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ABSTRACT: This report presents a case of debonding of plasma sprayed porous titanium coating from a threaded acetabular component which caused aseptic loosening of the implant. Weight bearing after delamination caused abrasive damage of the acetabular shell, and particles of the coating embedded in the acetabular liner. Microscopic examination of periprosthetic tissues showed presence of metal particles and macrophage infiltration. Despite microscopic examination of the retrieved component the cause of debonding remains unclear.
Journal of the mechanical behavior of biomedical materials. 08/2012;
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ABSTRACT: We report a case of a female patient using a McKee-Farrar prosthesis for 30 years, until revision surgery for aseptic loosening. Electron microscopy analysis of bearing surface of the retrieved implant was performed, and the results were presented in comparison with previously published papers.
Chirurgia narzadow ruchu i ortopedia polska 01/2012; 77:17-20.
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ABSTRACT: The choice of the treatment method in young patients with osteoarthritis secondary to the developmental hip dyplasia is one of the most difficult dilemmas in orthopaedic practice. Currently total cementless hip replacement with metal-on-metal articulation is a routine procedure. Young patients are particularly exposed to the risk of aseptic loosening due to their high activity and long duration of life with implant. Basing on our material, using selected clinical cases, options for treatment of OA secondary to DHD were presented. The paper presents the progress of OA seconary to DHD treated in childhood and its subsequent treatment using intertrochanteric osteotomy without changing the neck-shaft angle, intertrochanteric osteotomy combined with shelf procedures, isolated shelf procedures and periacetabular osteotomies according to Ganz. Both satisfactory results with pain relief for any years so like negative ones with total lack of improvement were shown. Presented options for treatment alternative to THR may be helpful in determining the individual management in young adults.
Chirurgia narzadow ruchu i ortopedia polska 02/2005; 70(5):325-9.
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ABSTRACT: The introduction of sonography to the evalution of the hip joint, allowed for the non-invasive examination in preterm neonates and thus assessment of the development their hip joints. MATERIAL AND METHODS. The examined group consisted of 143 preterm neonates with the body weight by delivery lower then 2000 grams (286 hip joints) and the control group of 31 children from term delveries forming the control group. The sonographic examination was conducted stricktly according to the rules presented by Graf. First examination was performed averagely in the 3rd week of life, second avg. in the 14th, third in avg. the 23rd, fourth avg inthe 33r week of life. Wyniki. In the first examination, done in the 3rd week of life it was noticed that highest rate of the hips Ia appeared in the group I (newborns with the lowest bogy weight), and together with the increase in body weight the incidence of such hips decreased, when the incidence of type IIa hips increased at the same time. At the final examination no statistically significant differences were found between the hip joints and no dysplastic hips were found. Wnioski. According to our results, we found that preterm delivery is not a risk factor for the developmetal hip dysplasia.
Chirurgia narzadow ruchu i ortopedia polska 02/2005; 70(4):301-5.
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ABSTRACT: Polymorphonuclear neutrophils (PMN) are the first cells to take part in the local foreign body reaction in aseptic loosening of endoprostheses. The aim of this study was to evaluate the systemic host reaction to total joint replacement by measuring the production of nitric oxide by neutrophils before and after total joint replacement.
Blood samples were collected from 33 patients (27 hips and 6 knees) before surgery, and 2 weeks, 2 months and 2.5-3 years after surgery. The levels of nitric oxide produced by PMN were measured by the method described by Markert et al. (1994).
Patients reporting pain in the region of the implant 3 years after surgery, and also patients with radiographic signs of loosening, had higher production of NO in the early period and 3 years after the implantation than those with good clinical results.
We propose that elevated levels of nitric oxide production by PMNs may serve as a marker of total joint prosthesis loosening.
Acta Orthopaedica Scandinavica 10/2004; 75(5):549-53.
