BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to...BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year f展开更多
Background There is a relatively high failure rate of the femoral component in patients with avascular necrosis at the intermediate-term follow-up. Improving the geometrical fit of the femoral stem against the medulla...Background There is a relatively high failure rate of the femoral component in patients with avascular necrosis at the intermediate-term follow-up. Improving the geometrical fit of the femoral stem against the medullary canal may help to provide long-term survivorship of the hip replacement for patients with avascular necrosis. Methods We designed a specific stem, based on morphometric studies of proximal femoral canals in Chinese avascular necrosis patients and evaluated the stem by finite element analyses, comparing the novel stem with two commercially available and commonly used stems. Results The morphometric data from avascular necrosis patients showed specific geometric differences in the proximal femoral canal, including profile curves in both the sagittal and coronary planes than the patients with femoral neck fracture. The shorter stemmed prostheses （FitmoreR and our stem） performed better than the longer stemmed prosthesis （VerSysR）. Conclusions This is the first study to investigate the femoral geometries of Chinese avascular necrosis patients. Our stem provides better stability and is theoretically beneficial to bone ingrowth, which may increase the long-term stability and fixation of the implant.展开更多
Background: There have been a few reports of SMFTM stem for dysplastic hips. The aim of this study is to evaluate the influence of stem alignment in dysplastic femurs on the stability of the implants and on the bone r...Background: There have been a few reports of SMFTM stem for dysplastic hips. The aim of this study is to evaluate the influence of stem alignment in dysplastic femurs on the stability of the implants and on the bone reaction by means of consecutive radiographical analysis. Methods: The preoperative diagnosis is dysplastic osteoarthritis in all patients. Twenty-nine hips in 28 patients after MIS-THA were followed up for two or more years (3.5 years in average). The average age at the surgery was 60. Those who belonged to Crowe’s classification I were 19 and those of II were 10 hips. The shape of the femur was classified as Dorr’s Type A in 5, B in 21, and C in 3 hips. Results: The varus alignment of the stem was 21 hips and non-varus was 8 hips. Crowe’s Grade did not have influence on the stem alignment. The ratio of non-varus alignment was more with Dorr’s Type C than with others. Achieving rate of mediolateral fixation was significantly higher in the varus alignment than in non-varus. The significant subsidence occurred in 3 hips (10.3%) although all stems became stable within 6 months. No revision was necessary. Conclusion: The varus insertion of the stem seemed more secure also in dysplastic femurs, but even non-varus ones seemed acceptable as they brought about no severe problem. Comprehensively evaluating the result, careful selection of the patient is essential to take the advantage of and to overcome the disadvantage of this short stem for dysplastic hips.展开更多
AIM: To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation.
BACKGROUND The direct anterior approach for total hip arthroplasty(DAA-THA)is increasing in popularity due to some advantages such as less surgical trauma,minimal dissection of soft tissues,shorter rehabilitation time...BACKGROUND The direct anterior approach for total hip arthroplasty(DAA-THA)is increasing in popularity due to some advantages such as less surgical trauma,minimal dissection of soft tissues,shorter rehabilitation times,faster return to daily activities,lower incidence of dislocation.On the other hand,the literature reports a high rate of intraoperative complications,with many different rates and complication types in the published papers.AIM To analyze our complications comparing results with the literature;to report measures that we have taken to reduce complications rate.METHODS All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre,between January 2010 and December 2019 were included in this retrospective study.All surgeries were performed using cementless short anatomical or straight stems and press fit cups.Patients’followup was performed,at 6 wk,3 mo,then annually post-surgery with clinical and radiological evaluation.Primary outcomes were stem revision for aseptic loosening and all-cause stem revision.Second outcome was intra-operative and post-operative complications identification.RESULTS A total of 394 patients underwent DDA-THA from January 2010 and December 2019,for a total of 412 hips;twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study.The average age at the time of surgery was 61 years(range from 28 to 78 years).Mean follow-up time was 64.8 mo(range 12-120 mo).Seven stems were revised.One cortical perforation,one trochanteric and lateral cortical wall intraoperative fracture,one diaphyseal fracture,three clinically symptomatic early subsidence and one late aseptic loosening.We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification.Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage,one early infection,one case of late posterior dislocation,18 case of asymptomatic ste展开更多
