations of proximal femoral fractures (PFFs) in recent years, it is predictable that total hip replacements (THRs) will be the preferred surgical procedure. The long-term survival of cemented THR (CTHR) revisions remains controversial in patients aged 30–60 years. The goal of this retrospective review was to evaluate the 10-year survival of CTHRs following prior failed primary fixations of PFFs in patients aged 30–60 years.MethodsWe retrospectively identified CTHR revisions implemented at four medical centres during 2008–2017 for a failed primary fixation of PFFs in consecutive patients aged 30–60 years. The primary endpoint was implant survival calculated using the Kaplan–Meier method with 95% confidence intervals (CIs); secondary endpoints included functional scores assessed by Harris hip scores (HHS) and main revision-related orthopaedic complications. Follow-up was executed at 1, 2, 3, and 8 years following revision and then at 1-year intervals until the revision, death, or study deadline, whichever occurred first.ResultsIn total, 120 patients (120 hips) who met the eligibility criteria were eligible for follow-up. The median follow-up was 10.2 years (range, 8–12 years). Kaplan–Meier survivorship showed that implant survival with revision for any reason as the endpoint was 95% at 5 years (CI: 93–97%), 89% at 8 years (CI: 86–92%), and 86% at 10 years (CI: 83–89%). Patients treated with three hollow screws had better revision-free survival than patients treated with proximal femoral nail antirotation (PFNA), dynamic hip screw (DHS) or titanium plate plus screws (three p < 0.05). Functional scores were apt to decrease gradually, and at the final follow-up, the mean HHS was 76.9 (range, 67.4–86.4). The overall rate of main revision-related orthopaedic complications was 18.3% (22/120).ConclusionCTHR implemented following prior failed primary fixations of PFFs tends to afford an acceptable 10-year survival, along with advantageous HHS and a low rate of main revision-related orthopaedic complications, which may support an inclination to follow the utilisation of CTHRs, especially in revision settings for intracapsular fractures.

Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis

PurposeThe neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. Material and methodsThe search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. ResultsA total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. ConclusionChoosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. Level of evidenceLevel I, systematic review and meta-analysis.

Femoral Stem Fracture and Successful Reimplantation Using Femoral Window Technique in Canine Cemented Total Hip Replacement: Case Report

A fractured stem is a very rare, late complication in total hip replacement procedure in dogs. Here, we present one case after cemented total hip replacement with successful reimplantation, including clinical signs and radiographic findings.

Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study.

ObjectiveTo compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C).MethodsPatient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter.ResultsThe mean follow-up was 84.12 (67–100) months for UTR and 84.23 (66–101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR).ConclusionIn the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.

Comparative study between outcome of noncemented and cemented total hip replacement

Background: To resolve the damage and pain in the joint in the hip, total hip replacement (THR) is used. There are some methods used to give THR, but cemented and noncemented THR are common to improve the result of the cemented THR as patients face some complications after replacement. In this study we compared the outcome of the noncemented and cemented THR. The aim of this study was to compare the outcome of noncemented and cemented THR and find out the favorable outcome.Methods: This was a randomized, comparative type of observational study and was conducted in the Department of Orthopedics of National Institute of Traumatology and Orthopaedic Rehabilitation, Bangladesh during the period from 2019 to 2020 on 60 patients, of which 2 groups were made with 30 patients in each group. The age range was less than 50 to more than 70. In group-A cemented THR was done and in group-B noncemented THR was done. Percentage was calculated to find out the proportion of the findings. Further statistical analysis of the results was done by computer software devised in the statistical packages for social scientist (SPSS-23) and MS excel.Results: After comparing outcomes, we saw that most of the patients get better result at the 2nd revision conducted in 6th months. There was no significant difference between the results of the two groups.Conclusions: Though noncemented THR had better result in pain and infection occurrence after treatment, the instability is higher comparing cemented THR. Besides, patients cemented THR also had many complications after treatment.

Dual mobility cup as a treatment of displaced femoral neck fractures in elderly: stability and function

