Cup Arthroplasty Research Articles

Results of Vitallium Cup Arthroplasty: Report on 23 Hips in 20 Patients

Results of Vitallium Cup Arthroplasty: Report on 23 Hips in 20 Patients

Effect of Surgical Treatment of Aseptic Femoral Head Necrosis

During past four years, twenty one surgical treatments were carried out on thirteen patients with aseptic necrosis of femoral head; drilling & bone nailing 1, intertrochanteric rotational osteotomy 7, cup arthroplasty 1, Moore's hip prosthesis 8, cup & socket arthroplasty 3 and total hip replacement 1.13 patients who were followed up for more than six months after operation were clinically evaluated according to criteria of coxarthrosis of Jap. Orthop. Ass.The patients who received intertrochanteric osteotomy showed good results in all cases. This method should be indicated as first choice of operation to early stadium with localized necrotic area. The results of hip endoprosthesis were also excellent for pain, mobility, gait and ADL. This operation was done in cases of moderate or advanced stadium in which the acetabular change was not observed.Cup & socket arthroplasty and total hip replacement appear to be indicated to the case of severe stadium which shows narrowing of joint space and acetabular arthrotic change.

Treatment for fixation complications: Femoral neck fractures.

Of 102 hips with femoral neck fracture complications, 75 required major secondary procedures such as total hip replacement, femoral prosthesis, cup arthroplasty, tibial bone grafting, and head and neck resection. The method chosen depended on the specific problem: nonunion, aseptic necrosis, infection, degenerative arthritis, or a failed primary prosthesis. Other factors influencing treatment were the patient's chronological and physiological age, his general health, his life pattern, and the familiarity of the surgeon with the technique and the advantages and disadvantages of the various salvage procedures.

Cup arthroplasty in patients with rheumatoid arthritis.

Cup arthroplasty in patients with rheumatoid arthritis.

The present status of surgery in the treatment of osteoarthritis of the hip joint.

The surgical management of degenerative conditions affecting the hip joint has undergone very radical changes over a number of years, necessitating a reassessment of our approach to this common problem. When considering surgery, it is important to recognize the main types of degenerative joint, which may present subluxation, or concentric or atrophic changes. The type of joint change as well as age, sex and multiplicity of joint problems must be considered in helping one to determine the appropriate operative management. This paper attempts to assess the present value of, and indications for, osteotomy, arthrodesis, and partial replacement arthroplasty in the light of recent developments in surgery of the degenerative hip joint. It is concluded that high femoral osteotomy and total hip replacement arthroplasty are the two most useful procedures available, and that other operations have only limited application in the treatment of osteoarthritis of the hip joint.SummaryIn conclusion, therefore, it is considered that cup arthroplasty and partial replacement arthroplasty have little place in the treatment of degenerative and rheumatic hip disease. Arthrodesis is indicated in very few patients, but it can be particularly indicated in a fit young man undertaking heavy physical work.The two operative procedures considered to be of value in the treatment of degenerative hip disease are high femoral osteotomy and total hip replacement. When these are used according to a number of well‐defined criteria, a high percentage of satisfactory results can be expected. Both procedures have problems. Osteotomy fails to achieve a high standard of normal function, and non‐union at the osteotomy site is a possibility. Total hip replacement can be complicated by loosening of the prosthesis, by wearing of the prosthetic socket, and rarely, by infection of the prosthetic joint.

Reankylosis of the hip joint in ankylosing spondylitis after total hip replacement

AbstractA case of osseous reankylosis occurred after total replacement of one hip in a patient having ankylosing spondylitis. Not only did the ankylotic disease involve the vertebral column, but the severity of this process had been manifest through osseous ankylosis of bilateral cup arthroplasties. We believe this to be the first report of reankylosis involving total hip replacement.

Comparative Evaluation of the Results of Cup Arthroplasty and Total Hip Replacement

Comparative Evaluation of the Results of Cup Arthroplasty and Total Hip Replacement

LOW-FRICTION ARTHROPLASTY OF THE HIP FOR THE FAILURES OF PREVIOUS OPERATIONS

1. Two hundred and seventeen low-friction arthroplasties performed between November 1962 and April 1969 in 203 patients with failed previous operations have been analysed. 2. The technical details of operation in relation to these conversion problems have been outlined. 3. The quality of the results in relation to pain, mobility and ability to walk has been assessed before operation and one year afterwards, with small numbers at three and five years. 4. Pain was completely relieved or was minimal in 96·3 per cent of the patients, and in no case was the pain worse. 5. The total range of movement was 100 degrees or more in 98·5 per cent. No hip lost movement after conversion. 6. The failures were principally due to infection and to technical difficulties. There were no mechanical failures without a technical or radiological explanation. 7. Low-friction arthroplasty is an excellent salvage procedure, especially for failed cup arthroplasty.

