Aims. The main aims were to identify risk factors predictive of a
This study aims to implement and assess the inter and intra-reliability of a modernised radiolucency assessment system; the Radiolucency In cemented Stemmed Knee (RISK) arthroplasty classification. Furthermore, we assessed the distribution of regions affected by radiolucency in patients undergoing stemmed cemented knee arthroplasty. Stemmed knee arthroplasty cases over 7-year period at a single institution were retrospectively identified and reviewed. The RISK classification system identifies five zones in the femur and five zones in the tibia in both the anteroposterior (AP) and lateral planes. Post-operative and follow-up radiographs were scored for radiolucency by four blinded reviewers at two distinct time points four weeks apart. Reliability was assessed using the kappa statistic. A heat map was generated to demonstrate the reported regions of radiolucency. 29 cases (63 radiographs) of stemmed knee arthroplasty were examined radiographically using the RISK system. Intra-reliability (0.83) and Inter-reliability (0.80) scores were both consistent with a strong level of agreement using the kappa scoring system. Radiolucency was more commonly associated with the tibial component (76.6%) compared to the femoral component (23.3%), and the tibial anterior-posterior (AP) region 1 (medial plateau) was the most affected (14.9%). The RISK classification system is a reliable assessment tool for evaluating radiolucency around stemmed knee arthroplasty using defined zones on both AP and lateral radiographs. Zones of radiolucency identified in this study may be relevant to implant survival and corresponded well with zones of fixation, which may help inform future research.
Radiolucent lines (RL) are a common radiographic finding following Oxford Uni knee arthroplastv. These RL are commonly seen at the bone-cement interface under the tibial tray and can only be evaluated using screened radiographs. These lines occur during the first year, are well defined and remain constant for years. The clinical relevance of this phenomenon is unclear. Pulse lavage has the potential to thoroughly clean the trabecular bone by clearing the bone from bone marrow and debris and can thereby facilitate cement penetration and interdigitation into trabecular bone. Pulse lavage can reduce the occurrence of radiolucent lines under the tibial tray by improving cement penetration and interdigitation. Since 2001 we routinely use pulse lavage before cementing the Oxford uni implants at the Orthopä-dische Universitätsklinik Heidelberg (group A). At Nuffield Orthopeadic Center, Oxford conventional irrigation has been used before cementing (group B). At a minimum follow-up of 1 year 56 screened AP radiographs of the knee after Oxford UCA have been blinded and evaluated for radiolucency and cement penetration by an independent observer. For standardized evaluation the cement bone interface has been devided into 4 zones and a specific algorithm for evaluation of the radiographs has been developed. Complete radiolucencies were detected in 2 cases (4%) in group A and in 13 cases (23%) in group B (p=0,001). Partial radiolucent lines were seen in 32 knees of group A (57%) and in 40 knees (71%) in group B. In zone 1 RLs were found in 31 tibias (55%) in group A, in 32 tibias (57%) in group B. In zone 2 17 (30%) group A, 29 (52%) group B. In Zone 3 4 (7%) in Gruppe A, 20 (36%) in group B. In Zone 4 6 (11%) group A, 30 (54%) group B. The differences between group A and B were significant (P=0.001) in zones 2, 3 and 4. In group A in 14 cases (25%) RL were limited to one zone, in group B in 5 cases (9%), respectively. In 12 cases (21%) 2 zones were affected in group A (12 cases (21%) group B). RLs in 3 zones were found in 4 cases (7%) in group A and in 10 cases (18%) in group B. Mean cement penetration (mm) was 2,3mm in group A and in 1,4mm in group B. The use of pulsed lavage led to an increase in cement penetration by a factor of 1,6 (cement penetration in group A/B zone 1: 1,4mm/0,8mm; zone 2: 2,4mm/1,5mm; zone 3: 1,4mm/0,7mm; zone 4: 4,0mm/2,4mm). The use of pulsed lavage significantly decreases the appearance of RLs at a minimum of 1 year follow-up by increasing cement penetration into cancellous bone. Even though the clinical relevance of tibial RLs in unclear we recommend the use of pulse lavage to improve cement penetration and interdigitation with cancellous bone. Unnecessary revisions due to misinterpretation of RLs may be prevented.