Background The main goal in the treatment of femoral neck fractures in the elderly is to enable early mobilization. Hemiarthroplasty is considered the gold standard line of treatment. In the past decade, total hip replacement (THR) was introduced to the orthopedic community with the advantage of better pain relief and functional outcome. However, the reported dislocation rates after THR in femoral neck fractures remained higher than the rates after hemiarthroplasty. Nowadays, there is renewed interest in dual mobility cups to solve the problems of hip instabilities for various reasons. Dual mobility cups aim to decrease the dislocation rate by associating two articular surfaces: one with a larger diameter situated between a metallic cup and a polyethylene insert, thus utilizing the concept of a large head size to reduce dislocation, and the other one with a smaller diameter situated between the femoral head and the retentive polyethylene insert to achieve more mobility. The authors believe that the results of the dual mobility concept after femoral neck fractures are under-reported, with few papers discussing the outcome specifically in the Egyptian population. Aim This study was carried out to assess the dislocation rate and clinical results for cemented THR with a dual mobility cup as the treatment of femoral neck fractures in elderly patients, after a minimum period of 1 year. Settings and design A prospective case series study was carried out at El Hadara University Hospital, Alexandria University. Patients and methods This study included 31 patients (32 hips) with displaced femoral neck fractures who were admitted to El Hadara University Hospital, Alexandria, Egypt. Their mean age was 66.6±6.3 years. There were 15 females and 16 males. All the patients were treated using a cemented dual mobility cup for THR using the standard posterior approach. Functional assessment was performed using the Harris hip score (HHS) with the assistance of physiotherapists to avoid bias. Results No dislocations were encountered in this series over 1 year of follow-up. The mean operative time was 136.9 min. The average blood loss was 756.3 ml. The mean HHS improved over the follow-up period from 80.3±7.9 (95% confidence interval: 74–86) at 12 weeks to an average of 92.6±11.1 (95% confidence interval: 88.7–96.5) at the 1-year follow-up. This increase in HHS was not statistically significant (P=0.143). Conclusions Dual mobility cup THR is a good method for the treatment of displaced femoral neck fractures in the elderly as it provides good stability, pain relief, and good function.

A prospective study on cancer risk after total hip replacements for 41,402 patients linked to the Cancer registry of Norway

BackgroundConcerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk. Several different materials, metals and fixation techniques are used in joint prostheses and different types of articulation can cause an increased invasion of particles or ions into the human body.MethodsPatients with THR registered in the Norwegian Arthroplasty Register during 1987–2009 were linked to the Cancer registry of Norway. Patients with THR due to osteoarthritis, under the age of 75 at time of surgery, were included. Standardized incidence ratios (SIR) were applied to compare cancer risk for THR patients to the general population. Types of THR were divided into cemented (both components), uncemented (both components), and hybrid (cemented femoral and uncemented acetabular components). To account for selection mechanisms, time dependent covariates were applied in Cox-regression, adjusting for cancer risk the first 10 years after surgery. The analyses were adjusted for age, gender and if the patient had additional THR-surgery in the same or the opposite hip. The study follows the STROBE guidelines.ResultsComparing patients with THR to the general population in Norway we found no differences in cancer risk. The overall SIR for the THR-patients after 10 years follow-up was 1.02 (95% CI: 0.97–1.07). For cemented THR, the SIR after 10 years follow-up was 0.99 (95% CI: 0.94–1.05), for uncemented, 1.16 (95% CI: 1.02–1.30), and for hybrid 1.12 (95% CI: 0.91–1.33). Adjusted Cox analyses showed that patients with uncemented THRs had an elevated risk for cancer (hazard ratio: HR = 1.24, 95% CI: 1.05–1.46, p = 0.009) when compared to patients with cemented THRs after 10 years follow-up. Stratified by gender the increased risk was only present for men. The risk for patients with hybrid THRs was not significantly increased (HR = 1.07, 95% CI: 0.85–1.35, p = 0.55) compared to patients with cemented THRs.ConclusionsTHR patients had no increased risk for cancer compared to the general population. We found, however, that receiving an uncemented THR was associated with a small increased risk for cancer compared to cemented THR in males, but that this may be prone to unmeasured confounding.

Hemodynamic changes in patients undergoing cemented total hip replacement surgery: a literature review

Cemented total hip arthroplasty is believed to offer adequate pain relief, satisfactory walking ability, and activities of daily living as one of the most widely used techniques for treating hip fragility fractures. However, some complications may occur perioperatively, not to mention the catastrophic bone cement implantation syndrome. Thorough assessment, perioperative monitoring, early detection, and treatment plays an essential role to maximalize the result of this procedure, as well as minimalizing morbidity and mortality. Some anesthetic measures that can be done in order to keep the stability of intraoperative conditions are avoiding volatile anesthetic agents in high-risk patients, administering 100% inspired oxygen throughout the procedure, invasive hemodynamic monitoring, and maintenance of normovolemia.A central line placement also provides a rapid route of drug administration if resuscitation becomes necessary. Orthopaedic surgeons should also consider thorough lavage of the femoral medullary canal, especially pulsatile jet lavage, removal of tissues before cementation to minimize the formation of microemboli during the procedure, and using cement restrictor to compartmentalize the bone marrow tissue and blood separately from the cement. Therefore, it can be concluded that understanding hemodynamic changes during this procedure is essential, not only for the operator but also for the anaesthesiologists.

Comparison of functional outcome of cemented total hip replacement versus cemented dual-mobility cup total hip replacement for the management of displaced femoral neck fractures in the active elderly patients.

