PURPOSE OF THE STUDY Considered to be one of the most common causes of aseptic loosening of endoprostheses is the THA failure due to the wear of articulating components, UHMWPE in particular. The purpose of this study is to verify, in terms of oxidative damage and other parameters, the differences between the UHMWPE implants made by various manufacturers explanted for aseptic loosening with the same life span in vivo. MATERIAL AND METHODS In the period 2010-2015, a total of 21 THA articulating components (cups) made of Ultrahigh molecular weight polyethylene by seven different manufacturers were explanted. For each manufacturer, three UHMWPE cups with the same life span (10-12 years after the primary implantation) were evaluated. The damage to the examined joint replacements was described in complexity using three different criteria, namely independently by three evaluators - experienced orthopaedic surgeons. The evaluated criteria were the following: degree of osteolysis determined based on the preoperative radiographs, wear rate of the explanted UHMWPE component, and extent of perioperatively detected granuloma. Oxidative damage and other structural characteristics of explanted cups were studied by means of infrared spectroscopy and microhardness testing. The correlation between the clinical orthopaedic assessment and oxidative damage were statistically processed. RESULTS Strong correlations between the oxidative damage and crystallinity, strong correlations between all types of orthopaedic assessments, negligible correlations between trans-vinylene index and all the other quantities, and moderate correlations between the oxidative damage and clinical evaluation were identified. It was confirmed by experimental measurement that the observed high oxidative damage, resulting in increased crystallinity, manifested itself also in micromechanical properties of the material at the respective site of the THA articulating component. DISCUSSION The discussion includes the comparison of correlations of individual quantities as well as potential effects on the differences in values of components made by individual manufacturers. The values are related to the data in literature and generally accepted claims. CONCLUSIONS At the time of failure almost all the components showed severe or even critical oxidative damage that strongly correlated with the overall clinical evaluation of the damage to the implant. This confirmed that the oxidative degradation is one of the main causes of THA failure. Key words: UHMWPE, oxidation index, crystallinity, THA failure, wear.
- MeSH
- kyčelní protézy * škodlivé účinky MeSH
- lidé MeSH
- náhrada kyčelního kloubu přístrojové vybavení MeSH
- odstranění implantátu MeSH
- polyethyleny * škodlivé účinky MeSH
- protézy - design MeSH
- selhání protézy etiologie MeSH
- testování materiálů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- MeSH
- časové faktory MeSH
- hodnocení rizik MeSH
- krček femuru MeSH
- lidé středního věku MeSH
- lidé MeSH
- luxace kyčle epidemiologie etiologie MeSH
- náhrada kyčelního kloubu * metody škodlivé účinky MeSH
- reoperace statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- rozdělení chí kvadrát MeSH
- selhání protézy etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
- MeSH
- biomechanika MeSH
- femoroacetabulární impingement epidemiologie komplikace patofyziologie prevence a kontrola MeSH
- krček femuru anatomie a histologie MeSH
- kyčelní protézy normy MeSH
- lidé MeSH
- náhrada kyčelního kloubu * metody škodlivé účinky MeSH
- ortopedické výkony metody MeSH
- selhání protézy etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- kyčelní protézy normy MeSH
- lidé MeSH
- luxace kyčle epidemiologie etiologie terapie MeSH
- náhrada kyčelního kloubu * metody normy statistika a číselné údaje MeSH
- pooperační komplikace epidemiologie etiologie MeSH
- reoperace metody statistika a číselné údaje škodlivé účinky MeSH
- rizikové faktory MeSH
- rozdělení chí kvadrát MeSH
- selhání protézy etiologie MeSH
- Check Tag
- lidé MeSH
We present two patients who required extracorporeal membrane oxygenation (ECMO) support after bioprosthetic mitral valve replacement, who developed early structural valve failure due to leaflet fusion. Percutaneous balloon valvuloplasty restored normal leaflet motion and allowed discontinuation of ECMO support.
