Total Hip Artroplasty Research Articles

Revision of The Total Hip Artroplasty Previously Placed False Acetabulum

A 43-year-old female patient underwent total hip arthroplasty as a result of coxarthrosis in an external center, and it was observed that the acetabular cup was placed in the false acetabulum. Later, as a result of the examination and examination performed on the patient who applied to the outpatient clinic with the complaint of hip pain, loosening of the acetabular cup was found and revision total hip arthroplasty was performed approximately 26 months after the first surgery. The acetabular cup, which was previously placed in the false acetabulum, was left in place to act as a bone stock in the superior acetabulum. There were no complications in the patient's follow-up and clinical improvement was observed in the patient.

Some aspects concerning the patients′ rehabilitation after total hip artroplasty

Some aspects concerning the patients′ rehabilitation after total hip artroplasty

Effect of Graphene-Oxide Addition on the Microstructure and Mechanical Properties of Two-Stage Sintered Zirconia-Toughened Alumina (ZTA) Composites

United Nations has estimated that 130 million people would suffer from osteoarthritis worldwide by 2050. This disease would require patients to undergo a surgery known as Total Hip Replacement (THR) which has a failure rate of approximately 1 % with a lifespan of 20 years. The biomaterials used to manufacture this total hip artroplasty are mainly made of Zirconia-Toughened Alumina. In this work, Zirconia Toughened Alumina (ZTA) composites with 10 vol% Y-TZP content were doped with small amount (0.01 to 1 wt%) of graphene oxide (GO). The GO-doped ZTA composites were produced via two-stage sintering with T1 ranging between 1400°C and 1550°C, heating rate of 20°C/min, followed by T2 of 1350°C and 12 hours holding time. The sintered ZTA samples were then evaluated on its microstructure and mechanical properties such as bulk density, Vickers hardness, Young’s modulus and fracture toughness to investigate the effect of GO addition on ZTA samples prepared via two-stage sintering. The results showed that ZTA composites containing up 0.1 wt% GO is beneficial in improving the microstructural and mechanical properties of ZTA composites prepared via two-stage sintering. The sample recorded a high hardness of up to 18.5 GPa, Young’s modulus of 406 GPa and fracture toughness of 5.8 MPam1/2 when sintered at T1 of 1450℃.

Anesthesia type have the effect of extremity length award in patients with total hip artroplasty?

Aim: Leg length discrepancy (LLD), instability and periprosthetic infection are most common reasons patient complaint after total hip replacement (THR) surgery. Degree of soft tissue release in operating room may mislead us about LLD. The objective of this study is to report the effect of the anesthesia type on leg lengthening amount. Material and Method: In this study, 36 primary coxarthrosis patients who underwent THR surgery in two different medical centers under different types of anesthesia during2016-2017 were enrolled retrospectively. Patients are divided into two groups. Group 1 (n:18) who underwent general anesthesia, group 2 (n:18) who underwent regional anesthesia. Distance between greater trochanter-ischial tuberocity (GT-IT) is measured radiologically for leg lengthening, umbilicus-medial malleolus distance is measured clinically for LLD. Harris hip score (HHS) is measured for functional scoring. Results: The average follow-up time was 13 months (12-15 months). No deep infection or neurovascular damage were seen in patients. According to GT-IT distance, leg lengthening was 19.76±9.83 mm in group 1 and 3.2±3.96 in group 2 (p:0.000*). According to 12 month umbilicus-medial malleolus distance, 9 patients experienced leg lengthening (<2cm) and 9 patients had no LLD in group 1 where 3 patients experienced leg shorthening (<1cm), 5 patients experienced leg lengthening (<1cm) and 11 patients had no LLD in group 2. Average HHS was 77.17±4.4 in group 1 where 78.64±5.73 in group 2 (p:0.410). When all patients were considered 12 patients (33%) experienced 1-10 mm lengthening, 4 patients (11%) experienced 10-20 mm lengthening. HHS was 79.62 in patients with no LLD, 77.41 in 1-10 mm LLD, 75.21 in 10-20 mm LLD (p:0.140) Conclusion: In THR surgery, leg lengthening is seen in patients whom underwent general anesthesia more than regional anesthesia patients. We think that this is because soft tissue relaxation is more significant after general anesthesia.