Current guidelines recommend treating displaced femoral neck fractures with a total hip replacement in fit and active elderly patients. Dislocation remains the main complication. Dual-mobility cup (DMC) hip replacements maybe a solution to decrease dislocation, with the benefit of increasing stability, achieving better range of motion and functional outcomes. This is a prospective randomised controlled trial which included 62 patients with Garden III and IV femoral neck fractures. The mean age was 67.2 years. 30 males and 32 females were included, randomised and allocated to 2 treatment groups; a cemented DMC replacement group, or a cemented 32-mm head total hip replacement (THR). The posterior approach was used in all patients. Postoperative functional outcome was assessed using Harris Hip Score (HHS). Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire. The mean HHS for the DMC group at 4, 6 and 12 months were higher than mean HHS scores for the THR group (p < 0.001). The range of motion at 1 year was statistically better in the DMC group compared to the THR group (p < 0.001). The DMC showed a statistically better effect on the HRQoL measurements as compared to the THR group. There were no dislocations in both groups. DMC hip replacements provide better functional, patient reported outcomes, and range of motion than the conventional THR. Combined with its stability, DMC replacements are a useful solution in managing femoral neck fractures in active elderly patients.Trial serial number 020841 (IRB Number 00007555).

Assessment of Functional Outcome between Cemented and Uncemented Total Hip Replacement: A Comparative Study

Assessment of Functional Outcome between Cemented and Uncemented Total Hip Replacement: A Comparative Study

Canal occlusion in cemented primary total hip replacement: autologous compacted bone block compared to a commercially available gelatine plug.

To evaluate the stability of 2 canal occlusion systems; an autologous, compacted bone block and the biodegradable C-plug. We also sought to investigate any relationship between stability of the systems and the quality of cementation. A retrospective radiographic comparative review was conducted. A total of 203 consecutive patients were analysed, 89 received an autologous bone block and 114 had C-plugs. There was no significant differences between the groups in terms of age, sex and primary diagnosis. The mean cement tail length in the bone block group (6.42 mm; range 0-31) was significantly shorter than in the C-plug group (17.11 mm; range 0-65.7). The proportion of patients with good quality of cementation (Barrack grade A) was significantly higher in the bone block group (80.6%) as compared to the C-plug group (56%) (p < 0.001). There was a negative correlation between the length of the cement tail and the Barrack grade, indicating that a short cement tail is associated with better quality cementation. We have shown that improved cement penetration and shorter cement tails can be achieved with the cheapest of all options for canal occlusion, an autologous compacted bone block and hence recommend this technique.

A study to assess functional outcome of cemented and uncemented total hip replacement in a tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Total hip replacement (THR) is the most successful and cost effective treatment with aim of pain relief and functional rehabilitation for hip disorders. As the implant designs of THR have evolved over time, the functional outcome and survivorship has improved. Even after so many advancements, it remains unclear that which implants are better, uncemented or cemented. Hence, we took up this study to analyze which of the uncemented or cemented THR have better functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a longitudinal study conducted during 2014 to 2018. Hundred cases were randomized into groups of 50 each. All patients with age between 55-80 years in whom THR was indicated were included in the study. Uncemented THR was done in Group A and cemented THR was done in Group B. Patients were followed up at 12 weeks, 6 months, 12 months, and 3 years. At follow-up, functional examination in terms of visual analogue scale (VAS) score and Harris hip score (HHS) was done.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of patients in Group A (uncemented) and Group B (cemented) was 62.5 years and 60 years respectively. We found that the difference of VAS score and HHS between Group A and B was statistically significant at 12 weeks and 6 months. The difference of VAS and HHS scores between Group A and B at 12 months and 3 years was not significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude that cemented THR has better functional outcome at short term. They are cost effective option at age ≥55-60 years.&lt;/p&gt;

Periprosthetic joint infections after total hip replacement: an algorithmic approach.

An algorithm for managing periprosthetic joint infections (PJIs) after total hip replacement (THR) surgery using a multidisciplinary approach and a clearly defined protocol may improve infection eradication rates. In this article, we present an algorithm for the management of different types of PJIs including the acutely infected cemented and cementless THRs where the components are well-fixed postoperatively and when the infection is secondary to haematogenous spread in previously well-functioning and well-fixed implants. For chronic PJIs where the components are often loose, the standard treatment includes a two-stage revision procedure. However, in a highly selected subset of patients, a single-stage approach has been utilised with high rates of eradicating infections.

The Dynamics of D-dimer Level Fluctuation in Patients after the Cemented and Cementless Total Hip and Total Knee Replacement

The Dynamics of D-dimer Level Fluctuation in Patients after the Cemented and Cementless Total Hip and Total Knee Replacement

Fatigue Fracture of Co-Cr-Mo Femoral Stems after Canine Cemented Total Hip Replacement

Fatigue Fracture of Co-Cr-Mo Femoral Stems after Canine Cemented Total Hip Replacement