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ABSTRACT: Background. Both conservative and surgical treatment are applied in the treatment of developmental hip dislocation in the second year of life. Our study to evaluated the results of surgical treatment at this age using open reduction combined with transiliac osteotomy and translation of the distal insertion of the iliopsoas muscle. Material and methods. The analyzed group consisted of 21 hip joints. The mean follow-up was 6 years (2-11 years). The age of the patients at surgery was 13 -24 months, average 18 months. Results. According to Severin's classification scheme 71% of the patients had excellent results and 29% good. However, when the analyzed joints were evaluated according to our classification scheme, the results were significantly worse: 29% excellent, 48% good, 23% satisfactory. The difference between the results was caused by parameters not included in Severin's classification: neck-shaft angle and neck centering angl. The true antetorsion angle was decreased in the final examination in comparison to preoperative results. The mean head-metaphyseal index of Kruczyński averaged 120.61% of normal in the whole group, and values higher than 120% were found in 13 cases (62%). Conclusions. The described method of treatment provided stable reduction with good coverage of the femoral head by the acetabular roof in more than 90% of cases. The problem of increased neck-shaft angle and neck centering angle occurring in 25% of cases remains unsolved. The antetorsion angle is still high in some cases at follow-up.
Ortopedia, traumatologia, rehabilitacja 03/2004; 6(1):34-43.
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ABSTRACT: Total hip replacement became a method of choice in treatment of the severe osteoarthritis. Despite the progress in constructing the implants and also the surgical technique, the number of complications rises together with the number of arthroplasties performed. The periprosthetic osteolysis and its consequence--the loosening is the one of the greatest problems of today's joint replacement. It creates the main obstacle for the long-term efficiency of the total hip arthroplasty. It was proved by the numerous research, wear debris of the implant induce the chronic periprosthetic inflammatory process. Many studies emphasize the influence of the proinflammatory cytokines on the bone metabolism. The aim of the study was the evaluation of the inflammatory process in patients with the severe osteoarthritis before the surgery and in subsequent periods after total hip replacements and also in patients with the aseptic loosening of the endoprosthesis, by the monitoring the levels of IL-6 in serum of the peripheral blood. The results suggest, that in patients following THA with the elevated level of IL-6, the inflammatory process was present. This inflammation may lead in future to the aseptic loosening of the implant.
Chirurgia narzadow ruchu i ortopedia polska 02/2004; 69(2):121-4.
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ABSTRACT: Background. Recent studies on the developmental dysplasia of the hip emphasize the role of the last trimester of pregnancy in the origin of the pathology. The aim of the study was to evaluate the development of the hip joints of preterm neonates born with different weight and in different periods of pregnancy.
Material and metods. 286 hip joints of preterm neonates born between 24 and 37 week of pregnancy and 62 ones of newborns from term deliveries were analysed. The evaluated newborns were divided into 3 groups of preterm ones: with the weight at birth below 1000 g (23 children), between 1000 and 1500 g (40 children), between 1500 and 2000 g (80 children) and a control group- 31 children from term deliveries with normal weight. In every case 4 single sonographic examinations were performed using the method presented by Graf. First, before the 6 week of age (mean 3 weeks), next after the 3rd month af age (mean 14 weeks), next after 5th month of age (mean 23 weeks) and the last one after the 7th month. The evaluation of the remodeling of the hips was based on the observation of changes in a and ss angles.
Results. It was found that the lower was the newborn's weight at birth the higher was the b angle. The similar tendency was noticed for the ss angle but was observed only in the group of preterm neonates. When the evaluation was based on the postconceptional age at the examination, it was found that the values of both angles worsened together with age, reaching the worst values between 37th and 42th week of postconceptional age. It proves the theory, that in the last trimester of the pregnancy, the acatabulum becomes more shallow and vertical together with the worsening of the cartilaginous femoral head coverage with time.
Conclusion. The presented results show that the worst anatomical parameters of the hip joint can be found at physiological term of delivery.
Ortopedia, traumatologia, rehabilitacja 12/2003; 5(6):703-11.
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ABSTRACT: This paper describes the radiological status on the start of walking in 31 hip joints in 24 children, in which the treatment of the developmental dysplasia with dislocation of the hip began in the first 2 weeks. Before the beginning of the treatment, ultrasonographic assessment revealed type D in 22% hips, type III in 55% and type IV in 23%. The radiographic evaluation was based on 6 parameters, which values were compared to the normal ones for the age group. It was estimated that only 32% hips had a correct radiological status, the other hips revealed smaller or greater dysplasia.
Chirurgia narzadow ruchu i ortopedia polska 02/2003; 68(5):303-5.