Results of total hip artroplasty in our clinic

Aim: Patients undergone total hip replacement, performed in our clinic were retrospectively reviewed and discussed in the light of the available literature. The aim of this study was to determine our clinical results.Materials and Methods: The records of patients with total hip arthroplasty performed in our clinic between 2002 and 2008 were evaluated retrospectively. Laboratory values, Harris hip score and complications of these patients were examined.Results: The mean preoperative VAS of the 72 patients with a mean follow-up of 28.9 months was 81.6 preoperatively and the mean VAS was 35.7 in the last control. Harris hip score was 36.7 before the operation and 70.3 in the last control. According to Harris hip score of the patients in the preoperative period, 30 patients were evaluated as moderate and 42 patients as poor. In the postoperative period, 10 patients (13.8%) were excellent, 19 (26.3%) were very good, 30 (41.6%) were good, 6 (8.3%) were moderate, 7 (10%) were poorly rated according to Harris hip score. Biochemical laboratory values measured from venous blood taken at the time of arrival of patients, mean HsCRP 11.67±15.4 mg / l, insulin 14.87±29.53 IU / ml, glucose level 139.11±74.3 mg / dl, CK 426 9±12x8.9 mg / dl and CK-MB were determined as 41.1±46.8 mg / dl.Conclusion: As a result, we think that total hip arthroplasty is still an effective method in advanced hip arthrosis.Keywords: Arthroplasty; hip pain; loosening; complication.

Total Hip Artroplasty

Total Hip Artroplasty

Concomitant Repair of Idiopathic Abductor Tears During Primary Total Hip Arthroplasty: Technique, Review and Outcomes

This is a retrospective, consecutive, single-surgeon case series which examines the clinical and radiographic outcomes of 19 hips with the incidental finding of hip abductor tears during primary Total Hip Artroplasty (THA). The incidence of abductor tears was 0.68% during our study period from 1994 – 2008. We found that positive preoperative Trendelenburg gait was a positive predictor of the presence of an abductor tear. Seven out of 19 patients had an intraoperative change in surgical approach due to the extent of the abductor tear. Bilaterality and the presence of sclerosis preoperatively were significantly associated with a longer limp period postoperatively. In conclusion, idiopathic abductor tears are rare during primary THA, however there is a high likelihood of changing the intraoperative approach if they are encountered.

Total Hip Artroplasty Under Spinal Anesthesia With Low-Dose Dexmedetomidine in Chronic Renal Failure Patients: A Primarily Clinical Evaluation

Total Hip Artroplasty Under Spinal Anesthesia With Low-Dose Dexmedetomidine in Chronic Renal Failure Patients: A Primarily Clinical Evaluation

720. Total Hip Artroplasty Under Spinal Anesthesia With Low-Dose Dexmedetomidine in Chronic Renal Failure Patients: A Primarily Clinical Evaluation

720. Total Hip Artroplasty Under Spinal Anesthesia With Low-Dose Dexmedetomidine in Chronic Renal Failure Patients: A Primarily Clinical Evaluation

720: Total Hip Artroplasty Under Spinal Anesthesia With Low-Dose Dexmedetomidine in Chronic Renal Failure Patients: A Primarily Clinical Evaluation

720: Total Hip Artroplasty Under Spinal Anesthesia With Low-Dose Dexmedetomidine in Chronic Renal Failure Patients: A Primarily Clinical Evaluation

Factors affecting aseptic loosening of 4750 total hip arthroplasties: multivariate survival analysis