[目的]比较生物型短柄和标准柄对全髋关节置换术(total hip arthroplasty,THA)股骨偏距的影响差异。[方法]回顾性分析2018年1月~2018年12月本院收治且行单侧THA的患者,共100例患者纳入本研究。其中50例采用短柄假体置换,50例采用标准柄...[目的]比较生物型短柄和标准柄对全髋关节置换术(total hip arthroplasty,THA)股骨偏距的影响差异。[方法]回顾性分析2018年1月~2018年12月本院收治且行单侧THA的患者,共100例患者纳入本研究。其中50例采用短柄假体置换,50例采用标准柄假体置换,比较两组股骨偏距、颈干角和下肢长度差异。[结果]两组患者术前、术后偏距均无变化(P>0.05);术前与术后两组间的偏距差异均无统计学意义(P>0.05)。但是,术后短柄组与对侧偏距差值显著小于标准柄组,差异有统计学意义(P<0.05)。两组术后颈干角均较术前显著增加,差异有统计学意义(P<0.05);术前与术后两组间的颈干角差异均无统计学意义(P>0.05)。术后两组间与对侧颈干角差值无统计学意义(P>0.05)。两组术后双下肢长度差值较术前显著减少(P<0.05)。术前两组间双下肢长度差值的差异无统计学意义(P>0.05),术后短柄组的双下肢长度差值显著小于标准柄组,差异有统计学意义(P<0.05)。[结论]生物型短柄比标准柄能更好的恢复正常股骨偏距、重建术后正常生物力线。展开更多
BACKGROUND Failure in restoring individual anatomy could be a reason for persistent functional limitations post total hip arthroplasty.Femoroacetabular offset(FAO)plays an important role in anatomic restoration,as los...BACKGROUND Failure in restoring individual anatomy could be a reason for persistent functional limitations post total hip arthroplasty.Femoroacetabular offset(FAO)plays an important role in anatomic restoration,as loss of offset≥5 mm is associated with altered gait and decreased functional outcome.Preoperative assessment by use of digital templating has shown to be a reliable method for sizing the components in total hip arthroplasty,and can show if anatomic restoration is achieved.In recent years,short stems are growing in popularity as it could allow better restoration due to more variety in placement.AIM To assess whether restoration of the FAO differs between a short or a conventional stem by use of digital templating.Additionally,association of the preoperative offset and caput-colllum-diaphyseal angle(CCD-angle)within restoration of both stems was investigated,and the reliability of measurements was assessed.METHODS A total of 100 standardized hip radiographs were used for digital templating.Restoration of FAO was classified into“restored”or“not restored”,when a<5 mm or≥5 mm difference from baseline value presented,respectively.Differences between the two stems concerning proportions of correct restoration of the FAO were analyzed by use of McNemar tests.To assess association between CCDangle and preoperative FAO with absolute FAO restoration,multi-level analysis was performed by use of a linear mixed model to account for paired measurements.Through determination of the optimal point under the curve in operating curve-analysis,bootstrapping of thousand sets was performed to determine the optimal cutoff point of the preoperative FAO for restoration within the limits of 5 mm.Three observers participated for inter-observer reliability,with two observers measuring the radiographs twice for intra-observer reliability.RESULTS The mean preoperative FAO was 79.7 mm(range 62.5-113 mm),with a mean CCD-angle of 128.6°(range 114.5°-145°).The conventional stem could only restore the FAO in 72 of the cases展开更多
AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHip^(TM) system. METHODS In a prospective study, 186 patients u...AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHip^(TM) system. METHODS In a prospective study, 186 patients underwent hip arthroplasty with a partial neck preserving short stem(MiniHip^(TM), Corin). Elderly patients were not excluded from this study, thus the mean age at the time of surgery was 59.3 years(range 32 to 82 years). Surgery and the follow-up assessments were performed at two Centers. Up until now, the mean follow-up was 112.5 ± 8.2 mo. The Oxford Hip Score(OHS) and the Hip Dysfunction Osteoarthritis and Outcome Score(HOOS) was assessed pre-and each year after surgery. The clinical follow-up was accompanied by standardized a.p. and axial radiological examinations. Periprosthetic lucencies, hypertrophies within the Gruen zones one to fourteen were assessed. A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker.RESULTS The OHS and HOOS improved from 18 ± 3.3 to 46 ± 2.0 and from 30 ± 8.3 to 95 ± 4.6 points, P < 0.001 respectively. There were no differences regarding age, etiology, friction pairings, etc.,(P > 0.05). Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively. Thus, the survivorship for aseptic loosening at nine to ten years was 98.66%. Including one stem revision due to a symptomatic exostosis, bursitis and thigh pain as well as one revision because of a septic stem loosening, the overall survival for the stem with revision for any reason was 97.32%. Besides one asymptomatic patient, radiological signs of a proximal stress-shielding, such as bone resorptions within the proximal Gruen zones, were not noticed. Findings suggesting a distal loading, e.g., bony hypertrophies or bone appositions of more than 2 mm, were also not detected. CONCLUSION Regarding these first long-term results on the MiniHip^(TM), the implant performed exceedingly well with a high rate of survivorshi展开更多
