BACKGROUND: We studied which factor could predict aseptic loosening in ABG I hip prosthesis with hydroxyapatite coating. Aseptic loosening and periprosthetic osteolysis are believed to be caused, at least in part, by increased polyethylene (PE) wear rate via particle disease. Based on it, increased PE wear rate should be associated with aseptic loosening regardless of the type of implant. METHODS: We analyzed data from 155 revisions of ABG I hip prostheses to examine the influence of patient, implant, surgery, and wear related factors on the rate of aseptic loosening at the site of the cup. This was calculated by stepwise logistic regression analysis. The stability of the implant and severity of bone defects were evaluated intraoperatively. RESULTS: We found that men (odds ratio, OR = 5.6; p = 0.004), patients with Charnley class C (OR = 6.71; p = 0.013), those having more severe acetabular bone defects (OR = 4 for each degree of severity; p = 0.002), and longer time to revision surgery (OR = 1.51 for each additional year; p = 0.012) had a greater chance of aseptic loosening of the cup. However, aseptic loosening was not directly predicted by polyethylene wear rate in our patients. CONCLUSION: Severity of bone defects predicts the risk for aseptic loosening in ABG I cup. Factors potentially associated with the quality of bone bed and biomechanics of the hip might influence on the risk of aseptic loosening in this implant.

• MeSH
• artróza kyčelních kloubů diagnostické zobrazování   patologie   chirurgie   MeSH
• kyčelní kloub diagnostické zobrazování   patologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu škodlivé účinky   MeSH
• pooperační komplikace epidemiologie   MeSH
• progrese nemoci MeSH
• radiografie MeSH
• rizikové faktory MeSH
• selhání protézy trendy   MeSH
• senioři MeSH
• sexuální faktory MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY: The aim of the study is a retrospective evaluation of our patients with a dysplastic acetabulum treated by total hip arthroplasty (THA), who were followed up for at least 5 years, and a comparison of our intermediate-term results with those in the relevant literature. MATERIAL: In the period from June 1995 to June 2005, a total of 1305 total hip replacements were performed. Of these 293 were done in patients (213 women and 48 men) with the diagnosis of a dysplastic acetabulum; bilateral total hip arthroplasty was carried out in 18 women and four men. The evaluation was based on the Harris scoring system. The condition of at least 5-year follow-up was met by 65 patients (54 women and 11 men; average age, 53 years; average follow-up, 82 months). Eventually, 63 patients were assessed, because one patient died and one moved away. METHODS: The Hartofilakidis radiological system was used for preoperative evaluation. In more severe cases, 3D CT and multiplanar reconstruction were used. Intraoperative findings were assessed by the AAOS classification, and postoperative radiograms were evaluated on the basis of Gruen's criteria. The Bauer transgluteal approach to the hip joint was used. Antibiotics in prophylactic doses and medication for prevention of thromboembolic disease were administered in all cases. The final assessment of Harris hip scores was carried out in 63 patients in September and October 2005. All underwent implantation of a Zweymüller Bicon-Plus acetabular component. As diagnosed according to the Hartofilakidis radiological system, 42 type I, 21 type II and two type III hips were operated on for a dysplastic acetabulum. RESULTS: The average preoperative and postoperative Harris scores were 39 (range, 21-58) and 85 (range, 66-98) points. All patients reported satisfaction with the results; excellent outcomes were achieved in 41, good in 10 and satisfactory in six patients. No radiographic cup loosening was found at 3- and 6-month follow-up or at 1 year. None of the patients received a solid bone graft. DISCUSSION: The crucial problem in treating hip arthritis due to acetabular dysplasia is precise surgical reconstruction of the acetabulum. This involves implantation of an acetabular component into the original anatomical position in order to sufficiently cover the cup and provide mechanical stability. Various operative procedures discussed in the literature include the use of a small cup placed into the original acetabulum, techniques of acetabular component medialization, with perforation or "controlled fracture" of the acetabular wall, when indicated, and involvement of bone grafts to repair the acetabular defect in both cemented and cementless acetabular components. CONCLUSIONS: Our intermediate-term results with the use of Zweymüller Bicon-Plus acetabular components give support to the previous good experience with this prosthesis in the treatment of hip arthritis following acetabular dysplasia.

