The purpose of the present study is to assess 5–10 years' follow-up results after acetabular impaction bone grafting (IBG) in primary cemented total hip arthroplasty (THA) for cases with acetabular bone defect. We performed 36 primary cemented THA with acetabular IBG in 33 patients between November 2004 and May 2009. As one patient died due to unrelated disease at 6 months after the surgery, 35 hips of 32 patients were included in this study. The average age at the surgery was 62.4 years, and the average follow-up period was 7.9 years (5–10 years). Diagnoses were osteoarthritis due to acetabular dysplasia in 28 hips (26 patients), Rheumatoid arthritis (RA) in 4 hips (3 patients), rapidly destructive coxopathy (RDC) in 1 hip (1 patient), idiopathic acetabular protrusion in 1 hip (1 patient), and acromegaly in 1 hip (1 patient). For clinical assessment, the Merle d'Aubigné and Postel hip score was assessed and degree of post-operative improvement was classified according to their method as very great improvement, great improvement, fair improvement, and failure. Perioperative complications were also recorded. Acetabular bone defects were assessed at the surgery and categorized using AAOS acetabular bone defect classification system. For radiological assessment, anteroposterior radiographs of the bilateral hip joints were analyzed preoperatively and post-operatively. Radiolucent lines (RLL) of more than 2 mm around the acetabular components were assessed using the DeLee and Charnley zone classification. Acetabular component loosening was assessed according to the Hodgkinson et al. classification system, and type 3 (complete demarcation line) and type 4 (migration) were classified as “loosening”.Purpose
Patients and methods
Impaction bone grafting (IBG) using a circumferential metal mesh is one of the options that allow restoration of the femoral bone stock and stability of the implant in hip arthroplasty. Here we examined the clinical and radiographic outcome of this procedure with a cemented stem and analyzed experimentally the initial stability of mesh–grafted bone–cemented stem complexes. We retrospectively reviewed 6 hips (6 patients) that had undergone femoral revisions with a circumferential metal mesh, impacted bone allografts, and a cemented stem. The mean follow-up period was 2.9 years (range, 1.4–3.8 years). Hip joint function was evaluated with the Japanese Orthopaedic Association hip score, and radiographic changes were determined from radiographs. The initial resistance of cemented stem complexes to axial and rotational force was measured in a composite bone model with various segmental losses of the proximal femur.Background
Methods
Segmental defects of the femur present a major problem during revision hip arthroplasty. In particular, calcar segmental defects may compromise initial and long-tem femoral stem stability. The objective of the present study is to assess mid-term clinical and radiographic follow-up results at least two years after femoral revision comprising reconstruction for calcar segmental defect using metal wire mesh and impacted morcellised allograft.Introduction
Objective
In order to elucidate the influence of sympathetic nerves on
lumbar radiculopathy, we investigated whether sympathectomy attenuated
pain behaviour and altered the electrical properties of the dorsal
root ganglion (DRG) neurons in a rat model of lumbar root constriction. Sprague-Dawley rats were divided into three experimental groups.
In the root constriction group, the left L5 spinal nerve root was
ligated proximal to the DRG as a lumbar radiculopathy model. In
the root constriction + sympathectomy group, sympathectomy was performed
after the root constriction procedure. In the control group, no
procedures were performed. In order to evaluate the pain relief
effect of sympathectomy, behavioural analysis using mechanical and
thermal stimulation was performed. In order to evaluate the excitability
of the DRG neurons, we recorded action potentials of the isolated
single DRG neuron by the whole-cell patch-clamp method.Objectives
Methods
Exeter stem was introduced to Japanese market at 1996. Since then, owing to its excellent clinical results, the number of the stem used has been increased year by year and more than 2000 stems have been implanted during the year 2009. The present study aims to prove its efficacy for Japanese patients by evaluating short term results of four major dedicated hip centers. We present the short-term multi-center results of primary THA with Exeter stem combined with modern cementing technique in 881 patients (1000 hips). The average age of the patients at operation was 62.3years (ranging 23 to 89 years). Mean postoperative follow up period was 4.0 (ranging 2 to 9) years.Purpose
Method
Total hip arthroplasty (THA) often requires complex reconstruction for acetabular bone defect in patients with developmental dysplasia. We performed autogenous bulk structural bone grafting to deal with the lack of acetabular bone stock. The purpose of the present study was to assess the clinical and radiographic results after mean follow-up of 12 years. Between April 1992 and December 1997 the single senior author performed 75 consecutive primary THA for patients with degenerative osteoarthritis. Acetabular bone grafting was performed for 27 joints. Of these, six patients (six hips) were lost to follow up. Left 20 patients (21 hips) included in the study. There were two male and 18 female with a mean age at the time of the operation of 54.5 years (40–66 years). The mean duration of follow-up was 12 years (8–15 years). The diagnosis for all hips at the time of operation was secondary osteoarthritis due to developmental dysplasia. The degree of subluxation as categorized according to the classification of Crowe et al was group I in 11 hips, group II in 6 hips, group III in 4 hips. All operations were performed through a posterolateral