The scientific community is continuously working to translate the novel biomedical techniques into effective medical treatments.CRISPR-Cas9 system(Clustered Regularly Interspaced Short Palindromic Repeats-9),commonly ...The scientific community is continuously working to translate the novel biomedical techniques into effective medical treatments.CRISPR-Cas9 system(Clustered Regularly Interspaced Short Palindromic Repeats-9),commonly known as the“molecular scissor”,represents a recently developed biotechnology able to improve the quality and the efficacy of traditional treatments,related to several human diseases,such as chronic diseases,neurodegenerative pathologies and,interestingly,oral diseases.Of course,dental medicine has notably increased the use of biotechnologies to ensure modern and conservative approaches:in this landscape,the use of CRISPR-Cas9 system may speed and personalize the traditional therapies,ensuring a good predictability of clinical results.The aim of this critical overview is to provide evidence on CRISPR efficacy,taking into specific account its applications in oral medicine.展开更多
BACKGROUND Total hip replacement has become one of the most successful orthopaedic procedures.The length of the femoral stem constitutes one of the most important geometrical and mechanical features of the prosthesis....BACKGROUND Total hip replacement has become one of the most successful orthopaedic procedures.The length of the femoral stem constitutes one of the most important geometrical and mechanical features of the prosthesis.Several different implants are currently available but data are limited concerning the clinical results for some of these implants.AIM To report the short-term clinical and radiological results of a novel squared section,tapered design–with four conicity-short stem in total hip replacement.METHODS This is a retrospective study of a prospectively collected data using of MINIMA?short stem in 61 consecutive patients with at least 1 year follow-up.The collected data included patients’demographics,type of arthritis,bone morphology,perioperative data,clinical results using Harris Hip Score,EuroQol(EQ-5D),pain score and satisfaction rate,complications and radiological results.RESULTS Total 61 patients were included in our study with a mean age of 56 years of age(range 25-73 years).The majority of them(68.6%)were women,thirty seven patients(56.9%)were less than 60 years of age and almost half of patients(45.1%)suffered from secondary osteoarthritis(hip dysplasia,osteonecrosis,etc.).The mean time of follow-up examination was 33.4 mo(2.8 years)with a range of 12-57 months(1-4.8 years).In 35 patients(56.9%)the follow-up examination was more than 3 years.No major complications such as revision,periprosthetic fracture,dislocation or infection were presented.Re-admission 90 d postoperatively or laterwas deemed unnecessary for any reason regarding the operation.Respectively,the mean pain score,mean Harris hip score,and mean EQ-5D were improved from 6.3,58.7 and 77.3 preoperatively to 0.1,95.1,and 79.8 postoperatively.The Satisfaction rate at the final follow-up was 9.9(SD 0.3,range 8.0-10.0).All stems were classified as stable bone ingrowth and no radiolucent lineswere revealed in any of the modified Gruens’zone at the postoperative Xrays.Stem subsidence was within acceptable limits and the incidence of dista展开更多
BACKGROUND Subsidence is one of the concerning early complications in cementless femoral stem.Few publications have studied the influencing factors for subsidence in short cementless stems,due to their metaphyseal anc...BACKGROUND Subsidence is one of the concerning early complications in cementless femoral stem.Few publications have studied the influencing factors for subsidence in short cementless stems,due to their metaphyseal anchoring without diaphyseal invasion,they might demonstrate different subsidence patterns than with the conventional stems.AIM To analyze the factors associated with significant subsidence in short stems,including any radiographic parameters.METHODS The digitized radiographs of 274 consecutive short stem total hip arthroplasties were retrospectively reviewed.Subsidence,neck-filling ratio(NFR),seating height and lateral stem contact were evaluated after a minimum of two years follow-up.A threshold of subsidence>3 mm was considered a clinically significant migration.RESULTS For the entire cohort,subsidence occurred in 75 cases(27.4%)with the mean stem subsidence of 0.5 mm.(0-12.7,1.68).Twelve hips(4.4%)had significant subsidence(>3 mm).The univariate regression analysis demonstrated that age,diagnosis,BMI,Dorr’s type B,NFR,and seating height had no significant influence on significant subsidence,whereas insufficient lateral stem contact(≥1 mm)did have a statistically significant influence[Odds ratio(OR)=5.02;95%CI:1.3-18.9;P=0.017].The multivariate regression analysis also demonstrated that insufficient lateral stem contact was a statistically significant influencing factor(OR=5.5;95%CI:1.4-21.4;P=0.014).There was no femoral stem revision for aseptic loosening in our cohort.CONCLUSION This study demonstrated that insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence.Therefore,it is a particularly important step to create proper lateral cortical contact when performing the short stem total hip arthroplasty.展开更多
文摘BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year f
基金This research was supported by grants from the National High-tech Research and Development Program of China （No. 2011AA030101） and the Chinese National Natural Science Foundation （No. 81101387）.
