Cementless Endoprosthesis Research Articles

The Impact of Early Rehabilitation and the Acceptance of the Disease on the Quality of Life of Patients after Hip Arthroplasty: An Observational Study.

Background: The early introduction of physiotherapy significantly shortens the time required for a patient to regain full mobility after hip arthroplasty. Obtaining the expected result is determined by cooperation with a physiotherapist and the patient's involvement in the rehabilitation process. The aim of this study was to assess the quality of life, life satisfaction, and motor ability of patients after hip arthroplasty. Methods: This study included 147 patients who underwent hip arthroplasty at the Orthopedic and Trauma Department. The research material was collected using questionnaires, and the study used the Barthel Index (BI), Harris Hip Score (HHS), Visual Analogue Scale (VAS), Acceptance of Illness Scale (AIS), and Quality of Life Assessment Questionnaire (WHOQOL-BREF). In the studied group of patients, the Excia cementless endoprosthesis was primarily used (69.39%), as well as the Metha Short Hip prosthesis (15.65%), AM hip prosthesis (10.20%), and bipolar hip prosthesis (4.76%). Results: The analyzed group of patients included 95 women (64.63%) and 52 men (35.37%); the average age was 67 years. Six weeks after hip arthroplasty, mild disability occurred in 53.74% of the patients, while the remaining 46.26% had no disability, and 95.24% of the patients achieved a high level of acceptance of the disease and quality of life. Conclusions: Early improvement after hip replacement surgery contributes to eliminating the disability of the hip joint in the following areas: pain sensation, functionality, lack of deformation, and range of motion. Each subsequent stage of treatment increased the level of acceptance of the disease in the study group. The applied surgical treatment increased satisfaction with overall health and quality of life.

Total hip arthroplasty in the treatment of severe stages of osteonecrosis of the femoral head and osteoarthritis: results and complications

BACKGROUND: Nowadays total hip arthroplasty (THA) is the method of choice for the treatment of late stages osteonecrosis of the femoral head (OFH) and osteoarthritis (OA) of the hip joint.
 OBJECTIVE: To evaluate the efficacy and complication pattern of THA in late stages of OFH and OA.
 MATERIALS AND METHODS: The study included 74 patients who underwent primary THA for OA stages IIIIV (Kellgren and Lawrence classification) and for OFH stages IIIIV (ARCO classification). Group 1 included 34 patients with OFH stages IIIIV, and group 2 40 patients with OA stages IIIIV. The groups were comparable by gender and age. All patients underwent implantation of endoprosthesis components using press-fit fixation with a metalpolyethylene articulation. Treatment results were assessed with regard to the incidence of complications and functional results at 3, 6 months, 1 and 3 years after THA.
 RESULTS: In our study, the survival rate of components after THA within 3 years after implantation was 100%. No cases of periprosthetic fracture, periprosthetic infection, and aseptic instability of endoprosthesis components were observed in both groups. The surface inflammation of the postoperative wound was detected in 1 (2.9%) patient in the OFH group and in 1 (2.5%) patient in OA group. Dislocation of the endoprosthesis occurred in 1 patient with OFH; there were no such findings in the OA group. The frequency of peri-implant osteolysis was twice lower (2.5%) in patients with OA compared to OFH group (5.8%). There were no statistically significant differences in the functional results dynamics before and after surgery between the groups (Harris score). The average Harris scale score in patients with OFH was 63 and reached 94 after 3 years; in OA group 58 and 94, respectively.
 CONCLUSION: THA is an alternative method in the treatment of severe hip arthroplasty. Endoprosthetics using a cementless endoprosthesis with a metalpolyethylene articulation demonstrated high efficacy as well as a low number of complications among patients with OFH and OA. We found no significant difference in THA results in terms of survival, postoperative complications, and functional outcome in patients with OFH and OA. Longer postoperative follow-up is advisable, which may allow us to establish some differences in treatment outcomes.