Introduction. We have investigated middle-term clinical results of total hip arthroplasty (THA) cemented socket with improved technique using hydroxyapatite (HA) granules. IBBC (interfacial bioactive bone cement method, Oonishi) (1) is an excellent technique for augmenting cement-bone fixation in the long term. However, the technique is difficult and there are concerns over some points, such as bleeding control, disturbance of cement intrusion to anchoring holes by granules, difficulty of the uniform granular dispersion to the acetabular bone. To improve the original technique, we have modified IBBC (M-IBBC), and investigated the middle-term clinical results and radiographic changes. Materials and Methods. K-MAX HS-3 THA (Kyocera, Japan), with tapered cemented stem with small collar and all polyethylene cemented socket, was used for THA implants (Fig.1). Basically the third generation cementing technique was used for THA using bone cement. The socket fixation was performed with bone cement (Endurance, DePuy) and HA granules (Ca10(PO4)6(OH)2, Boneceram P; G-2, 0.3–0.6mm in size, Olympus, Japan) (Fig.2). In original IBBC technique, HA granules were dispersed on reamed acetabulum before cementing. In M-IBBC technique, HA granules were attached to bone cement on plastic plate, then inserted to reamed acetabulum and pressurized (Fig.3). 112 hip joints (95 cases) were operated between June 2010 and March 2014, and followed. The average follow-up period was 6.5 years, and average age at operation was 66.5 years. The clinical results were evaluated by Japan Orthopaedic Association Hip Score (JOA score), and X-p findings were evaluated using antero-posterior radiographs. The locations of radiolucent lines were identified according to the zones described by Delee and Charnley for acetabular components, and Zone 1 was divided into two parts, outer Zone 1a and inner Zone 1b. Results and Discussion. Revision was not performed. JOA score improved from 47 to 88. Socket and stem loosening was not observed. X-p findings of sockets demonstrated
Aims. There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). Methods. We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for
Introduction. IBBC (interfacial bioactive bone cement method, Oonishi) (1) is an excellent technique for augmenting cement-bone fixation in the long term. However, the technique is difficult and there are concerns over some points, such as bleeding control, disturbance of cement intrusion to anchoring holes by granules, difficulty of the uniform granular dispersion to the acetabular bone (Zone 1 in particular). To improve this technique, we have modified IBBC (M-IBBC), and investigated the short-term clinical results and radiographic changes. Materials and Methods. K-MAX HS-3 THA (Kyocera Medical, Japan), with cemented stem and all polyethylene cemented socket, was used for THA implants. Basically the third generation cementing technique was used for THA using bone cement. The socket fixation was performed with bone cement (Endurance, DePuy) and hydroxyapatite (HA) granules (Ca10(PO4)6(OH)2, Boneceram P; G-2, Olympus, Japan). In original IBBC technique, HA granules were dispersed on reamed acetabulum before cementing. In M-IBBC technique, HA granules were attached to bone cement on plastic plate, then inserted to reamed acetabulum and pressurized. HA granules (G-2) are 0.3–0.6mm in size, with 35–38% porosity and sintered at 1150â��. 51 hip joints (49 cases) were operated between June 2010 and December 2011, and followed. The average follow-up was 3.9 years, and average age at operation was 66.5 years. The clinical results were evaluated by Japan Orthopaedic Association Hip Score (JOA score), and X-p findings were evaluated using antero-posterior radiographs. The locations of radiolucent lines were identified according to the zones described by Delee and Charnley for acetabular components, and Zone 1 was divided into two parts, outer Zone 1a and inner Zone 1b. Results and Discussion. Revision was not performed. Japanese orthopaedic association (JOA) score improved from 48 to 87. Socket and stem loosening was not observed. X-p findings of sockets demonstrated