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ABSTRACT: Aseptic loosening of the prosthesis is caused by the mechanical instability of it's components or it depends on direct tissue reaction--foreign body reaction to implant's wear debris. Former studies showed a significant role of macrophages in the process of the chronic inflammation leading to the aseptic loosening. There are few studies concerning the early reaction against the implant and concerning in this process the role of neutrophils--the cells which form the primary defence of the body and are activated during contact with the foreign body. The examined group consisted of 33 patients aged 59-79 with implanted cemented hip or knee endoprosthesis due to the primary osteoarthritis. The count of granulocytes, production of the nitric oxide and hydrogen peroxide with Pick's and Market's method was evaluated in samples collected before the surgery, 2 months and 3 years after the operation. 3 years postoperatively 8 patients reported pain of the operated joint and in two cases aseptic loosening was recognized. In this group the level of production of the nitric oxide and hydrogen peroxide by the neutrophils 2 months postoperatively was significantly higher in comparisons to the levels in the patients without pain and the control group. In patients without pain the production of nitric oxide and the hydrogen peroxide did not change significantly after the surgery. The presented results suggest the neutrophil's activation by the cytokines, which appear as a result of a local response to a foreign body, may be a factor initiating a chronic inflammation around the implant leading to the aseptic loosening.
Chirurgia narzadow ruchu i ortopedia polska 02/2002; 67(1):11-8.
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ABSTRACT: Aseptic loosening is a result of the chronic inflammatory reaction in periprosthetic tissues. Its intensity depends on the implants construction material and reactivity of the host's tissues. The aim of the study was the evaluation of the acute phase proteins in various periods following total hip replacement and comparison between acute phase response observed in patients with well-functioning implants and with aseptic loosening.
The study group consisted of 97 patients following THR due to the hip osteoarthritis. Patients of Group I were evaluated before the surgery and 6 months after primary THR. Group II consisted of patients 3-4 years after primary THR. Group consisted of patients with aseptic loosening. Patients of all groups were divided according to the implant type (cemente/uncemented).
Concentrations of evaluated acute phase proteins: C-reactive protein (CRP), transferrin (Tf) and alpha-glycoprotein were assessed using immunoelectrophoresis.
In vast majority of patients (71-95%) following THR had present w3 variant of AGP which should be negative in physiological conditions. The average concentrations of AGP and AGP-RC were higher in patients following cemented THR.
Implantation of the endoprosthesis raises a chronic inflammatory reaction expressed by changes in the profiles of acute phase proteins. This process is more visible in patients following cemented THR. The profiles of the acute phase proteins in patients with aseptic loosening were not different than those observed in patients with well-functioning implants, what makes them useless as a diagnostic tool for loosening. This lack of differences may be caused by adaptation of the generalised response to long lasting process of aseptic loosening
Chirurgia narzadow ruchu i ortopedia polska 72(5):305-9.
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ABSTRACT: Osteoarthritis is the most common joint disease in adults and according to WHO is one of the civilisation threats. Total joint replacement is the best method of treatment of severe osteoarthritis.
The study group consisted of 62 (44 women, 18 men) patients, who due to the severe osteoarthritis underwent total hip replacement at the Department of Orthopaedics Poznań University of Medicine. The mean age was 63 (range 30-87). For the evaluation of the quality of life the modified questionnaire WHOQOL-100 was used. The first evaluation was performed before the surgery, the second one 12-18 (average 14) months postoperatively.
At the final evaluation the improvement was observed in the following domains: physical, psychological, level of independence, environmental and the global quality of life. No change was observed in the domain "social relations". The greatest improvement was observed in the following subscales: "pain and discomfort", "vitality and fatigue", mobility, "everyday activities", "drug dependence", transportation. No significant change was found in the following subscales: "sleep and rest", "positive feelings", "ability to work and learn", "personal social relations" and accessibility and quality of healthcare.
Chirurgia narzadow ruchu i ortopedia polska 72(4):269-74.