- MeSH
- anuloplastika mitrální chlopně metody MeSH
- bioprotézy škodlivé účinky MeSH
- chirurgická náhrada chlopně metody MeSH
- lidé MeSH
- mimotělní membránová oxygenace škodlivé účinky MeSH
- mitrální chlopeň chirurgie MeSH
- selhání protézy etiologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY Aseptic loosening of endoprosthetic components is the most frequent reason for total hip arthroplasty revision. This paper aimed to verify the influence of the type of hip-component fixation of total hip replacement in correlation with the age of patients on aseptic loosening of components during mid-term survival. MATERIAL AND METHODS The retrospective, monocentric study statistically evaluated the data of 67 cases of implanted total hip replacements in 66 patients with the loosening of at least one of the components requiring a revision of the total number of 1,488 primary total hip replacements implanted during the 1995 to 2006 period at a single department. The study compares the implants by Johnson&Johnson (Ultima threaded cups, Duraloc sector, Ultima UHMWPE cups. Mecroblock MR, AML and Ultima straight stems, Charnley and Elite plus cups and stems), Fehling Medical AG (HPQ and Müller cups, Müller Geradschaft stems) and Biomet (Mallory-Head and Müller cups, Bi-Metric cemented and uncemented stems) with respect to the age of patients. First-generation and second-generation cementing techniques were used. Primary arthroplasty of revised endoprostheses were indicated for primary and post-dysplastic coxarthrosis not requiring skeletal reconstruction. In order to determine the influence of age, three age categories were considered: under 54 years of age, 55 to 64 years of age, and elderly individuals aged 65 and over. The data was statistically evaluated by the test for two proportions and the Student's t-test. RESULTS The mean age of patients with total hip replacement loosening was lower than the mean age of the other patients (p < 0.05). The age category 55-64 reported a significantly higher failure rate only for HPQ - Müller-Geradschaft endoprosthesis compared to the uncemented and hybrid version of Mallory-Head - Bi-Metric, Duraloc - AML and Charnley group (p < 0.05). Duraloc - Charnley showed worse results than Mallory-Head - Bi-Metric porous (p = 0.0437). Except for HPQ - Müller-Geradschaft endoprosthesis, there were no statistically significant differences in the achieved revision rate of components used in endoprostheses. In the younger age category, only uncemented and hybrid versions were assessed. Hybrid endoprostheses made by Fehling and Biomet failed more often than uncemented Mallory-Head - Bi-Metric porous (p < 0.05) and Duraloc - AML (p < 0.01). For the category of 65 plus, cemented and hybrid endoprostheses were assessed. A higher revision rate was seen only in HPQ - Müller-Geradschaft endoprosthesis compared to the cemented version of Biomet (p < 0.05). No difference was reported in mid-term survival of the applied cemented and uncemented cups. DISCUSSION Despite the development of uncemented versions of total hip arthroplasty components, the current literature includes opinions supporting the cemented technique of total hip replacement. Especially for elderly patients the implant of uncemented components is questionable. The presented study did not identify a higher mid-term revision rate of uncemented implants, namely with respect to acetabular components, not even in the elderly patients. CONCLUSIONS No difference was found in the mid-term revision rate of evaluated endoprostheses for the medium age category of 55-64 years, regardless of whether cemented or uncemented components were implanted. The only exception was represented by hybrid HPQ-Müller Geradschaft endoprosthesis with a higher revision rate of the femoral and acetabular components. The younger age category showed a lower revision rate for uncemented versions than for the used hybrid versions of endoprostheses. For the group of elderly patients, there was no difference between the survival rate of hybrid and cemented joint replacement. Key words:arthroplasty with total hip replacement, cemented joint replacement, uncemented joint replacement, joint replacement failure, aseptic loosening of total replacement, age, joint replacement survival. 046_053_kubinec 20.2.18 14:12 Stránka 46 47/ Acta Chir Orthop Traumatol Cech. 85, 2018, No. 1 PŮVODNÍ PRÁCE.