文摘Background There is a relatively high failure rate of the femoral component in patients with avascular necrosis at the intermediate-term follow-up. Improving the geometrical fit of the femoral stem against the medullary canal may help to provide long-term survivorship of the hip replacement for patients with avascular necrosis. Methods We designed a specific stem, based on morphometric studies of proximal femoral canals in Chinese avascular necrosis patients and evaluated the stem by finite element analyses, comparing the novel stem with two commercially available and commonly used stems. Results The morphometric data from avascular necrosis patients showed specific geometric differences in the proximal femoral canal, including profile curves in both the sagittal and coronary planes than the patients with femoral neck fracture. The shorter stemmed prostheses （FitmoreR and our stem） performed better than the longer stemmed prosthesis （VerSysR）. Conclusions This is the first study to investigate the femoral geometries of Chinese avascular necrosis patients. Our stem provides better stability and is theoretically beneficial to bone ingrowth, which may increase the long-term stability and fixation of the implant.
文摘Background: There have been a few reports of SMFTM stem for dysplastic hips. The aim of this study is to evaluate the influence of stem alignment in dysplastic femurs on the stability of the implants and on the bone reaction by means of consecutive radiographical analysis. Methods: The preoperative diagnosis is dysplastic osteoarthritis in all patients. Twenty-nine hips in 28 patients after MIS-THA were followed up for two or more years (3.5 years in average). The average age at the surgery was 60. Those who belonged to Crowe’s classification I were 19 and those of II were 10 hips. The shape of the femur was classified as Dorr’s Type A in 5, B in 21, and C in 3 hips. Results: The varus alignment of the stem was 21 hips and non-varus was 8 hips. Crowe’s Grade did not have influence on the stem alignment. The ratio of non-varus alignment was more with Dorr’s Type C than with others. Achieving rate of mediolateral fixation was significantly higher in the varus alignment than in non-varus. The significant subsidence occurred in 3 hips (10.3%) although all stems became stable within 6 months. No revision was necessary. Conclusion: The varus insertion of the stem seemed more secure also in dysplastic femurs, but even non-varus ones seemed acceptable as they brought about no severe problem. Comprehensively evaluating the result, careful selection of the patient is essential to take the advantage of and to overcome the disadvantage of this short stem for dysplastic hips.
文摘AIM: To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation.
