PURPOSE OF THE STUDY Fractures of the femoral neck have been serious health and social issues of the recent decades. Although up-to-date implants and perioperative care are now available, the treatment is still associated with an increased risk of postoperative complications. The aim of this study was to specify early postoperative complications and to ascertain which factors, if any, can predict them. MATERIAL AND METHODS Between October 2005 and February 2007, a total of 155 patients were treated for femoral neck fractures in our department. The group of elderly patients (n=82) who underwent elective total hip arthroplasty for osteoarthritis served as controls. The selected pre-, peri- and post-operative characteristics were prospectively collected. Each patient was followed-up for at least one month after surgery. The data were first compared by univariate analysis and then, for statistically significant factors, their predictors were identified by the logistic regression. RESULTS The average age of the patients with femoral neck fracture was 77 years and that of the control patients was 75 years. The ratio of men to women was similar in both groups; the groups differed in body height, weight, preoperative morbidity, ASA score, lymphocyte counts, severity of brain atherosclerosis, independence in walking, and self-sufficient living. The number of complications in the hip-fracture group was 87 while, in the control group, it was only 15 (p=0.0002). The hip-fracture group showed significantly higher occurrence of postoperative delirium (34 versus 4; p=0.001) and prosthesis dislocation (12 versus 0; p=0.009). The subsequent multifactorial analysis showed that the risk of postoperative delirium was associated with preoperative lack of self-sufficiency (odds ratio, OR=4.814; 95 % Cl, 1.551-14.942) and the length of operative time (OR=0.970; 95% Cl, 0.951-0.989). Prosthesis dislocation was predicted by an increased height of the patient (OR=1.087 per each cm; 95% Cl 1.001-1.159). An interval between injury and surgery longer than 48 hours was not associated with higher mortality. DISCUSSION Postoperative delirium is a complication found in up to 60% of the patients with surgery for femoral neck fracture. The frequency of this complication depends on the instruments used to identify cognitive dysfunction - with a more sensitive instrument cognitive dysfunction is probably detected in more patients. The higher occurrence of dislocation in the hip-fracture group is also in agreement with the literature data. On the other hand, its association with patient height should not be overestimated, because a coincidence of several other factors may have been involved in the mechanism of dislocation. Displacement can be prevented by the use of offset acetabular components and 36-mm femoral heads for primary implantation in such patients. CONCLUSIONS A significantly higher frequency of prosthesis dislocation and postoperative delirium was found in the patients undergoing total hip arthroplasty for traumatic indication than in the patients after elective surgery. A subsequent multifactorial analysis revealed a potential association of prosthesis dislocation with the patient's height and that of postoperative delirium with the duration of operative time and the degree of preoperative self-sufficiency.
Background: Hydroxyapatite coated (HAC) hip implants have been used in clinical practice for more than twodecades. However, the majority of studies have reported only intermediate term outcomes that are not reliable forpredicting long-term behavior in all implants. The aim of this study was to determine the performance of HAC totalhip arthroplasty in younger patients over a 10-year follow-up period.Methods and Results: This was an observational retrospective study of a 137 consecutive hips with the ABG I prosthesis.Of these, 128 were available for the last investigation. Median duration of follow-up was 10.9 years. The meanage at time of index surgery was 46±6.7 years. Probability of implant survival was estimated using the Kaplan-Meiermethod. The overall 12-year cumulative survival was 0.55 (95% CI, 0.443-0.659). Periprosthetic osteolysis (57 %) wasthe most frequent reason for failure followed by aseptic loosening (28 %). When only aseptic loosening was includedin the analysis, the same fi gures for cup and stem were 0.873 (95% CI, 0.808-0.938) and 0.992 (95% CI, 0.976- 1.0),respectively. Patients with a smaller cup size were those at high risk for revision due to wear-related complications(odds ratio, OR=4.3; 95% CI, 1.734-10.555).Conclusion: This study reports one of the poorest 12-year survivorship data for cementless acetabular componentin the literature. The main reason for premature failure was osteolysis, strongly related to high wear rate of polyethylene.
