AIM: To present the results of total hip arthroplasty(THA) for post tubercular arthritis of the hip joint.METHODS: Sixty-five patients(45 male, 20 female) with previously treated tuberculosis of the hip joint underwen...AIM: To present the results of total hip arthroplasty(THA) for post tubercular arthritis of the hip joint.METHODS: Sixty-five patients(45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years(range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction(PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also recorded.RESULTS: The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years(range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min(range, 65-125) whereas the mean blood loss was 600 m L(range, 400-900 m L). The average follow up was 8.3 years(range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabularprotrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no evidence of any loosening or osteolysis on X-rays. There we展开更多
AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless ...AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement(THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47(95%CI: 0.45-0.48), 0.9(0.84-0.95), 1.29(1.06-1.57) and 0.69(0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82(0.76-0.89), 2.65(1.14-6.17), 0.98(0.7-1.38), and 0.67(0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7(0.65-0.75), 0.85(0.49-1.5), 1.47(0.93-2.34) and 1.13(0.98-1.3).CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.展开更多
Background: A previous report evaluated the initial 310 cementless, Buechel-Pappas (B-P), Semi-Constrained Rotating Platform total knee replacements in 257 patients followed for an average of 7.6 years, range 2 - 18 y...Background: A previous report evaluated the initial 310 cementless, Buechel-Pappas (B-P), Semi-Constrained Rotating Platform total knee replacements in 257 patients followed for an average of 7.6 years, range 2 - 18 years. Diagnoses were osteoarthritis in 233 patients, post traumatic arthritis in 4 patients and rheumatoid arthritis in 22 patients. Knee Scores, using a strict knee scoring scale were 86.4% excellent, 12.3% good, 0.3% fair and 1.0% poor results. Survivorship, using an end point of revision for any mechanical reason (including component loosening, bearing wear and bearing dislocation) was 99.4%. Survivorship for a poor knee score (including persistent pain, loosening, instability and infection was 97.6%. The purpose of the present study is to report the updated results of this same patient cohort at a minimum follow-up of twenty years. Methods: The average age of patients at the time of surgery was 67 years, range 34 to 91 years. A total of 20 patients (22 knees) were still living, with a follow-up of 20 - 30 years (mean 23.47 years). The same strict knee scoring scale and survivorship analysis were used to evaluate patient outcomes at the 20 to 30 years interval. Results: Survivorship, in the current study, using the same end points as in the previous study, was 96.5% at the 20 and 30-year intervals. Late mechanical failure and osteolysis were not identified. Conclusion: This cementless, semi-constrained rotating platform total knee replacement has stood the test of time for more than 20 years and can be considered acceptable for long-term use, in properly selected patients.展开更多
Background: The Buechel-Pappas (BP) meniscal bearing total ankle replace-ment was initially developed as a “shallow-sulcus” talar component device using cobalt-chromium-molybdenum alloy, in 1978, and later, modified...Background: The Buechel-Pappas (BP) meniscal bearing total ankle replace-ment was initially developed as a “shallow-sulcus” talar component device using cobalt-chromium-molybdenum alloy, in 1978, and later, modified to a “deep-sulcus” talar component device using titanium nitride (TiN) ceramic and porous coating in 1989. Wear related osteolytic cysts were noted in the tibia and talus surrounding these devices that compromised long term fixation and stability when using standard ultra-high molecular weight polyethylene (UHMWPe) as a bearing material. This study explores the use of highly cross-linked UHMWPe (HXLPe) to minimize osteolysis by replacing standard UHMWPe with this more wear-resistant material. Methods: There were 12 primary and 8 revision total ankle replacements followed for 13 to 15 years. HXLPe was used in all meniscal bearings, either as primary or revision implants. All stable metallic tibial and talar components were retained in revision cases. Osteolytic cysts greater than 10 mm in diameter were bone grafted with homologous morselized banked bone through cortical windows in the tibia or talus. No adjuvant screw fixation was used to stabilize any metallic implant. Results: No HXLPe bearings failed in this study, and no re-revisions were performed. No primary total ankle replacement failed in this study, and there were no substantial osteolytic cysts (>2 mm) observed in primary total ankle replacements on plain X-rays. All bone grafted osteolytic cysts in revision ankle replacements remained stable, even though partial resorption of the grafted material was identified in most of the ankles. No loosening of porous coated and TiN coated tibial and talar components were seen;the longest surviving metal components in the revision group was 24 years with the revised bearing at 15 years. Conclusions: HXLPe has greatly improved wear resistance in meniscal-bearing BP total ankle replacements in both primary and revision arthroplasties. Osteolytic cysts can be successfully bone grafted during beari展开更多
[目的]探讨应用早期国产生物型人工全髋关节置换术(total hip arthroplasty,THA)的中远期疗效。[方法]自1997年10月～2004年3月,46例49髋不同病因的髋关节病变行国产生物型THA。通过临床效果及影像学分析治疗效果。[结果]46例平均随访时...[目的]探讨应用早期国产生物型人工全髋关节置换术(total hip arthroplasty,THA)的中远期疗效。[方法]自1997年10月～2004年3月,46例49髋不同病因的髋关节病变行国产生物型THA。通过临床效果及影像学分析治疗效果。[结果]46例平均随访时间8.5年(5～11.5年)。Harris评分由术前38分(35～50分),提高到末次随访的82分(70～90分)。影像学检查发现假体松动9髋,其中单纯髋臼松动3髋,股骨假体松动4髋,髋臼及股骨假体均松动2髋;脱位3例5次,1例为术毕回房搬动时发生,另外2例各2次为院外不当活动所致,均闭合复位成功。出现异位骨化1例,Brooker分级1级;1例出现髋部疼痛、跛行,X线片显示假体无明显松动,但骨质疏松明显,经抗骨质疏松治疗后症状缓解。无感染病例。优良率为73.9%。[结论]早期国产髋关节假体解决了患者的髋关节病痛,价格较低,缓解了患者的经济压力。同时,早期国产生物型髋关节假体在设计、工艺及配套器械方面有待改进,降低松动率,提高远期疗效。展开更多
文摘AIM: To present the results of total hip arthroplasty(THA) for post tubercular arthritis of the hip joint.METHODS: Sixty-five patients(45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years(range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction(PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also recorded.RESULTS: The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years(range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min(range, 65-125) whereas the mean blood loss was 600 m L(range, 400-900 m L). The average follow up was 8.3 years(range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabularprotrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no evidence of any loosening or osteolysis on X-rays. There we
文摘AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement(THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47(95%CI: 0.45-0.48), 0.9(0.84-0.95), 1.29(1.06-1.57) and 0.69(0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82(0.76-0.89), 2.65(1.14-6.17), 0.98(0.7-1.38), and 0.67(0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7(0.65-0.75), 0.85(0.49-1.5), 1.47(0.93-2.34) and 1.13(0.98-1.3).CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.