文摘BACKGROUND The direct anterior approach for total hip arthroplasty(DAA-THA)is increasing in popularity due to some advantages such as less surgical trauma,minimal dissection of soft tissues,shorter rehabilitation times,faster return to daily activities,lower incidence of dislocation.On the other hand,the literature reports a high rate of intraoperative complications,with many different rates and complication types in the published papers.AIM To analyze our complications comparing results with the literature;to report measures that we have taken to reduce complications rate.METHODS All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre,between January 2010 and December 2019 were included in this retrospective study.All surgeries were performed using cementless short anatomical or straight stems and press fit cups.Patients’followup was performed,at 6 wk,3 mo,then annually post-surgery with clinical and radiological evaluation.Primary outcomes were stem revision for aseptic loosening and all-cause stem revision.Second outcome was intra-operative and post-operative complications identification.RESULTS A total of 394 patients underwent DDA-THA from January 2010 and December 2019,for a total of 412 hips;twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study.The average age at the time of surgery was 61 years(range from 28 to 78 years).Mean follow-up time was 64.8 mo(range 12-120 mo).Seven stems were revised.One cortical perforation,one trochanteric and lateral cortical wall intraoperative fracture,one diaphyseal fracture,three clinically symptomatic early subsidence and one late aseptic loosening.We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification.Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage,one early infection,one case of late posterior dislocation,18 case of asymptomatic ste
文摘[目的]比较生物型短柄和标准柄对全髋关节置换术(total hip arthroplasty,THA)股骨偏距的影响差异。[方法]回顾性分析2018年1月~2018年12月本院收治且行单侧THA的患者,共100例患者纳入本研究。其中50例采用短柄假体置换,50例采用标准柄假体置换,比较两组股骨偏距、颈干角和下肢长度差异。[结果]两组患者术前、术后偏距均无变化(P>0.05);术前与术后两组间的偏距差异均无统计学意义(P>0.05)。但是,术后短柄组与对侧偏距差值显著小于标准柄组,差异有统计学意义(P<0.05)。两组术后颈干角均较术前显著增加,差异有统计学意义(P<0.05);术前与术后两组间的颈干角差异均无统计学意义(P>0.05)。术后两组间与对侧颈干角差值无统计学意义(P>0.05)。两组术后双下肢长度差值较术前显著减少(P<0.05)。术前两组间双下肢长度差值的差异无统计学意义(P>0.05),术后短柄组的双下肢长度差值显著小于标准柄组,差异有统计学意义(P<0.05)。[结论]生物型短柄比标准柄能更好的恢复正常股骨偏距、重建术后正常生物力线。
文摘BACKGROUND Failure in restoring individual anatomy could be a reason for persistent functional limitations post total hip arthroplasty.Femoroacetabular offset(FAO)plays an important role in anatomic restoration,as loss of offset≥5 mm is associated with altered gait and decreased functional outcome.Preoperative assessment by use of digital templating has shown to be a reliable method for sizing the components in total hip arthroplasty,and can show if anatomic restoration is achieved.In recent years,short stems are growing in popularity as it could allow better restoration due to more variety in placement.AIM To assess whether restoration of the FAO differs between a short or a conventional stem by use of digital templating.Additionally,association of the preoperative offset and caput-colllum-diaphyseal angle(CCD-angle)within restoration of both stems was investigated,and the reliability of measurements was assessed.METHODS A total of 100 standardized hip radiographs were used for digital templating.Restoration of FAO was classified into“restored”or“not restored”,when a<5 mm or≥5 mm difference from baseline value presented,respectively.Differences between the two stems concerning proportions of correct restoration of the FAO were analyzed by use of McNemar tests.To assess association between CCDangle and preoperative FAO with absolute FAO restoration,multi-level analysis was performed by use of a linear mixed model to account for paired measurements.Through determination of the optimal point under the curve in operating curve-analysis,bootstrapping of thousand sets was performed to determine the optimal cutoff point of the preoperative FAO for restoration within the limits of 5 mm.Three observers participated for inter-observer reliability,with two observers measuring the radiographs twice for intra-observer reliability.RESULTS The mean preoperative FAO was 79.7 mm(range 62.5-113 mm),with a mean CCD-angle of 128.6°(range 114.5°-145°).The conventional stem could only restore the FAO in 72 of the cases
基金Supported by A sponsorship from Corin (Corin Group,Cirencest,United Kingdom)
文摘AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHip^(TM) system. METHODS In a prospective study, 186 patients underwent hip arthroplasty with a partial neck preserving short stem(MiniHip^(TM), Corin). Elderly patients were not excluded from this study, thus the mean age at the time of surgery was 59.3 years(range 32 to 82 years). Surgery and the follow-up assessments were performed at two Centers. Up until now, the mean follow-up was 112.5 ± 8.2 mo. The Oxford Hip Score(OHS) and the Hip Dysfunction Osteoarthritis and Outcome Score(HOOS) was assessed pre-and each year after surgery. The clinical follow-up was accompanied by standardized a.p. and axial radiological examinations. Periprosthetic lucencies, hypertrophies within the Gruen zones one to fourteen were assessed. A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker.RESULTS The OHS and HOOS improved from 18 ± 3.3 to 46 ± 2.0 and from 30 ± 8.3 to 95 ± 4.6 points, P < 0.001 respectively. There were no differences regarding age, etiology, friction pairings, etc.,(P > 0.05). Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively. Thus, the survivorship for aseptic loosening at nine to ten years was 98.66%. Including one stem revision due to a symptomatic exostosis, bursitis and thigh pain as well as one revision because of a septic stem loosening, the overall survival for the stem with revision for any reason was 97.32%. Besides one asymptomatic patient, radiological signs of a proximal stress-shielding, such as bone resorptions within the proximal Gruen zones, were not noticed. Findings suggesting a distal loading, e.g., bony hypertrophies or bone appositions of more than 2 mm, were also not detected. CONCLUSION Regarding these first long-term results on the MiniHip^(TM), the implant performed exceedingly well with a high rate of survivorshi
文摘The scientific community is continuously working to translate the novel biomedical techniques into effective medical treatments.CRISPR-Cas9 system(Clustered Regularly Interspaced Short Palindromic Repeats-9),commonly known as the“molecular scissor”,represents a recently developed biotechnology able to improve the quality and the efficacy of traditional treatments,related to several human diseases,such as chronic diseases,neurodegenerative pathologies and,interestingly,oral diseases.Of course,dental medicine has notably increased the use of biotechnologies to ensure modern and conservative approaches:in this landscape,the use of CRISPR-Cas9 system may speed and personalize the traditional therapies,ensuring a good predictability of clinical results.The aim of this critical overview is to provide evidence on CRISPR efficacy,taking into specific account its applications in oral medicine.