Investigation of the Influence of Osteoporosis and Aging on Periprosthetic Femoral Fractures using Finite Element Analyses

With the increasing life expectancy and more active lifestyles of patients, the number of total hip replacements is constantly rising. Consequently, the incidence of periprosthetic femoral fractures (PFF) is also growing and facilitated by osteoporosis as well as advancing age of the patient. One way to prevent PFF is to optimize the treatment of individual patients, who are potentially at risk of osteoporotic fractures, by choosing the most suitable implant design for their subject specific circumstances. Thereby, revision surgeries due to PFF can be avoided. In this context appropriate models are necessary to predict fractures for aging and osteoporotic bone. On the basis of quantitative computed tomography (QCT) data subject specific finite element models with a heterogeneous material definition were created that can simulate PFF via element deletion. Statistical studies on the changes of bone quality with increasing patient age and developing osteoporosis were incorporated into the models. With statistical data, the bone mineral density (BMD) values measured in the QCT scans of the modelled femurs were varied, while the individual heterogeneous density distribution was preserved. The new density values were mapped onto the FE meshes of the femurs. This way, the femur was modelled to mirror the condition of the bone in different age groups and with different severity levels of osteoporosis in high age. The final models incorporate the subject specific geometry and density distribution of a patient's femur as well as the statistical density values resulting from aging and osteoporosis. The FE analyses revealed that a statistical change of bone density with aging leads to a relative small decrease in fracture load for periprosthetic fractures of a femur with a cementless endoprosthesis. However, for osteoporosis, the fracture load can differ by up to 56% with a cementless endoprosthesis, depending on the severity level of the disease.

Surgical treatment of secondary hip osteoarthritis using cementless total hip endoprosthesis with Fitmore® Hip Stem: A case report

Introduction. Hip dysplasia with subluxation represents insufficient coverage of the femur's head placed in the dysplastic acetabulum. This lack of coverage ranges from barely noticeable to condition where half of femur head is uncovered by acetabulum. The caput-collum-diaphyseal angle of the proximal femur and anteversion angle of collum are increased, Wiberg?s angle is less than 15? and M?nard-Shenton line is interrupted. Hip joint degeneration occurs very early. When radiological signs of hip joint degenerative changes are discovered in elderly they are associated with pain, limited movements and leg shortening. Case report. We present a 53-year old female treated conservatively in childhood because of hip diyplasia with subluxation. After pregnancy, right hip pain emerged. Clinical and radiological examinations revealed hip subluxation with the signs of degenerative osteoarthritis. Initial treatment was conservative and included drugs and balneophysical procedures. Since pain and movement impairment progressed and became constant, a hip replacement using cementless total endoprosthesis with Fitmore? Hip Stem was done. In the pre-operative preparation, anteroposterior x-ray of the hip(with third of the proximal femur) was made. This X-ray enabled precise planning of implantation endoprosthesis component. The early postoperative course was uneventful with very good therapeutic effect. Following successful physical rehabilitation, the patient returned to work and full life activity. Conclusion. Implantation of the cementless endoprosthesis with Fitmore? Hip Stem in the treatment of secondary hip osteoarthritis is a good choice in the treatment of young patients with good bone quality. Future clinical and radiological follow-up and comparative studies are needed to show the advantages of this type of stem compared to the classical cementless long stem.

Comparison of Biocompatibility of Cemented vs. Cementless Hip Joint Endoprostheses Based on Postoperative Evaluation of Proinflammatory Cytokine Levels.