Probable Place of Total Hip Arthroplasty in Rheumatoid Arthritis Involving the Hip

Summary At the time of this writing our experience with total hip arthroplasty is entering its third year. We are using the Charnley low friction arthroplasty and feel confident in advising total hip arthroplasty to patients with rheumatoid arthritis. In rheumatoid arthritis and rheumatoid spondylitis involving the hips, this procedure gives the most predictable result for both relief of pain and restoration of function. Complications are considerably less than with any other surgical procedure used before for relief of pain and improvement of function; this would include cup arthroplasty and replacement of the femoral head. Special consideration must be given the rheumatoid patient because of the general nature of his disease and the involvement of multiple joints in most instances. Yet although this may preclude his ambulating as well as the patient with osteoarthritis, the rheumatoid patient is usually quite satisfied when he is able to move about as he wishes with little or no pain or when he can move even from bed to chair with greater ease than before the operation. We have operated on patients younger than 50 years of age, which is our standard lower age for total hip arthroplasty, because so many rheumatoid patients have involvement at a younger age and because of the severe crippling nature of the disease. The problem is usually bilateral. These patients tend to put less stress on their new hip joints than those with osteoarthritis.

Replacement Endoprostheses in the Treatment of the Damaged Hip

Summary Although much emphasis is being placed today on total hip replacement, the endoprosthesis still has a place in treatment. The endoprosthesis is most useful in the treatment of a fresh fracture of the femoral neck in an elderly patient and in fractures of the femoral neck with nonunion, avascular necrosis of the head, comminution of the head, or dislocation. The results of its use in degenerative arthritis in which there is acetabular damage are not sufficiently good to justify this procedure. The endoprosthesis can be used as an alternative to a cup arthroplasty in an active person who is more than 60 years old and who has unilateral advanced disease, when the femoral head is grossly distorted and collapsed. In the patient with osteoarthritis, rheumatoid arthritis, or rheumatoid spondylitis without fracture of the femoral neck, the mold arthroplasty gives better long-term results. In the elderly patient with extensive changes in the acetabulum and in the head, a total hip replacement is the current treatment of choice.

Bilateral Vitallium Mold Arthroplasty of the Hip: 31-Year Follow-Up

To the Editor.— A cobalt-chromium alloy (Vitallium) mold arthroplasty of the hip, first performed by SmithPetersen in June 1938, has become an established procedure for the treatment of degenerative hip disease. 2,3 Recently a patient who had undergone bilateral mold arthroplasties of one hip 31 and the other 29 1/2 years ago presented the longest living follow-up of bilateral cup arthroplasty. 2 Her postoperative course is remarkable. Report of a Case.— Four years prior to admission to the Massachusetts General Hospital in 1939, at age 28, the patient began to experience pain in the left hip. Progressive loss of motion in the involved joint was accompanied by incapacitating pain. No trauma or childhood hip disease was known. X-ray films showed shallow acetabulae with broad and flattened femoral heads, consistent with congenital dysplastic hip disease. This woman walked with a bilateral Trendelenberg gait. The range of motion was 30° of

Immediate Effect of Osteotomy on the Intramedullary Pressure of the Femoral Head and Neck in Patients with Degenerative Osteoarthritis

Recently, Arnoldi, Linderholm & Miissbichler (1971, and to be published) demonstrated a considerable hypertension in the cancellous bone marrow of the proximal part of the femur in patients with advanced stages of coxarthrosis. Simultaneous examinations by means of intraosseous phlebography indicated that the high pressure was accompanied by impaired venous drainage from the femoral head and neck. There are indications that intramedullary hypertension may be a causative factor for the aching rest pains typical of these patients. Therefore we have thought it of interest to investigate the effect upon intramedullary pressure of two operative procedures routinely performed for painful conditions in osteoarthritis of the hip. In both procedures the medullary space is opened and drained, in osteotomy, in the subtrochanteric region, in Smith Petersen cup arthroplasty by removal of bone and cartilage from the femoral head. In the present study the immediate effect of both procedures upon the intramedullary pressure was tested. MATERIAL Two groups of patients with degenerative osteoarthritis of the hip joint were examined. The first group consisted of seven patients treated by means of intcrtrochanteric osteotomy. In the second group, containing eight patients, Smith Petersen cup This work was supported by the Swedish Medical Research Council (Project No.