- MeSH
- analýza přežití MeSH
- dospělí MeSH
- financování organizované MeSH
- hydroxyapatit terapeutické užití MeSH
- Kaplanův-Meierův odhad MeSH
- lidé MeSH
- náhrada kyčelního kloubu metody využití MeSH
- osteolýza MeSH
- polyethylen terapeutické užití MeSH
- retrospektivní studie MeSH
- statistika jako téma MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
Hydroxypatite coating (HAC) was introduced into total hip arthroplasty (THA) practice to improve the fixation interface between bone and prosthesis. To test this assumption however, long-term follow-up investigations are needed. In this study, we present data for two consecutive series of THA stems with HAC and a minimum ten-year follow-up. MATERIAL Overall, 249 patients (271 hips) were included in the study, of these 122 (135 hips) had Walter hip arthroplasty (WHA group) with a two-layered TiO2/HAC at the proximal part of the stem and 127 (136 hips) had ABG I prostheses (ABG I group) with a single-layered HAC at the proximal part of the stem. Mean length of follow-up was 11.4 years (0.8-13) and 9.8 years (4-12) in WHA and ABG I groups, respectively. Mean age at the time of surgery was 62 years (23-79) and 47 years (21-65) in WHA and ABG I groups, respectively. METHODS Probabilities of implant survival were estimated using the Kaplan-Meier method. Radiographic data were included to construct the worst-case scenario. Differences in survival curves were evaluated by Gehan's Wilcoxon test. Harris hip score was used to compare preoperative status with that of final follow-up. RESULTS The overall survival of WHA was significantly better than the ABG I (0.85 versus 0.66; p < 0.05). The main reason for a high revision rate in ABG I was periprosthetic osteolysis followed by aseptic loosening. With regard to stems, the survivorship curve for the Walter stem was significantly better than for the ABG I stem even when radiographic results were included (p = 0.0002). In the WHA group, two stems (1.5%) were revised due to sepsis, in contrast to thirty-one stems (23.5%) revised in the ABG I group due to osteolysis and aseptic loosening (p < 0.05). Significant improvement was achieved in both groups under study in terms of Harris hip score. DISCUSSION Data presented here appear surprising at first glance because the differences between the stems under study are only minor. The failure in ABG I was most probably caused by poor polyethylene quality and poor locking mechanism of polyethylene liner in the metallic shell. In addition, HAC used in ABG I prosthesis was not able to prevent the development of polyethylene disease stimulated by high wear rate. CONCLUSION This study revealed excellent survivorship for WHA stems after a minimum ten-year survival and significantly poorer survivorship for the ABG I stems.This may be explained at least particularly by combined two-layered HAC used in WHA stems which provide simultaneously endurable bone interlocking and effective barrier against expansion of polyethylene disease.
- MeSH
- analýza přežití MeSH
- biokompatibilní potahované materiály MeSH
- dospělí MeSH
- financování organizované MeSH
- hydroxyapatit MeSH
- kyčelní protézy MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu MeSH
- následné studie MeSH
- selhání protézy MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- artroplastiky kloubů škodlivé účinky MeSH
- biologické markery MeSH
- diagnostické techniky radioisotopové MeSH
- diferenciální diagnóza MeSH
- infekce spojené s protézou mikrobiologie prevence a kontrola MeSH
- jehlová biopsie MeSH
- lidé MeSH
- peroperační monitorování MeSH
- předoperační péče MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
Periprosthetic osteolysis is associated with accelerated wear rates. The goal of this study was to investigate the influence of demographic and technical variables on wear rates and size of osteolytic lesions. Eighty retrieved ABG I prostheses were analyzed according to prospectively established criteria. There were 22 men and 58 women with an average age of 52 years (34-65) at the time of revision. The average time from index surgery to revision was 67 months (26 to 106). Polyethylene wear measurements were performed using a Universal-type measuring microscope. The average linear wear and volumetric wear rate was 0.363 mm per year (0-0.939, SD 0.241) and 161 mm(3) per year (0-467, SD 118.2), respectively. The wear rates were significantly higher (a) in patients with primary osteoarthritis in comparison with postdysplastic hips, (b) in hips where zirconia prosthetic heads articulated against the polyethylene liner, and (c) in cups placed laterally to Kohler's line. Risk that linear wear rate could be more than 0.2 mm per year was three times higher in patients who were operated in 1997 and later (OR 3.0, 95 % CI 1.126-7.993, p = 0.03). A strong association was revealed between magnitude of wear and size of femoral osteolysis.
- MeSH
- acetabulum patologie MeSH
- dospělí MeSH
- hlavice femuru MeSH
- kyčelní protézy MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu MeSH
- osteolýza etiologie patologie MeSH
- polyethylen MeSH
- reoperace MeSH
- selhání protézy MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Background: Polyethylene wear is considered a most important part of periprosthetic osteolysis development. Thus, its measurement is central to contemporary orthopaedics. AIMS: The aim of this paper was to compare the accuracy of three radiographic techniques for wear measurement. Secondly, the influence of the abduction angle of the cup on measurement accuracy was investigated. METHODS: Wear was measured manually in 80 patients by a single observer according to the Livermore, Charnley, and Dorr description. A multi-component statistical analysis was used to test the hypothesis that the Livermore technique was superior. In vitro data obtained from a Universal-type measuring microscope served as a gold standard. RESULTS: In vitro measurements showed an average linear wear of 0.363 mm per year (0.000-0.939, SD 0.241) with a corresponding volumetric wear rate of 161 mm3 per year (0-467, SD 118.2). The Livermore technique showed the least deviation from the optical reference standard and a superior position from the viewpoint of error analysis but the correlation coefficient was slightly less (r = 0.761) than for the Dorr and Charnley techniques (r = 0.795 and r = 0.778, respectively). In addition, the mean error of the Dorr method differed significantly from zero (p = 0.036). Overall, the Livermore technique was the most accurate method for polyethylene wear measurement regardless of the abduction angle of the cup. CONCLUSIONS: The Livermore technique performed manually was more accurate than the Charnley and Dorr methods. Nevertheless, we consider the Dorr technique an adequate tool for day-to-day wear measurements, mainly due to its simplicity.
- MeSH
- analýza selhání vybavení MeSH
- dospělí MeSH
- kyčelní protézy MeSH
- lidé středního věku MeSH
- lidé MeSH
- odstranění implantátu MeSH
- polyethylen MeSH
- selhání protézy MeSH
- senioři MeSH
- techniky in vitro MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dítě MeSH
- dolní končetina chirurgie patologie MeSH
- dospělí MeSH
- externí fixátory využití MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- ortopedické výkony metody využití MeSH
- prodloužení kosti metody využití MeSH
- výsledek terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
