Introduction. Intraosseous transcutaneous amputation prostheses (ITAP) provide an alternative means of attaching artificial limbs for amputees. Conventional stump-socket devices are associated with soft tissue complications including; pressure sores and tissue necrosis. ITAP resolves these problems by attaching the exo-prosthesis transcutaneously to the skeleton. The aim of this study is to increase the attachment of dermal fibroblasts to titanium alloy in vitro. Fibronectin (Fn) and laminin 332 (Ln) enhance early cell growth and adhesion. We hypothesize that silanized dual
Aims. The Intraosseous Transcutaneous Amputation Prosthesis (ITAP)
may improve quality of life for amputees by avoiding soft-tissue
complications associated with socket prostheses and by improving
sensory feedback and function. It relies on the formation of a seal
between the soft tissues and the implant and currently has a flange
with drilled holes to promote dermal attachment. Despite this, infection
remains a significant risk. This study explored alternative strategies
to enhance soft-tissue integration. Materials and Methods. The effect of ITAP pins with a fully porous titanium alloy flange
with interconnected pores on soft-tissue integration was investigated.
The flanges were coated with fibronectin-functionalised hydroxyapatite
and silver
Introduction. Following amputation, residual stumps used to attach the external prostheses can be associated with sores, infection and skin necrosis. These problems could be overcome by off loading the soft tissues. Intraosseous transcutaneous amputation prostheses (ITAP) attach external implants directly to residual bone reducing these complications. However, a tight seal at the skin implant interface is crucial in preventing epithelial down-growth and infection. Fibronectin (Fn) and laminin 332 (Ln), enhance early cell growth and adhesion of keratinocytes. Silanization to titanium alloy (Ti) allows these proteins to bond to the metal directly. We hypothesize that silanized dual
Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade.Aims
Methods
Aim. Previous studies of primary internal fixation of infected non-unions have reported high failure rates. Local antibiotic carriers and
Introduction. The postoperative management of patients after total hip replacement traditionally includes restrictions of movements and the use of aids (toiletelevation, sleeping pillow, a.o.) in the first 3 months after operation. Few studies have investigated the benefit of such restrictions. The aim of the present study was to evaluate how patients with total hip replacements (THR) are doing with and without restrictions in the first 3 months after surgery, and if walking ability and patients satisfaction was influenced by the postoperative regime. Patients and Methods. 80 patients undergoing primary uncemented THR were randomized to either the conventional regime with restrictions of movement and obligatory use of aids, or a postoperative regime without restrictions. Surgery was performed through a posterolateral short incision. The femoral component was the uncemented Bimetric prosthesis, non collared with HA
INTRODUCTION. The lifetime of UHMWPE implants may be limited by wear and oxidative degeneration. Wear produced particles are in general biologically active, and may induce osteolysis. As threshold of PE wear rate below which osteolysis is rarely observed is postulated to be less tahn 0.1 mm per year. Moreover, PE delamination and breakage are consequences of the embrittlement of the PE due to oxidation. Both demonstrate, that improving the clinical behaviour of UHMWPE means reduction of wear particles. The first can be achieved by cross-linking the second by the anti-oxidative stabiliser vitamin E. The highly cross-linked PE vitamys ® used for the isoelastic monobloc cup RM Pressfit (Mathys AG Bettlach, Bettlach, Switzerland) is mixed with 0.1% of synthetic vitamin E and is the first and only highly cross-linked PE used in total hip replacement that meets all requirements for the best grade UHMWPE in yield strength, ultimate tensile strength and elongation at break. METHODS AND MATERIAL. With the first implantation of RM Pressfit vitamys® a prospective multicentre study was started. So far 256 cases in 7 clinics from Europe and New Zealand are included. This report presents the first clinical experiences of one Swiss clinic from the multicentre study. Prospective data collection includes Harris Hip score (HHS), patient satisfaction and radiographic analysis. Clinical and radiographic follow-up is done after 6 weeks, 6, 12 and 24 months, and thereafter for long-term results. Standardized documentation of surgery and postoperative course is performed. RESULTS. 81 patients were included in the study. Mean age at implantation is 69 years. The indication was primary OA in 57% and secondary OA in 36%, the others were treated either for necrosis, fracture or hip dysplasia. 68% of the patients received a 36mm femoral head, 31% a 32mm and 1% a 28mm. Intraoperatively two minor complications occurred, one femur and one trochanter fissure. No complications occurred during implantation of the cup. Most of the cups (59%) were implanted with an inclination of 40°-50°, 30% with 35°-40°. There were no signs of early loosening and a good Harris Hip Score was achieved. DISCUSSION. The principals of this monobloc cup with its isoelastic property and the thin titanium
The osteointegration of a new three-dimensional reticular titanium material, Trabecular Titanium™, was assessed using a bilateral cancellous (distal femur, proximal tibia) and cortical (tibia diaphysis) bone drill hole model in 18 sheep. TT is a novel Ti6Al4V material characterized by a high open porosity and composed of multi-planar regular hexagonal cells. Two 5.0 mm diameter, 12 mm long cylinders (TT1 & TT2) of two different porosities (TT1:650 μm, TT2:1250 μm) were tested and compared to two solid predicate 5.0 mm diameter, 12 mm long Ti cylinders (PT1 & PT2) coated with porous Ti (PT1: vacuum-plasma spray
This study explores data quality in operation type and fracture classification recorded as part of a large research study and a national audit with an independent review. At 17 centres, an expert surgeon reviewed a randomly selected subset of cases from their centre with regard to fracture classification using the AO system and type of operation performed. Agreement for these variables was then compared with the data collected during conduct of the World Hip Trauma Evaluation (WHiTE) cohort study. Both types of surgery and fracture classification were collapsed to identify the level of detail of reporting that achieved meaningful agreement. In the National Hip Fracture Database (NHFD), the types of operation and fracture classification were explored to identify the proportion of “highly improbable” combinations.Aims
Patients and Methods
Periprosthetic femoral fractures (PFF) following total hip arthroplasty
(THA) are devastating complications that are associated with functional
limitations and increased overall mortality. Although cementless
implants have been associated with an increased risk of PFF, the
precise contribution of implant geometry and design on the risk
of both intra-operative and post-operative PFF remains poorly investigated.