BackgroundTotal hip arthroplasty is a successful surgery, that fails at a rate of approximately 10% at ten years from surgery. Causes for failure are mainly aseptic loosening of one or both components partially due to wear of articular surfaces and partially to design. The present analysis aimed to identify risk factors and quantify their effects on aseptic failure.MethodsMultivariate survival analysis was applied to 4,750 primary total hip arthroplasties performed between 1995 and 2000.ResultsThe survival of the prosthesis is affected by gender, age, pathology, type of the prosthesis and skill of the. The worst conditions are male patients, younger than 40 years, affected by sequelae of congenital diseases, operated by a who performed less than 400 total hip artroplasty in the period. Furthermore, cemented cups and stems (less expensive) have a higher risk of failure compared with uncemented ones (more expensive).ConclusionThe only variable that affects survival and that can be modified by is the type of prosthesis: a lower cost is associated to a higher risk. Results concerning the risk associated with cemented components are partially in disagreement with studies performed in countries where cemented prostheses are used more often than uncemented ones.

Total hip artroplasty after failure of conservative treatment of osteonecrosis of the femoral head

目的 比较股骨头缺血坏死显微外科保头治疗失败后全髋关节置换(THA)与初次全髋关节置换的疗效差别.方法对应用带血管蒂骨瓣转移治疗失败后改行THA治疗的57例(61侧)股骨头缺血性坏死与同期初次即选用THA治疗的58例(65侧)股骨头缺血性坏死进行随访观察,骨瓣组平均年龄47.2岁(36～65岁),非骨瓣组平均年龄60.5岁(48～82岁),THA手术前根据Ficat分期标准,骨瓣组Ⅲ期7侧,Ⅳ期54侧;非骨瓣组Ⅲ期29侧,Ⅳ期36侧.手术方式:骨瓣组:小切口26侧;常规切口手术35侧;非骨瓣组:小切口22侧;常规切口手术33侧.两组病例平均随访6.2年(2～9年).比较两组病例切口长短、术中出血量、手术时间、围手术期并发症、术后半年及随访期末HHS评分及髋关节翻修情况的差异.结果骨瓣组手术切口长度9～17cm,平均12.8 cm,对照组为9～16cm,平均12.2 cm(P=0.213);骨瓣组术中出血平均480 ml(400～750 ml),非骨瓣组术中平均出血420 ml(350～600 ml;P=0.09);骨瓣组平均手术时间为105 min(90～130 min),非骨瓣组为100 min(90～120 min;P=0.168);骨瓣组围手术期并发症发生率为4.9%,对照组并发症发生率为8.6%(P＜0.05);两组病人均未出现术中并发症.骨瓣组术后半年的HHS平均为85.8分(80～92分),非骨瓣组为80.5(76～90分),骨瓣组随访期末的HHS平均为96.9分(92～100分),非骨瓣组为92.6分(86～100分)(P＜0.05).两组在随访期间均无翻修病例.结论应用显微外科技术保头手术治疗失败的股骨头坏死改行人工全髋关节置换不增加手术难度及围手术期并发症的发生率,术后关节功能恢复满意。

Outcome of Primary Total Hip Arthroplasty in Patients with Osteonecrosis of the Acetabulum after Previous Pelvic Irradiation

Purpose: To describe the results of Total Hip Artroplasty (THA) treatment, and to analyze the risk factors related to the early failure of acetabular components in irradiated hips. Materials and Methods: Between January 1990 and January 2000, eighteen primary total hip arthroplasties in twelve patients were treated at our hospital. The mean follow-up period was fifty-eight months. The acetabular components were of hemispherical design with an ingrowth surface in fourteen cases and roof rings in four cases. The risk factors analyzed: age, total radiation dose, onset of symptoms after irradiation (≤4 years, >4 years), and the risk of failure of acetabular components after THA. Results: The latent period was significantly related to the survival rate with a cutoff point of four years (p=0.03). Adjusting for age, total radiation dose, and component type, the risk of failure was fifteen times higher (95% confidence interval: 1.03-227.44) in patients with a disease onset latency of ≥4 years than in those with a latent period of Conclusion: It is suggested that any arthroplasty might be unwise if the portal of irradiation includes the acetabulum and the latent period of disease onset after irradiation exceeds four years.