Introduction & Aim. The use of All-Poly Tibia has been in practice since the early 1970's. Recently due to the reports on wear and osteolysis in other articulations, this component has generated significant interest. In the current study we aim to report early medium-term results of All-poly Tibial components in elderly (>70 years) patients. Method. Study of 455 cases done between 2005-2020. All the cases were performed by a single surgeon. All-Poly Tibial component implantations were performed using Standard mechanical jigs and the same posterior-stabilized implant was used for all cases. Results. 20 cases were lost to follow-up. 25 patients died due to natural causes. Mean age at index surgery was 74 years (70 - 91 years). Preop KSS average was 47 (31- 62). Post operative at the last follow up was 87 (71- 93). Of the 410 cases there were 8 revisions, 6 for deep sepsis and 2 for periprosthetic fractures. There were no revisions for aseptic loosening or osteolysis. All cases are performing well functionally and clinically. 18 cases had a non-progressive
Introduction. The clinical impact of radiolucent glenoid lines is controversial, where the presence of a radiolucent glenoid lines has been suggested to be an indicator of clinical glenoid loosening. The goal of this database analysis is to quantify and compare the pre- and post-operative outcomes of 427 patients who received a primary aTSA with one specific prosthesis and were sorted based upon the radiographic presence of a
Purpose. Short metaphyseal fitting femoral stems convey stress to proximal femur and have no distal fixation. They have advantages in that there is no thigh pain and no bone loss due to stress shielding, but there is a concern for weakened fixation. So the authors evaluated whether short metaphyseal fitting femoral stems, which have only metaphyseal and no diaphyseal fixation, can acquire sufficient stability. Materials & methods. 39 cases of 36 patients who undervent uncemented total hip arthroplasty with DePuy Proxima. TM. (Johnson & Johnson orthopaedics, New Milton, UK) short metaphyseal fitting femoral stems from August 2009 to September 2011 were retrospectively evaluated. There were 19 male and 20 female cases. The mean follow-up period was 35.8(21.8∼49.2) months. Harris hip scores, WOMAC scores, UCLA scores, and presence of femoral pain were evaluated to assess clinical outcome. Femoral radiolucency in coronal and sagittal views of the hip, femoral stem loosening, and displacement was measured to evaluate radiological outcome. Distance between femoral stem and cortical bone was also measured to assess the relationship with radiolucency and loosening according to degree of contact. Results. Harris hip score before and after operation was 49.8(37–59) and 96.0(71–100) on average. WOMAC score improved from 44.1(31.9–56.3) to 91.8(62.3–100)after operation. UCLA activity score improved from 3.8(2–5) to 7.5(4–9) after operation. When assessed with 1mm as the standard,
In order to eliminate the “conflict” that can occur with physiological roll back of the femur on the tibia, most modern knee arthroplasty prostheses are designed to have little conformity between the femoral and tibial surfaces. However, a consequence of this design is paradoxical anterior sliding of the femur on tibia, which can result in clinically significant gait abnormalities. Recent studies show that during movement of the knee, the medial side remains very nearly stable like a ball-in-socket joint, whilst the lateral side moves front to back, rotating around the centre of the medial side. A total knee joint prosthesis designed with these same kinematics may therefore be advantageous. The objective of this study was to investigate the hypothesis that the increased constraint of a medial pivot knee promotes earlier loosening of the prosthesis. METHODS: This was a retrospective radiographic cohort study. Using our unit’s knee arthroplasty database, all patients with a Freeman-Samuelson 1000 knee arthroplasty (medial pivot design) or a Freeman-Samuelson Modular knee arthroplasty with a minimum follow-up of 2 years were identified, and matched as closely as possible for age, length of follow-up and pre-operative diagnosis (Osteoarthritis, Rheumatoid arthritis or Post-traumatic arthritis). This was a single surgeon series using a standard surgical approach with a posterior cruciate sacrificing technique. Standardised anteroposterior and lateral radiographs taken postoperatively, at 6 months, 1 year and then at yearly intervals, were examined systematically and independently of the senior surgeon (GS). Component migration and