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ABSTRACT: Degenerative joint disease is the most common joint pathology and the main cause of disability of elderly people in developed countries. It is caused by imbalance between degeneration and regeneration of articular cartilage accompanied by pathological changes of other joint structures. No generally recognizable description of the pathogenetic pathway of osteoarthritis (OA) exists so far, however recent studies have widened the knowledge of the underlying pathology. In this review views regarding the role of genetic and mechanical factors in OA pathogenesis were presented. The role of pro-inflammatory mediators such as cytokines (IL-1, TNF-alfa, IL-6), lipid mediators, NO, reactive oxygen species, were discussed. The contribution of adipokines (fat tissue derived hormones with cytokine activity) to the pathogenesis of degenerative joint disease was also described. The role of synovial membrane, articular cartilage, subchondral bone and such structures as osteophytes and infrapatellar fat pad in development of osteoarthritis were presented as well.
Chirurgia narzadow ruchu i ortopedia polska 75(4):248-60.
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ABSTRACT: The uncemented total hip replacement became a standard in treatment of the severe hip osteoarthritis. Its long term efficiency is based on the correct osteointegration which depends on the adequate implantation. Material. The study group consisted of 49 patients (52 hips) following total hip replacement with ABG II stem and Trident PSL cup. The follow-up ranged between 6 months and 2 years. Methods: In each case the Harris hip score was performed and high resolution x-rays were taken. On X-ray the fit and position of the stem, linear osteolysis around the stem and bone atrophy at the greater trochanter were evaluated. Results. The mean HHS at the last follow up was 90.4 (50-99). The mean angle of the stem position was 2.9 varus. The mean fit index was was 0.75. The significant correlation was found between the fit index and the varus stem position angle. The linear osteolysis surrounding the stemin the 1st Gruen zone was found in 70% of cases. The phenomenon of the linear radiolucenecy surrounded by linear densification was found in the 76% of cases. Bone atrophy at the greater trochanter was found in the 42% of cases. Conclusions. The use of ABG II stems provided very good clinical results. The stem has a tendency to a varus position, which seems to be connected with the use of the too small stems. Specific radiographic observations create a need of futher follow-up, but existed without the influence on the clinical results.
Chirurgia narzadow ruchu i ortopedia polska 75(5):287-90.
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ABSTRACT: The influence of physical activity on the survival of total hip replacement remains not fully recognized. It is unclear which activities are beneficient for patients following THR.
The study was conducted on group of 87 patients (94 hips) following uncemented THR with ABGII/Trident and 45 patients (51 hips) following hip resurfacing. The follow-up period was 6-30 months for THR group and 6-42 months for resurfacing group.
The patients answered a questionnaire based on WOMAC and SF-36 score, UCLA activity scale with additional questions concerning patients physical activity, working and place of living.
In WOMAC, physical domains of SF-36 and UCLA activity score patients following hip resurfacing showed better results. The most preferred activity in both groups was exercise walking and biking. The last one was particularly preferred by patients living in rural areas.
The vast majority of patients restricted their activity to disciplines with a safe range of hip weight bearing.
Chirurgia narzadow ruchu i ortopedia polska 74(6):348-52.
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ABSTRACT: Total knee replacement in knees with severe valgus and defects of the medial tibial condyle are at higher risk complications than in knees with a correct axial allignement.
The study group included 10 patients (11 knees) with with severe valgus and defects of the medial tibial condyle in which TKR was performed. In 8 cases bone defects were filled with bone autograft in 3 cases defects were filled with metal augments. The mean follow-up was 37 months (26 months to 4 years). Clinical results were measured with the knee society score, the level of activity was evaluated with the UCLA score. Radiographic evaluation was based on radiograms taken preoperatively, postoperatively and at the follow-up examination.
In All cases an improvement in clinical results was noted, the mean KSS result rised from 25.3 preoperatively to 87 postoperatively and the level of activity rised from 3.4 to 5.4 postoperatively. No signs of loosening were found in radiographic evaluation.
TKR in joint with severe varus and medial tibial condyle defects creates a need for the reconstruction of defects. In lesser defects reconstruction with bone autografts is sufficient, in severe cases filling the defect with metal augments is needed. When indicitions are followed both methods provide good clinical results.
Chirurgia narzadow ruchu i ortopedia polska 75(6):375-9.
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ABSTRACT: The acute phase proteins are commonly known universal markers of the inflammatory process. The aim of the study was the evaluation of the acute phase response in the first 6 months THR. The secondary aim was to check if the type of hip replacement affects the acute phase response.