Postoperative epidural analgesia and possible transient anterior spinal artery syndrome. (HaEmek Medical Center, Afula, Israel) Reg Anesth Pain Med 2001;26:274–277.

An unusual complication of epidural analgesia used to facilitate postoperative pain relief while mobilizing a patient is presented in this case report. A 65‐year‐old woman with a history of chronic obstructive pulmonary disease, atherosclerotic cardiovascular disease, chronic renal failure, and degenerative vertebral anatomy underwent resection of the left ureter due to an obstructing tumor. The day following the surgery, mobilization to an armchair was started, followed by a decrease in blood pressure. Soon after, flaccid paralysis was sparing of sensory functions, consistent with anterior spinal artery syndrome, was diagnosed. This complication should be taken into account, especially in patients at risk, when considering epidural analgesia techniques in the postoperative period.Comment by Pedro F. Bejarano, M.D. Fortunately infrequent, the Anterior Spinal Artery Syndrome (ASAS) has been described in the early postoperative period in association with surgery involving the retroperitoneum (specially on the left side), as well as unexpectedly with regional anesthesia procedures (Spinal, Epidural and Celiac Plexus Blocks) in the vicinity of the T6 to L2 “critical zone” of medulary arterial blood flow.1,2 This case highlights the importance of a proper evaluation and prevention when feasible, of combining risk factors (besides type of surgery and anesthetic technique) that may potentiate otherwise subclinical—but certainly prevalent—vascular, circulatory or spinal anatomy aging derangements leading to ASAS.As the authors state in the discussion of this case, it is remarkable the aethiological association with an apparently uncomplicated and retrospectively “preventable” hypotensive episode, whether it be a consequence of a relative hypovolemia, a pharmacological (postanesthetic or not) impairment of baropressor responses, or to an excessive local anesthetic sympathetic blockade.Learning from unexpected negative outcomes in anesthesia makes us more sensible to risk factors that are not specially highlighted in daily practice. In this sense, a case with so multiple patient's risk factors including the diagnosis of spinal stenosis, may had lead to other postop analgesia choices, namely systemic or even sole epidural opioid analgesia (that maybe was not considered here due to the COPD) as has been suggested before.3 Moreover, in the scope of an obstructive coronary disease high‐risk patient, a more aggressive treatment to the hypotensive episode including quick return to the recumbent or trendelemburg position limiting the isquemia could have favored this neurological adverse outcome.1. Hong DK, Lawrence HM: Anterior Spinal Artery Syndrome following total Hip Artroplasty. Anesth Intensive Care. 2001;29:62–66.2. Hachisuka K, Ogata H, Kohshi K: Postoperative Paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report. Paraplegia. 1991 Feb;29(2):131–136.3. Linz SM, Charbonnet C, Mikhail MS, et al.: Spinal artery syndrome masked by postoperative epidural analgesia. Can J Anaesth. 1997;44(11):1178–1181.

Mixed oxides prosthetic ceramic ball heads. Part 3: effect of the ZrO 2 fraction on the wear of ceramic on ceramic hip joint prostheses. A long-term in vitro wear study

Using ceramic materials it is possible to obtain a number of beneficial mechanical properties such as considerable hardness, good chemical resistance, high tensile strength, and a good fracture toughness. The use of ceramic-on-ceramic as bearing surfaces for hip joint prostheses has been reported to produce a lower wear rate than other combinations (i.e. metal-on-polyethylene and ceramic-on-polyethylene) in total hip artroplasty. These advantages may increase the life expectancy of hip implants and improve the life of patients. Two new types of mixed-oxide ceramics (alumina and yttria-stabilised zirconia) femoral heads and acetabular cups containing different ratios of alumina and zirconia were compared with pure commercial alumina in terms of wear behaviour in a hip joint simulator. Hip joint wear simulator studies were carried out with a full-peak load of 2030 N and a frequency of 1 Hz in bovine calf serum. After 10 million cycles the measured weight loss of all specimens was very low. However, the experimental results did not show any significant difference between the new experimental mixed-oxide ceramics prototype and the commercial ceramic material couplings.