文摘BACKGROUND Total hip replacement has become one of the most successful orthopaedic procedures.The length of the femoral stem constitutes one of the most important geometrical and mechanical features of the prosthesis.Several different implants are currently available but data are limited concerning the clinical results for some of these implants.AIM To report the short-term clinical and radiological results of a novel squared section,tapered design–with four conicity-short stem in total hip replacement.METHODS This is a retrospective study of a prospectively collected data using of MINIMA?short stem in 61 consecutive patients with at least 1 year follow-up.The collected data included patients’demographics,type of arthritis,bone morphology,perioperative data,clinical results using Harris Hip Score,EuroQol(EQ-5D),pain score and satisfaction rate,complications and radiological results.RESULTS Total 61 patients were included in our study with a mean age of 56 years of age(range 25-73 years).The majority of them(68.6%)were women,thirty seven patients(56.9%)were less than 60 years of age and almost half of patients(45.1%)suffered from secondary osteoarthritis(hip dysplasia,osteonecrosis,etc.).The mean time of follow-up examination was 33.4 mo(2.8 years)with a range of 12-57 months(1-4.8 years).In 35 patients(56.9%)the follow-up examination was more than 3 years.No major complications such as revision,periprosthetic fracture,dislocation or infection were presented.Re-admission 90 d postoperatively or laterwas deemed unnecessary for any reason regarding the operation.Respectively,the mean pain score,mean Harris hip score,and mean EQ-5D were improved from 6.3,58.7 and 77.3 preoperatively to 0.1,95.1,and 79.8 postoperatively.The Satisfaction rate at the final follow-up was 9.9(SD 0.3,range 8.0-10.0).All stems were classified as stable bone ingrowth and no radiolucent lineswere revealed in any of the modified Gruens’zone at the postoperative Xrays.Stem subsidence was within acceptable limits and the incidence of dista
文摘BACKGROUND Subsidence is one of the concerning early complications in cementless femoral stem.Few publications have studied the influencing factors for subsidence in short cementless stems,due to their metaphyseal anchoring without diaphyseal invasion,they might demonstrate different subsidence patterns than with the conventional stems.AIM To analyze the factors associated with significant subsidence in short stems,including any radiographic parameters.METHODS The digitized radiographs of 274 consecutive short stem total hip arthroplasties were retrospectively reviewed.Subsidence,neck-filling ratio(NFR),seating height and lateral stem contact were evaluated after a minimum of two years follow-up.A threshold of subsidence>3 mm was considered a clinically significant migration.RESULTS For the entire cohort,subsidence occurred in 75 cases(27.4%)with the mean stem subsidence of 0.5 mm.(0-12.7,1.68).Twelve hips(4.4%)had significant subsidence(>3 mm).The univariate regression analysis demonstrated that age,diagnosis,BMI,Dorr’s type B,NFR,and seating height had no significant influence on significant subsidence,whereas insufficient lateral stem contact(≥1 mm)did have a statistically significant influence[Odds ratio(OR)=5.02;95%CI:1.3-18.9;P=0.017].The multivariate regression analysis also demonstrated that insufficient lateral stem contact was a statistically significant influencing factor(OR=5.5;95%CI:1.4-21.4;P=0.014).There was no femoral stem revision for aseptic loosening in our cohort.CONCLUSION This study demonstrated that insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence.Therefore,it is a particularly important step to create proper lateral cortical contact when performing the short stem total hip arthroplasty.