文摘Background: A previous report evaluated the initial 310 cementless, Buechel-Pappas (B-P), Semi-Constrained Rotating Platform total knee replacements in 257 patients followed for an average of 7.6 years, range 2 - 18 years. Diagnoses were osteoarthritis in 233 patients, post traumatic arthritis in 4 patients and rheumatoid arthritis in 22 patients. Knee Scores, using a strict knee scoring scale were 86.4% excellent, 12.3% good, 0.3% fair and 1.0% poor results. Survivorship, using an end point of revision for any mechanical reason (including component loosening, bearing wear and bearing dislocation) was 99.4%. Survivorship for a poor knee score (including persistent pain, loosening, instability and infection was 97.6%. The purpose of the present study is to report the updated results of this same patient cohort at a minimum follow-up of twenty years. Methods: The average age of patients at the time of surgery was 67 years, range 34 to 91 years. A total of 20 patients (22 knees) were still living, with a follow-up of 20 - 30 years (mean 23.47 years). The same strict knee scoring scale and survivorship analysis were used to evaluate patient outcomes at the 20 to 30 years interval. Results: Survivorship, in the current study, using the same end points as in the previous study, was 96.5% at the 20 and 30-year intervals. Late mechanical failure and osteolysis were not identified. Conclusion: This cementless, semi-constrained rotating platform total knee replacement has stood the test of time for more than 20 years and can be considered acceptable for long-term use, in properly selected patients.
文摘Background: The Buechel-Pappas (BP) meniscal bearing total ankle replace-ment was initially developed as a “shallow-sulcus” talar component device using cobalt-chromium-molybdenum alloy, in 1978, and later, modified to a “deep-sulcus” talar component device using titanium nitride (TiN) ceramic and porous coating in 1989. Wear related osteolytic cysts were noted in the tibia and talus surrounding these devices that compromised long term fixation and stability when using standard ultra-high molecular weight polyethylene (UHMWPe) as a bearing material. This study explores the use of highly cross-linked UHMWPe (HXLPe) to minimize osteolysis by replacing standard UHMWPe with this more wear-resistant material. Methods: There were 12 primary and 8 revision total ankle replacements followed for 13 to 15 years. HXLPe was used in all meniscal bearings, either as primary or revision implants. All stable metallic tibial and talar components were retained in revision cases. Osteolytic cysts greater than 10 mm in diameter were bone grafted with homologous morselized banked bone through cortical windows in the tibia or talus. No adjuvant screw fixation was used to stabilize any metallic implant. Results: No HXLPe bearings failed in this study, and no re-revisions were performed. No primary total ankle replacement failed in this study, and there were no substantial osteolytic cysts (>2 mm) observed in primary total ankle replacements on plain X-rays. All bone grafted osteolytic cysts in revision ankle replacements remained stable, even though partial resorption of the grafted material was identified in most of the ankles. No loosening of porous coated and TiN coated tibial and talar components were seen;the longest surviving metal components in the revision group was 24 years with the revised bearing at 15 years. Conclusions: HXLPe has greatly improved wear resistance in meniscal-bearing BP total ankle replacements in both primary and revision arthroplasties. Osteolytic cysts can be successfully bone grafted during beari
文摘[目的]探讨应用早期国产生物型人工全髋关节置换术(total hip arthroplasty,THA)的中远期疗效。[方法]自1997年10月～2004年3月,46例49髋不同病因的髋关节病变行国产生物型THA。通过临床效果及影像学分析治疗效果。[结果]46例平均随访时间8.5年(5～11.5年)。Harris评分由术前38分(35～50分),提高到末次随访的82分(70～90分)。影像学检查发现假体松动9髋,其中单纯髋臼松动3髋,股骨假体松动4髋,髋臼及股骨假体均松动2髋;脱位3例5次,1例为术毕回房搬动时发生,另外2例各2次为院外不当活动所致,均闭合复位成功。出现异位骨化1例,Brooker分级1级;1例出现髋部疼痛、跛行,X线片显示假体无明显松动,但骨质疏松明显,经抗骨质疏松治疗后症状缓解。无感染病例。优良率为73.9%。[结论]早期国产髋关节假体解决了患者的髋关节病痛,价格较低,缓解了患者的经济压力。同时,早期国产生物型髋关节假体在设计、工艺及配套器械方面有待改进,降低松动率,提高远期疗效。
