BACKGROUND: To augment cement-bone fixation, Dr. Hironobu Oonishi attempted additional physicochemical bonding through interposition of osteoconductive crystal hydroxyapatite (HA) granules at the cement-bone interface in 1982. He first used the interface bioactive bone cement (IBBC) technique in 12 selected patients (12 hips) in 1982 (first stage) and followed them for 2 years. In 1985, the technique was applied in 25 total hip arthroplasty (THA) patients (second stage) and the effects were investigated by comparing the side with the IBBC technique and the other side without the IBBC technique. He has employed this technique in all THA patients since 1987 (third stage). METHODS: In the IBBC technique, HA granules (2 to 3 g) were smeared on the bone surface just before the acetabular and femoral components were cemented. In the first stage, 12 hips were operated using the IBBC technique in 1982. In the second stage, THA was performed without the IBBC technique on one side and with the IBBC technique on the other side within 1 year in 25 patients. In the third stage, THA was performed with the IBBC technique in 285 hips in 1987. RESULTS: In the first stage patients, implant loosening was not detected at 30 years after operation. In the second stage patients, revision was required in 7 hips without the IBBC technique due to cup loosening (5 hips) and stem loosening (2 hips), whereas no hip was revised after THA with the IBBC technique at 26 years after operation. In the third stage patients, the incidence of radiolucent lines and osteolysis was very few at 25 years after operation. CONCLUSIONS: The long-term follow-up of THA performed around the inception of the IBBC technique has revealed low incidences of radiolucent lines, osteolysis, and revision surgery.
Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Hip/adverse effects/instrumentation/methods ; *Bone Cements/adverse effects/therapeutic use ; Bone-Implant Interface/physiology ; Follow-Up Studies ; Hip/diagnostic imaging/surgery ; Humans ; Hydroxyapatites/therapeutic use ; Middle Aged ; Young Adult

A 45-year-old man with no history developed pain and paralysis in his left lower extremity. When he visited his previous physician, CT was performed, which showed Stanford type A aortic dissection with an aberrant right subclavian artery and Kommerell's diverticulum and narrowing of the true lumen of the left common iliac artery. He was accompanied by lower limb symptoms. He was then rushed to our hospital for emergency surgery. The operation was planned and performed in two stages. A median sternotomy was conducted, and cardiopulmonary bypass using the right common femoral artery, left axillary artery, and right atrium was initiated. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion were performed. The tear's entry was located in the distal arch of the aorta. The aortic arch was transected between the left common carotid and left subclavian arteries. We inserted an open stent graft to cover the diverticulated origin of the right subclavian artery. The left subclavian artery was reconstructed using a fenestration technique. The ascending aorta, aortic arch, and right and left common carotid arteries were reconstructed using a 4-branch prosthesis graft. The right subclavian artery was reconstructed through the thoracic cavity. On the day after the surgery, we performed percutaneous embolization of the right subclavian artery distal to the Kommerell's diverticulum. Postoperative CT showed no endoleakage or blood flow to the Kommerell's diverticulum. The patient's postoperative course was uneventful.

The case is that of a 90-years-old man. A previous doctor performed abdominal graft replacement for an abdominal aortic aneurysm 5 years earlier and continued outpatient CT follow-up. Follow-up CT showed the right aortic arch and dilation of the thoracic aortic aneurysm, and the patient was referred to our hospital. Contrast-enhanced CT showed an aortic arch aneurysm ; the aneurysm diameter was 62 mm in major axis and 60 mm in minor axis, which was judged to be suitable for surgery. It was a rare right-sided aortic arch with no congenital heart malformation and no situs inversus. Endovascular treatment was considered because he was 90 years old and very elderly, but there were concerns about the risk of embolism, irregular manipulation and central landing. For the surgical method, we selected total arch replacement using a frozen elephant trunk technique. We succeeded in avoiding serious complications by selecting an appropriate treatment method through careful evaluation.