BackgroundThe yearly increase in the number of procedures involving implantation of hip joint endoprostheses forces prosthetics manufacturers to search for biologically neutral implants. The goal of this study was to assess the concentration of Interleukin-6 (IL-6) and its correlation with C-reactive protein (CRP), depending on the type of hip joint endoprosthesis (cemented or cementless endoprosthesis) in order to determine implant biotolerance during the early postoperative period.Material/MethodsThe sample comprised 200 patients [mean age=64 (31–81) years] with coxarthrosis. All patients underwent hip joint arthroplasty using a cemented or cementless endoprosthesis. Blood samples were collected 3 times: before the procedure, on the first day after the procedure, and after 6 weeks. IL-6 and CRP levels were assayed using immunoenzymatic methods. The results were subjected to statistical analysis using the Shapiro-Wilk test.ResultsOn the 1st day after the procedure, CRP and IL-6 concentration increased rapidly after implantation of both cemented and cementless endoprostheses. At 6 weeks postoperatively, the CRP value remained at a similar level in patients after cemented arthroplasty and was almost 2-fold lower in patients who underwent cementless arthroplasty. The IL-6 value returned to the baseline level in patients after cementless arthroplasty and showed an ongoing increasing tendency in patients after cemented arthroplasty.Conclusions1. The measurement of C-reactive protein and Interleukin-6 is a high-sensitivity test, assessing implant biotolerance. 2. The implantation of a cemented endoprosthesis induces a higher increase in the level of proinflammatory cytokines as compared with a cementless endoprosthesis. 3. For a complete assessment of both early and later body responses to implantation and the related surgical procedure, further studies using available approaches and tools are recommended.

Status and problematic issues of joint replacement in Ukraine (an enforcement of the XVI Congress of orthopaedics and traumatologists of Ukraine)

Status of development and outlooks of joint replacement procedures in Ukraine were analyzed. It is noted that under the auspices of the Ministry of Health, the National Academy of Medical Sciences, and the Association of Orthopaedic Surgeons and Traumatologists of Ukraine there were established and actively deal some regional centers in Kiev, Kharkov, Dnepropetrovsk, Donetsk as well as regional and city centers equipped with modern kinds of endoprostheses and instruments. There are qualified surgeons experienced on joint replacement, anesthesiologists and rehabilitation specialists working there. Over the past 5 years the specialists of these centers for improvement of their skills have been trained in leading hospitals in Ukraine, Europe and America. Many of anesthesiologists, rehabilitation specialists as well as nurse practitioners and other medical staff also were trained, and this significantly improved the quality of joint replacement procedures as a whole, and social adaptation of the patients.Ongoing researches on the development of novel domestic endoprostheses keep doing. At the Sytenko Institute for Spine and Joints Pathology of the National Academy of Medical Sciences of Ukraine along with the SPA "Monocrystal" and the LLC "Sumaral-Med" a novel construct of hip endoprosthesis with friction pair of monocrystalline corundum (sapphire) was developed and passed clinical testing. In Kiev at the Institute for Orthopeadics and Traumatology of the National Academy of Medical Sciences of Ukraine construct of total revision hip cementless endoprosthesis with modern titanium covering, perfect anatomical shape and wear resistant pair of friction with ceramic head was designed.Despite on a special computer program called "Register" established in Ukraine which allows you to enter information about the operations of replacement without too much difficulties an issue on registration and analysis of outcomes of surgeries performed remains open and unresolved. Further strengthening of the material-technical base of the centers for joint replacement procedures and for the departments of orthopedic and trauma in the regional hospitals is important for solving this problem.An issue on annually increasing amount of revision joint replacement surgeries remains complicated and unresolved. For instance, in the Western Europe the number of revision cases is about 20%. Analysis of this situation made at the Sytenko Institute for Spine and Joints Pathology indicates that the number of revision cases in Ukraine does not exceed 10%. This is a worrying signal for the future. Fitting up with revision systems, instruments and properly trained professionals presents an acute problem. Rehabilitation centers for patients with endoprostheses of the large joints existing in Ukraine have not yet fully ensure process of treatment which also requires solutions. It was proposed to create the state research program "Revision hip and knee joints replacement in Ukraine" within which provision of the existing centers with necessary medical equipment, instruments and metal artificial joints will be substantiated, and development and manufacturing of surgical instruments for systems in revision cases based on domestic producers will be planned. All of this will allow improving the quality of life of the patients.