• MeSH
• acetabulum patologie   MeSH
• artróza kyčelních kloubů patologie   chirurgie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

PURPOSE OF THE STUDY: The acetabular protrusion changes anatomical conditions for implantation of a cup in total hip replacement. The aim of this study was to evaluate different approaches to implantation of acetabular components in patients with this condition. MATERIAL: A total of 50 hips in 33 patients who had surgery for osteoarthritis with acetabular protrusion between 1992 and 2000 were evaluated. Their initial diagnoses were: idiopathic rotrusio acetabuli in 20 patients, rheumatoid arthritis in nine, arthropathy due to psoriasis in two and Bekhterev's disease in two patients. The average age of the patients was 64.1 years (range, 27 to 74 years). In group I including 18 hips, cemented polythylene cups were used (11 Poldi, 5 Ultima and 2 Weber prostheses). In group II involving 32 hips, uncemented cups were employed (29 CLS, 2 Morscher and 1 Balgrist prostheses). Bone grafts inserted in the acetabular bottom were used in eight and 25 cases of groups I and II, respectively. The mean follow-up was 7.1 years. METHODS: The following parameters were evaluated: Wiberg's angle, protrusion grades according to Sotelo-Garzy, Charnley scores, teardrop collapse, angle of acetabular inclination, approximate femoral head center and center of the femoral prosthesis head, and the distance between them in both horizontal and vertical directions, deviation of the center of the femoral component head from the anatomical center of rotation in horizontal and vertical directions, radiolucent zones according to de Lee and Charnley, position of the femoral head center inside or outside the TAR triangle and aseptic loosening of the acetabular component. RESULTS: At a follow-up of 7.1 years in group I, 10 hips showed full osteointegration, five underwent revision arthroplasty for aseptic loosening and three showed some degree of aseptic loosening. All failures occurred in the acetabular cups implanted without bone grafting of the acetabular bottom. In group II, 29 hips showed full clinical survival with complete osteointegration of the acetabular cup and three were found to have a radiolucent zone of 1 mm in width. DISCUSSION: The complete osteointegration of a cemented acetabular cup was achieved in 10 out of 18 hips, with eight having spongioplasty of the acetabular bottom. The use of uncemented cup resulted in full clinical survival and complete osteointegration in 29 cases out of 32. The best outcome was achieved with the use of an expansion, uncemented CLS cup. This is designed for peripheral fixation, which is useful in the protrusion of an acetabulum with a thin bottom and permits acetabular bottom grafting and positioning of the femoral component head in the center of hip rotation. It provides full osteointegration even with low bone quality. CONCLUSION: Prerequisites for successful arthroplasty in hips with acetabular protrusion include the firm implantation of an acetabular component, placement of the femur lateral to Köchler's line, location of the center of the femoral component head inside the TAR triangle and an agreement between the approximate center of the femoral head and the center of the femoral component head. The firm and lasting implantation of a cemented cup requires spongioplasty of the acetabular bottom. At an average of 7.1 years after surgery, uncemented cups in conjunction with bone grafting of the acetabular bottom showed better outcomes than cemented acetabular components.

• MeSH
• acetabulum diagnostické zobrazování   patologie   MeSH
• artróza kyčelních kloubů diagnostické zobrazování   patologie   chirurgie   MeSH
• dospělí MeSH
• kyčelní protézy MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * MeSH
• radiografie 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

OBJECTIVE: To determine the structure (disease) modifying effect of a glycosaminoglycan polypeptide association complex (GP-C; Rumalon) in patients with knee and hip osteoarthritis (OA). METHODS: Double-blind, randomized, placebo-controlled five-year study. Primary assessment criterion was change in radiographic joint space width between baseline and follow-up at 5 years. Secondary outcome criteria included Lequesne algofunctional index (LAI), pain on passive motion and consumption of non-steroidal antiinflammatory drugs (NSAIDs). The patients received 10 courses of injections of placebo or GP-C 2 ml intramuscularly in 5 years (two courses each year). Each course included 15 injections administered twice weekly. RESULTS: There were 277 patients with knee OA and 117 patients with hip OA. Control and GP-C treated groups were comparable as to sex, age, duration of disease, body weight, X-ray stage and value of LAI at the baseline. Knee joint space at 5 years decreased 0.37+/-0.08 (mean+/-standard deviation) mm for GP-C and 0.42+/-0.08 mm for placebo groups (P=0.68). Hip joint space at 5 years decreased 0.21+/-0.08 mm for GP-C and 0.22+/-0.08 mm for placebo groups (P=0.53). In a subset of patients with hip OA, Kellgren-Lawrence> or =2 and JSW> or =1 mm, there was a trend in favor of GPC for lower joint space narrowing in 5 years (P=0.11). In addition, there were no statistical differences between the treatment groups in LAI, pain on passive motion and consumption of NSAIDs. Side-effects after GP-C (14.5%) were rare, mild and not more frequent than in the placebo group (15%). CONCLUSION: We were not able to demonstrate a structure modifying effect of GP-C in OA of the hip or knee. Radiographic progression of OA in both knee and hip OA was lower than expected in both study groups.

• MeSH
• antirevmatika škodlivé účinky   terapeutické užití   MeSH
• artróza kolenních kloubů farmakoterapie   patologie   MeSH
• artróza kyčelních kloubů farmakoterapie   patologie   MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• glykosaminoglykany škodlivé účinky   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• A73025 MeSH Prohlížeč
• antirevmatika MeSH
• glykosaminoglykany MeSH