Aims. Limb salvage in bone tumour patients replaces the bone with massive segmental prostheses where achieving bone integration at the shoulder of the implant through extracortical bone growth has been shown to prevent loosening. This study investigates the effect of multidrug chemotherapy on extracortical bone growth and early radiological signs of aseptic loosening in patients with massive distal femoral prostheses. Methods. A retrospective radiological analysis was performed on adult patients with distal femoral arthroplasties. In all, 16 patients were included in the chemotherapy group with 18 patients in the non-chemotherapy control group. Annual radiographs were analyzed for three years postoperatively. Dimensions of the bony pedicle, osseointegration of the hydroxyapatite (HA) collar surface, bone resorption at the implant shoulder, and
Purpose. To evaluate the radiographic long-term result of femoral revision hip arthroplasty using impacted cancellous allograft combined with cemented, collarless, polished and tapered stem. Materials and methods. Among 28 patients with impacted cancellous allograft with a cemented stem, 28 hips from 26 consecutive patients were analyzed retrospectively. The average patient age was 59 years. The follow-up period ranged 9 years 6 months to 14 years 5 months (mean, 12, 5 years). Radiographic parameters analyzed in this study included subsidence of the stem in the cement, subsidence of the cement mantle in the femur, bone remodeling of the femur,
Purpose. To evaluate the radiological changes after metal on metal resurfacing arthroplasty. Materials and Methods. Between December 1998 and August 2004, 166 hips in 150 patients who underwent metal resurfacing arthroplasty and followed up more than 4 years. Their mean age at the time of operation was 37.3 years(range, 15–68 years) and mean period of follow-up was 6.1 years(range, 48–95 months). The cause of arthroplasty included 115 avascular necrosis, 43 osteoarthritis, 7 ankylosing spondylitis, 1 haemophilic arthropathy. All patients had anteroposterior, translateral radiographs of the hip made preoperatively and each follow-up visit, and we analyzed radiographic findings such as radiolucencies or impingement signs around implant, neck narrowing and heterotopic ossification. Results. There was a no significant difference between preoperative and postoperative Harris hip score and range of motion. The mean stem-shaft angle was 137.4°, and 55.4% were ranged 130° to 140°. The mean inclination of acetabular component was 44.9°. There were no radiolucent lines or osteolytic lesion around the acetabular components, but 3 hips showed radiolucency around the head-neck junction(1.8%) and 4 hips showed
Purpose. We have compared the short-term clinical results of total hip arthroplasty (THA) using PMMA bone cement and hydroxyapatite (HA) granules (interfacial bioactive bone cement method; IBBC) with the results of conventional method using PMMA bone cement. Materials and Methods. K-MAX HS-3 THA (JMM, Japan), with cemented titanium alloy stem and all polyethylene cemented socket, was used for THA implants. The third generation cement technique was used for the conventional THA (Group C) using bone cement (Endurance, DePuy). In the IBBC group (Group BC), the socket fixation was performed by the third generation cement technique with HA granules (Boneceram P; G-2, Olympus, Japan) according to the Ohnishi's method. In both groups, the stems were fixed by conventional cementing technique using cement gun. 76 hip joins (69 cases) were operated between April 2005 and August 2007, and followed. The group C (22 hips, 19 cases, average follow-up; 5.6 years, average age at operation; 64 years) and the group BC (54 hips, 50 cases, 5.4 years, 65 years) were investigated. Results. One revision was performed in BC group due to late infection. Japanese orthopaedic association (JOA) score improved from 42/48 to 85/87 in Group C/BC. Socket loosening was not observed radiographically. X-p findings of Group C/BC demonstrated
Background. Total ankle arthrpoplasty (TAA) was performed frequently for ankle deformity caused by rheumatoid arthritis (RA) and osteoarthritis (OA). TAA has some advantages over ankle arthrodesis in range of motion (ROM). However, loosening and sinking of implant have been reported with several prostheses, especially constrained designs. Recently, we have performed mobile bearing TAA and report short term results of this prosthesis followed average 3 years. Method. 20 total ankle prostheses were implanted in patients with RA (n=14) or OA (n=6) in 19 patients (5 male and 14 female, one bilateral), between 2005 and 2009. We used FINE total ankle arthroplasty that is mobile bearing system (Nakashima Medical Co., Ltd, Okayama, Japan). All patients were assessed for American Orthopaedic Foot and Ankle Society (AOFAS) score, ROM in plantar flexion and dorsiflexion at the point of pre-operation and final follow-up. We evaluated