Конечно-элементный анализ эффекта врастания костных тканей в процессе остеоинтеграции бесцементного эндопротеза

Конечно-элементный анализ эффекта врастания костных тканей в процессе остеоинтеграции бесцементного эндопротеза

The modular endoprosthesis for mandibular body replacement. Part 1: Mechanical testing of the reconstruction

IntroductionIn this paper we present the results of the mechanical testing of a new generation modular endoprosthesis, which has been designed to improve the results of mandibular reconstruction. Materials and methodsThe new cementless endoprosthesis consists of a male part, a female part (both with screws on the stems), connected via a dove-tailed connection and secured with a coronal screw.The endoprosthesis was fitted into standardized blocks of synthetic bone (Synbone AG, Malans, Switzerland). The set-up was fixed to an ElectroPuls testing machine at one end and loaded at the other end 25mm away. Three specimens were loaded continuously until failure to determine the average load to failure of the construct. Five specimens were then loaded cyclically between 10 and 150N until either failure or 500,000 cycles. A finite element analysis was also performed on the set-up. ResultsOf the five specimens in the fatigue testing, only one survived while the other four either were bent or fractured at the stem of the clamped portion. The specimen that survived had very good bony contact with the prosthesis at the lower border. The connection of the modules via the dove-tailed design did not show any loosening. Finite element analysis showed areas of stress concentration at the superior surface of the stems to 188.8MPa. This was well below the yield strength of titanium alloy of 897MPa. Statistical analysis performed for specimens 1 to 4 to calculated lower tolerance bounds on cycles to failure, representing the estimated minimum achievable cycles to failure at 90, 95, and 99% of the population at 90 and 95% confidence levels, showed that the estimated mean cycles to failure was 10,132 cycles at the mean, minimum and maximum loads of 120N and 18.4N respectively. ConclusionGood bony contact seems to be essential at the lower border for long-term survival of the reconstruction. Small gaps increase the bending forces and thus shear stresses at the stem. The new design of the modular endoprosthesis is prone to stress concentrations at the superior surface of the stems. This is accentuated by the sharp screw threads of the stems. The loosening of the module connection seemed to have been stopped with the dove-tailed design.

Clinical results following the transgluteal and anterolateral (Watson-Jones) approach to hip prosthesis implantation

80 total hip endoprostheses with antero-lateral (Watson-Johnes) approach are compared with 77 total hip endoprostheses with transgluteal approach (Bauer) after a period of at least one year after the operation. In all cases a cementless implanted model has been used. After transgluteal approach we found less bleeding and hematoma, but slight increased periarticular ossifications. The clinical results (pain, range of motion, distance walked, walking aid, manner of walking) were only a little different. For the technic of implantation of the cementless endoprosthesis the transgluteal approach seems to be more useful.

Early results of cementless hip arthroplasty in the treatment of femoral head posttraumatic and atraumatic osteonecrosis

To evaluate the value of cementless hip arthroplasty in the treatment of posttraumatic and atraumatic osteonecrosis (ON) of the femoral head. The study was conducted at the Department of Orthopedics and Traumatology, Military Medical Academy, between January 1st, 1999 and December 31st, 2003. Twenty-five patients with 27 implanted endoprostheses, and the diagnosis of osteonecrosis of the femoral head, and radiographically confirmed Arlet-Ficat stage III and IV were evaluated retrospectively. The results were evaluated according to Harris Hip Score (HHS). The research included 10 patients with traumatically induced osteonecrosis and 15 patients (17 endoprothesis) with osteonecrosis of the femoral head. The mean age of the patients in the group with posttraumatic osteonecrosis of the femoral head was 41 (19-62) years, and in the group of the patients with atraumatic osteonecrosis of the femoral head it was 40.2 (21-53) years. Complications included one case with postoperative luxation, and one case with iatrogenic sciatic nerve palsy. The average Harris Hip Scores in the group of posttraumatic osteonecrosis were 31 points preoperatively and 86 points postoperatively. In the group of osteonecrosis of atraumatic etiology, the average Harris Hip Score was 28 points preoperatively, and 77 points postoperatively. Postoperative Harris Hip Scores were compared with the Student's t-test and the results showed no statistically significant difference (p = 0,125). Our study did not find any significant difference between the results of posttraumatic and atraumatic osteonecrosis of the femoral head treated with cementless endoprosthesis.