Results of Treatment of Hip Disorders with Cup Arthroplasty

We have analyzed our results after 543 cup arthroplasties in 475 patients with a variety of hip disorders. Data concerning the operation itself, postoperative management, and complications have been presented. Two hundred fifty-one patients (294 hips) were examined three to sixteen years after operation. The results have been compared with the preoperative condition. Over-all improvement occurred in 90 per cent of the patients. Pain was completely relieved in two-thirds of the patients and improved in 90 per cent. The results in terms of gait, working ability, and activities of daily living were enumerated. Results were correlated with technical factors, clinical examination and roentgenographic findings. We concluded that cup arthroplasty is a useful procedure in the treatment of hip disease and have pointed out some of the areas where further improvement is needed.

Biomechanics of Cup Arthroplasty

Biomechanics of Cup Arthroplasty

Postoperative Program for Patient Having Cup Arthroplasty

Postoperative Program for Patient Having Cup Arthroplasty

Surgical Approach and Technique of Cup Arthroplasty

Surgical Approach and Technique of Cup Arthroplasty

Management of the late effects of fracture-dislocations of the hip: Personal experiences

The results following 173 fracture-dislocations of the hip over 17 years have been studied. In only 17 cases had good primary treatment, by accurate reduction both of the femoral head and the fracture been carried out. Late effects can be considered in two groups, firstly those in which the femoral head has never been reduced, secondly those in which arthrosis follows deformity of acetabulum or femoral head after reduction. In treatment, arthrodesis, replacement arthroplasty, and cup arthroplasty are considered. The results in general greatly favour cup arthroplasty, but each case must be considered on its merits.

Mechanical analysis and optimization of a cup arthroplasty

The surgeon performing cup arthroplasty is free to relocate the acetabulum and the greater trochanter within certain limits. A method was developed so that optimum relocation can be accomplished based on a mechanical analysis of the hip. Clinical observations indicated that acetabular pressure and abductor muscle force should be minimized. A force and pressure analysis was written based on information that can be obtained from an X-ray. The problem was then formulated as a constrained optimization problem from which optimum geometry can be obtained which minimizes either acetabular pressure or abductor force. A computer program was written using the sequential unconstrained minimization technique, and extensive numerical results were obtained. The results show that minimum abductor force is the best optimization criterion, that the acetabulum should be moved medially and inferiorly, and that the tip of the greater trochanter should be moved laterally to obtain the minimum abductor force. An example is given which shows that these modifications can lead to significant reductions in abductor force and acetabular pressure.

USE OF THE AUSTIN MOORE PROSTHESIS FOR ADVANCED OSTEOARTHRITIS OF THE HIP

1. The early results of thirty Austin Moore arthroplasty operations with acetabular reaming in twenty-five patients with advanced osteoarthritis of the hip have been investigated. 2. The radiological changes after insertion of a prosthesis have been studied. 3. There was a variable degree of improvement in all patients. There was a worth-while improvement in function and relief of pain. Stability, however, was disappointing in more than half (and in all the bilateral cases). An average of three-quarters of an inch of shortening was found in the unilateral cases. 4. In such advanced cases the results of Austin Moore arthroplasty are probably of the same order as for cup arthroplasty, and in many cases they show no more than marginal improvement over pseudarthrosis. 5. It is concluded that at the present stage of progress in the development of arthroplasty the use of the Austin Moore prosthesis with acetabular reaming has very limited indications.

Diffuse Pigmented Villonodular Synovitis of the Hip Joint

Analysis of eight cases of diffuse pigmented villonodular synovitis of the hip joint and a review of the literature indicate that the disease was most common in persons in their fourth and fifth decades of life. In our series of seven women and one man, the duration of symptoms ranged from two and one-half to eleven years. Typical symptoms included increasing pain in the involved hip and a limp. In all cases the disease was monarticular and there were no systemic symptoms. Roentgenographic findings were cystic changes in the acetabulum and the femoral head and neck, narrowed joint space, and occasional diffuse sclerosis of the femoral head. Needle biopsy was the most useful diagnostic procedure. Treatment included complete synovectomy in all eight patients, arthroplasty with a Vitallium cup in six, and an Austin Moore prosthesis in two. Three patients had radiotherapy. Meticulous synovectomy and grafting of the cysts combined with cup arthroplasty are recommended for treatment of this disease. Our experience with the Austin Moore prosthesis in this disease is too limited to assess its value. It is our current belief that if the femoral head is destroyed by cystic changes, an Austin Moore prosthesis should probably be used.