Aim: To investigate the migration and rotation patterns of the socket in hip revisions with impacted morselized allograft bone and cement. Methods: 17 Exeter socket revisions were followed by radiostereometry (RSA) and radiography for 5 years. The surgical procedure described by the Nijmegen group in Netherlands was used. The allograft bone chips were prepared in a bone mill and had an approximate size of 3 mm. Results: All but 1 socket migrated proximally (accuracy 0.2 mm). Five socket revisions with a
Background. The short stem prosthesis showed good results in patients with primary osteoarthritis. However, there were a few studies about the short stem THA in patients with osteonecrosis of the femoral head (ONFH). Objective. To evaluate the clinical and radiographic results of the short stem THA in patients with ONFH. The authors hypothesized that the short stem THA would be a promising procedure for patients with ONFH. Material and Method. The authors reviewed 120 osteonecrotic hips in 93 patients who underwent THA with Metha® short stem from November 2010 to February 2013. The appearance of bone trabeculae development and
We hypothesised that the excellent alignments achieved in UKA using a navigation system(NA-MIS UKA) would improve mid-term clinical results versus UKA without a navigation system(MIS-UKA). The clinical results and the component alignment accuracies of NA-MIS UKA and MIS UKA were compared after a minimum follow-up of five years. 56 UKAs in the navigation group and 42 UKAs in conventional group were included. The radiological measurements with regard to the mechanical axis, the inclination of the femoral and tibial components, and
Background. Composite screws of uncalcined and unsintered hydroxyapatite (HA) particles and poly-l-lactide (PLLA) were developed as completely absorbable bone fixation devices. So far the durability of HA-PLLA composite screws is unclear when used for the fixation of acetabular bone graft in total hip arthroplasty under full-weight conditions. We have used this type of screw for the fixation of acetabular bone graft in cemented or reverse-hybrid total hip arthroplasty since 2003. Hence, we conducted a follow-up study to assess the safety and efficacy of these screws when used for cemented socket fixation. Methods. During 2003–2009, HA-PLLA composite screws were used for fixation of acetabular bone graft in cemented or reverse-hybrid primary THA in 106 patients (114 cases). All the THAs were performed through direct lateral approaches, and postoperative gait exercise with full weight bearing usually started two days after surgery. One patient died of an unrelated disease and seven patients were lost to follow-up within 5 years. Finally, 98 patients (106 cases) were followed up for over 5 years and were reviewed retrospectively (follow-up rate, 93%). Radiographic loosening of the acetabular component was assessed according to the criteria of Hodgkinson et al., and the
Introduction. Achieving primary and long-term stability of femoral implant is critical for THA. This can be influenced by the shape and location of surface preparation as well as geometry. The Corail® stem has developed in 1986 in France, which is a straight quadrangular, and full HA coated standard titanium alloy stem featuring a metaphyseal tulip flare in combination with horizontal and vertical grooves. We have performed 75 THAs using it since May 2013. The purpose of this study was to evaluate radiographic changes of femur over time in Japanese patients after THA using this HA coated stem. Materials and Methods. Between May 2013 and September 2015, we implanted 75 THAs using a Corail® stem (DePuy-Synthes) in 66 patients. Their ages at operation were 47 to 93 years (avg. 66.5 years). Durations of follow up were 6 to 34 months after implantation (avg. 13.7 months). Acetabular components were standard titanium alloy, either 37 Pinnacle Porocoat®, 19 Pinnacle Gription® (DePuy-Synthes), 8 Ranawat®, 5 Regenerex®, or 6 G7® (Zimmer-Biomet) uncemented cups. Heads were either 73 BIOLOX delta® ceramic (CeramTec) or 2 CoCr. Liners were either 56 Marathon® (DePuy-Synthes) or 19 E1® HXLPE (Zimmer-Biomet). We studied 74 hips except one hip which was revised due to infection at the time of 3 weeks after surgery. Postoperative radiographic evaluations were done at the time of 2, 4, 6, 9, 12 months and then every 6 months thereafter. We examined cancellous condensation,