The study group consisted of 40 patients who underwent THA using uncemented (20) and cemented (20) endoprostheses. The concentrations of C-reactive protein, alpha-glycoprotein, and alpha-1-antichymotripsin, and microheterogeneity of AGP were evaluated.
The blood levels of the acute phase proteins CRP, AGP, ACT rose significantly at 2 and 14 days after the surgery to return to preoperative values at 6 months after the surgery. The V3 variant of microheterogeneity of AGP, absent under normal conditions, and representative of acute inflammation, was found in a few patients preoperatively. In postoperative evaluations, it was found in the vast majority of the patients.
The analysis of the profiles of the glycosylation of AGP shows that the presence of the acute inflammatory response immediately following total hip replacement, which later changes into persistent chronic inflammation, is more pronounced in patients receiving cemented endoprosthesis.
Ortopedia, traumatologia, rehabilitacja 11(4):324-32.
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ABSTRACT: Pedobarography is used more and more often in such fields as orthopaedics, traumatology, neurology, diabetology or rehabilitation. The aim of this work has been to evaluate the effects of right-side idiopathic thoracic scolioses and changes in angular values of physiological curvatures of the spine on sub-pedal pressure distribution. TWINN 99 software assisted PEL-38 measuring platform and Penny & Giles tensiometric electrogoniometre were used in the study which was carried out on the population of 30 girls with right-side idiopathic thoracic scoliosis. The girls exhibited a mild degree of scoliosis. The control was made up of a group of 30 healthy girls with no musculoskeletal system pathology. The girls in both groups were 10 years old. Measurements of spinal curvatures and distribution of sub-pedal pressure forces were carried out three times daily, always at the same time. The analysis of the results has shown that right-side idiopathic thoracic scoliosis leads to higher pressure being imposed on the halux and convex front part of the foot. Such pressure distribution stems from flattening of the thoracic kyphosis and enhancement of lumbar lordosis. The shift of the gravity centre to the front and to the right can as a result exacerbate the pathology not only in the foot, but also in the whole lower limb at the scoliotic side.
Chirurgia narzadow ruchu i ortopedia polska 73(3):187-91.
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ABSTRACT: Metal-on-metal bearings characterize lower wear than metal-poly, lower fracture risk than ceramics and they allow for the manufacturing of large diameter heads. The metal ion release from the bearings is the the major concern of these articulations.
The study group consisted of 16 patients who underwent hip resurfacing with Durom implant and had minimum 1 year follow-up period. Blood from the patients was collected 4 times: before the surgery, 2, 6 and 12 months postoperatively.
Clinical examination was done according to HHS, Radiographic image was used to measure the cup inclination, evaluation of chromium and cobalt ion blood levels was performed using graphite furnace atomic absorbtion spectrometry (GFAAS).
The levels of cobalt and chromium increased postoperatively significantly to decrease slightly at 6 months. At 1 year cobalt levels increased to the similar level like at at 2 months. The chromium level decresed to the values as low as preoperatively. The mean cup inclination angle measured on X-rays was 48 degrees(range 39 degrees - 56 degrees). The mean HHS result was 89.86 (range 64.43 to 98.73). The mean activity level measured with UCLA scale was 6 (range 3-9).
The metal ion blond levels increase sigficantly in the period 2-6 months following hip replacement with large diameter metal-on-metal articulation. In further examinations at 1 year post-op ion levels decrease.
Chirurgia narzadow ruchu i ortopedia polska 76(6):332-5.
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ABSTRACT: Modem indications for use of cemented or uncemented implants in revision hip arthroplasty are comparable. The use of bone cement provides predictable short term results, but the lack of osteointegration deteriorates its long term durability. Uncemented implants undergo osteointegration, but reduced contact with host bone may cause early loosening. Modular porous tantalum implants are highly osteointegrative, and the availability of bone stock augments increases the versatility of this system.
The study group consisted of 20 patients (21 hips) who underwent a revision hip arthroplasty using Trabecular Metal acetabular revision system. The follow-up period was between 7 and 31 months (average 20 months). All patients were evaluated with HHS and conventional radiography.
The mean HHS increased form40.45 (range 18.74-56.65) preoperatively to 78.8 (56.5-96) at the last follow-up. No mechanical failures, nor septic complications were noted.
Chirurgia narzadow ruchu i ortopedia polska 76(4):197-200.