A systematic review was performed to aggregate all of the PFF literature
with specific attention to the femoral implant used. A systematic search strategy of several journal databases and
recent proceedings from the American Academy of Orthopaedic Surgeons
was performed. Clinical articles were included for analysis if sufficient
implant description was provided. All articles were reviewed by
two reviewers. A review of fundamental investigations of implant
load-to-failure was performed, with the intent of identifying similar
conclusions from the clinical and fundamental literature.Aims
Patients and Methods
Our aim in this pilot study was to evaluate the fixation of, the bone remodelling around, and the clinical outcome after surgery of a new, uncemented, fully hydroxyapatite-coated, collared and tapered femoral component, designed specifically for elderly patients with a fracture of the femoral neck. We enrolled 50 patients, of at least 70 years of age, with an acute displaced fracture of the femoral neck in this prospective single-series study. They received a total hip replacement using the new component and were followed up regularly for two years. Fixation was evaluated by radiostereometric analysis and bone remodelling by dual-energy x-ray absorptiometry. Hip function and the health-related quality of life were assessed using the Harris hip score and the EuroQol-5D. Up to six weeks post-operatively there was a mean subsidence of 0.2 mm (−2.1 to +0.5) and a retroversion of a mean of 1.2° (−8.2° to +1.5°). No component migrated after three months. The patients had a continuous loss of peri-prosthetic bone which amounted to a mean of 16% (−49% to +10%) at two years. The mean Harris hip score was 82 (51 to 100) after two years. The two-year results from this pilot study indicate that this new, uncemented femoral component can be used for elderly patients with osteoporotic fractures of the femoral neck.
Using data from the Norwegian Hip Fracture Register,
8639 cemented and 2477 uncemented primary hemiarthroplasties for
displaced fractures of the femoral neck in patients aged > 70 years
were included in a prospective observational study. A total of 218
re-operations were performed after cemented and 128 after uncemented
procedures. Survival of the hemiarthroplasties was calculated using
the Kaplan-Meier method and hazard rate ratios (HRR) for revision
were calculated using Cox regression analyses. At five years the
implant survival was 97% (95% confidence interval (CI) 97 to 97)
for cemented and 91% (95% CI 87 to 94) for uncemented hemiarthroplasties.
Uncemented hemiarthroplasties had a 2.1 times increased risk of
revision compared with cemented prostheses (95% confidence interval
1.7 to 2.6, p < 0.001). The increased risk was mainly caused
by revisions for peri-prosthetic fracture (HRR = 17), aseptic loosening
(HRR = 17), haematoma formation (HRR = 5.3), superficial infection
(HRR = 4.6) and dislocation (HRR = 1.8). More intra-operative complications,
including intra-operative death, were reported for the cemented
hemiarthroplasties. However, in a time-dependent analysis, the HRR
for re-operation in both groups increased as follow-up increased. This study showed that the risk for revision was higher for uncemented
than for cemented hemiarthroplasties.
We undertook a prospective randomised controlled trial involving 400 patients with a displaced intracapsular fracture of the hip to determine whether there was any difference in outcome between treatment with a cemented Thompson hemiarthroplasty and an uncemented Austin-Moore prosthesis. The surviving patients were followed up for between two and five years by a nurse blinded to the type of prosthesis used. The mean age of the patients was 83 years (61 to 104) and 308 (77%) were women. The degree of residual pain was less in those treated with a cemented prosthesis (p <
0.0001) three months after surgery. Regaining mobility was better in those treated with a cemented implant (p = 0.005) at six months after operation. No statistically significant difference was found between the two groups with regard to mortality, implant-related complications, re-operations or post-operative medical complications. The use of a cemented Thompson hemiarthroplasty resulted in less pain and less deterioration in mobility than an uncemented Austin-Moore prosthesis with no increase in complications.