- MeSH
- hodnocení výsledků zdravotní péče MeSH
- kostní cementy * škodlivé účinky terapeutické užití MeSH
- kyčelní protézy škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky přístrojové vybavení metody MeSH
- protézy - design metody MeSH
- registrace MeSH
- reoperace * metody statistika a číselné údaje MeSH
- rizikové faktory MeSH
- selhání protézy etiologie MeSH
- senioři MeSH
- věkové faktory MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
PURPOSE OF THE STUDY The study aims to evaluate the long-term results of computer-navigated total knee arthroplasties performed by less experienced surgeon performing a small number of procedures per year. MATERIAL AND METHODS In the prospective randomised study functional and radiological results, rate of revision and probability of clinical and radiological survival were compared in 30 computer-navigated (in 28 patients: 19 women, 9 men, with the mean age of 66.9 years) and 31 conventionally implanted (in 30 patients: 27 women, 3 men, with the mean age of 66.5 years) cemented total knee replacements without patellar resurfacing. The group was composed of patients who underwent surgery performed by the same surgeon who at the time of enrolment of patient in the study had no previous experience with the total knee replacement surgery and performed up to 30 such procedures annually. The mean follow-up of patients was 11 years. RESULTS No statistically significant differences were detected regarding the mean age, sex, body mass index and etiology of osteoarthritis of the operated knee. The mean duration of computer-navigated surgeries (101±14.1; 80-140 min) was considerably longer than the duration of conventional joint replacements (94±8.2; 80-100 min; p = 0.01). When evaluating the radiological results, a statistically significant difference was found between the groups only with respect to the mean value of dorsal inclination of the tibial component (88.2˚±2.1 vs 86.2˚±3, p = 0.02). The mean values of other monitored angles did not show any significant differences. The number of correct implants (with a deviation of 3 degrees from the target values) was statistically significantly higher in the group of computer-navigated joint replacement surgeries in all the monitored parameters (aFT: 87% vs. 67%, p = 0.04; α: 87% vs. 71%, p = 0.04; β: 87% vs. 65%, p = 0.03; γ: 93% vs. 74%, p = 0.02; δ: 90% vs. 77%, p = 0.04). Radiologic signs of unstable fixation were detected in 2 cases of computer-navigated joint replacement surgeries and in 7 cases of conventional replacements. Cumulative probability of radiologic survival at 10 years reached 93% in the compute-navigated surgery and 77.4% (p = 0.047) in the group with conventional procedure. In total, 4 revision surgeries with a reimplantation of at least one prosthetic component were reported. All the cases came from the conventional implantation group due to aseptic loosening of the endoprosthesis. In the computer-navigated group, one revision was performed for patellar pain, without replacing or adding any endoprosthetic component. The probability of clinical survival in computer-navigated replacements after 10 years was 100%, in conventional total knee replacements it was 87% (p = 0.04). The cumulative total endoprosthesis revision rate in the computer-navigated group was 3.3%, whereas in the group with conventional total knee replacements it was 12.9% (p = 0.04). The clinical assessment based on the WOMAC and Knee Society Scores showed no statistically significant differences. DISCUSSION The most common cause of the failure of total knee arthroplasties is the malposition of implants which results in early aseptic loosening. The radiologically correct position of knee endoprosthesis is seen in 80% of standard replacement surgeries performed by experienced surgeons. The potential error rate can even increase if the arthroplasties are performed by less experienced orthopaedic surgeons. The computer-navigated total knee replacement was introduced to make the position of implants more accurate. However, the question remains unanswered if more accurate positioning of the implants achieved with computer navigation decrease the revision rate and extend the long-term survival of knee endoprostheses. CONCLUSIONS Kinematic computer navigation allowed a less experienced and low-volume orthopaedic surgeon to make the implantation of endoprostheses more accurate, to decrease the total revision rate, and thus to ensure a higher probability of long-term survival of total knee arthroplasties. Key words:computer navigation, total replacement, knee joint, long-term outcomes, low-volume surgeon, less experienced surgeon.
- MeSH
- chirurgie s pomocí počítače * škodlivé účinky metody MeSH
- dlouhodobé vedlejší účinky prevence a kontrola MeSH
- hodnocení výsledků zdravotní péče MeSH
- klinické kompetence normy MeSH
- lidé MeSH
- osteoartróza chirurgie MeSH
- protézy kolene škodlivé účinky MeSH
- selhání protézy etiologie MeSH
- senioři MeSH
- totální endoprotéza kolene * škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
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x
- MeSH
- embolie etiologie prevence a kontrola MeSH
- koronární bypass MeSH
- koronární cévy zranění MeSH
- koronární nemoc * chirurgie MeSH
- koronární restenóza diagnostické zobrazování MeSH
- koronární trombóza diagnostické zobrazování farmakoterapie MeSH
- lidé MeSH
- nemoci koronárních tepen chirurgie MeSH
- pooperační komplikace etiologie MeSH
- samoexpandibilní metalické stenty MeSH
- selhání protézy etiologie škodlivé účinky MeSH
- stenty uvolňující léky MeSH
- stenty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