approach using the femoral head for the graft. The grafts were screwed to the superolateral aspect of the acetabular roof. We used the Bioceram implant (Kyocera, Kyoto, Japan) with a 26 mm alumina-ceramic head. Both acetabular and femoral components were fixed with cement using the double-thumb technique in all procedures. Harris hip score was used for clinical evaluation. Standard anteroposterior radiographs were used for radiographic evaluation. The presence of a radiolucent line at the cement-bone interface in the three zones of DeLee and Charnley was recorded. Loosening of the acetabular component was classified according to the criteria of Hodgkinson et al. The remodeling process of the grafted bone was analyzed according to the method described by Knight et al. The initial postoperative anteroposterior radiographs were measured to define the proportion of the socket covered by bone graft according to the method described by Inao and Matsuno. The mean Harris hip score improved from 45.0 (24–60) before operation to 90.4 (77–100) at the final follow-up. At the final follow-up, 13 sockets showed the presence of a radiolucent line at the cement-bone interface and three sockets showed radiological evidence of loosening. According to the criteria of Hodgkinson et al, two sockets were type 3 and one were type 4. Bridging tarbeculation across the graft-host interface was seen in all cases. One case had the graft collapsed with migrated socket. The mean proportion of the socket covered by bone graft was 23.1% (9.8–42.3%). Three patients with loosed sockets had candidate for revision surgery, but no revision surgery was done because they had mild pain and did not demand the operation. Autogenous bulk structural bone grafting for reconstruction of the acetablum presented favorable results during mean follow-up of 12 years in the condition that the proportion of coverage of graft was less than 50%.
Though over ten-year follow-up results of impaction bone grafting for acetabular reconstruction from European countries are available in literatures, clinical reports from Asian countries are rare. The purpose of the present study is to assess mid-term clinical and radiographic follow-up results at least three years after acetabular reconstruction with impaction bone grafting technique by single surgeon in Japanese cohort. The senior author performed 24 acetabular revisions with impaction bone grafting technique in 24 patients from February 2001 to June 2005. The average age of the patients at the revision was 67.5 years (36–82 years). The average follow-up period was 5 years and 5 months (3–7.3 years). The reasons for the operation were aseptic loosening of sockets in 17 hips and migration of bipolar heads in seven. The acetabular bone defects were classified as cavitary in 3 hips and as combined segmental-cavitary in 21 hips according to AAOS classification. For clinical assessment, Merle d’Aubigné and Postel hip score was assessed. Peri-operative complications were recorded. For radiological assessment, antero-posterior hip radiograph was analyzed pre-operatively, and post-operatively at one month, 6 months and every 6 months thereafter. Clear lines more than 2 mm around the sockets using DeLee and Charnley zone classification, and migration of the sockets were assessed. Hodgikinson’s type 3 (complete demarcation line) and type 4 (migration more than 5 mm or change of the angle more than 5 degrees) were classified as “loosening”. Kaplan-Meier survival analysis was performed with radiographic loosening and any re-operation (including recommendation for the re-operation) for the sockets as the end point, respectively. The mean Merle d’Aubigné and Postel hip score improved from 11.5 points before operation to 15.7 points at the final follow-up. Though, intra-operative blow-out fracture of the acetabular floor was detected in 3 hips, re-containment had been achieved by adding metal mesh or bone graft. Clear lines at cement-bone interface were detected at zone 3 in 2 hips. Migration more than 5 mm was detected in 2 hips of type III defect at 2 years and 6 months. Re-revision was recommended for one migrated hip at 3 years and 6 months after the operation, and the other hip was stable with no clinical symptom without progressive migration at the final follow-up of 5 years. The Kaplan-Meier survival analysis, with loosening and re-operation as the end point, predicted a rate of survival of the socket of 91.7% and 95.2% at 5 years, respectively. In conclusion, acetabular reconstruction with impaction bone grafting is attractive, but technical demanding procedure. The survival rate of the present series was compatible with the results of previous literatures. However, careful follow-up is essential, especially for the cases with massive bone defect.
Segmental collapse occurs in the early stage of a vascular necrosis (AVN) of the femoral head, and is associated with a poor prognosis. Since it develops at a relatively young age, the long-term outcome after total hip replacement is a major concern. We have compared the long-term results of pedicle bone grafting (PBG) with those of transtrochanteric rotational osteotomy (TRO). In the PBG group there were 23 men (27 hips) and three women (4 hips) with a mean age at the time of surgery of 38 years and a mean follow-up of 13 years. In the TRO group there were 44 men (55 hips) and 19 women (22 hips) with a mean age at the time of surgery of 39 years and a mean follow-up of seven years. Failure was defined as a need for total hip replacement or a Harris hip score below 70. The long-term results were similar for the two groups. The survival rates at five and ten years were 85% and 67%, respectively, in the PBG group, and 71% and 61%, respectively, in the TRO group, according to Kaplan-Meier survivorship analysis. In the TRO group patients in stage II had significantly better results that those in stage III.
