Vascular complications after total hip arthroplasty (THA) are rare and mainly occur after revision surgery, and of these complications, large artery thrombosis is relatively uncommon. Nevertheless, this complication has potentially devastating effects on the affected lower extremity. The authors report a case of acute thrombosis in an iliac artery stent and femoro-popliteal bypass graft after primary cementless THA, and include relevant literature review.
Arteries ; Arthroplasty ; Hip ; Iliac Artery ; Lower Extremity ; Stents ; Tacrine ; Thrombosis ; Transplants

PURPOSE: The purpose of this study is to evaluate the early results and occurrence of complications of cementless total hip arthroplasty (THA) using an alumina-on-alumina articulation with a minimum follow up period of three years. MATERIALS AND METHODS: We prospectively followed 108 patients (121 hips) who underwent cementless THA using an alumina-on-alumina articulation. The mean age of the patients was 50.7 years (range, 20-80 years) and mean the follow up period was 48 months (range, 36-60 months). Preoperative diagnoses included osteonecrosis of the femoral head in 90 hips; secondary osteoarthritis due to hip dysplasia in 24 hips; secondary osteoarthritis after acetabular fracture in four hips; acute femoral neck fracture in three hips. Clinical evaluation was performed using Harris hip score (HHS) and radiographic evaluation was performed in terms of the fixation of components and the prevalence of osteolysis. In addition, we observed complications, including the occurrence of sound or fracture of the alumina head or liner. RESULTS: Mean HHS improved from 62.4 points to 94 points at final follow-up. Thigh discomfort was found in six hips and mild inguinal discomfort was found in eight hips. Both had disappeared within one year after operation. A clicking sound was detected in two patients. One hip had become dislocated and an alumina liner fracture had occurred in one hip. Loosening of component or osteolysis was not observed in any hip. The radiographic wear was not measurable. CONCLUSION: Early results of cementless THA using an alumina-on-alumina articulation were favorable, with osseointegration of the components and absence of periprosthetic osteolysis. However, longer-term follow up for a hip clicking sound and fracture of an alumina fracture are necessary.
Aluminum Oxide ; Arthroplasty ; Femoral Neck Fractures ; Follow-Up Studies ; Head ; Hip ; Humans ; Osseointegration ; Osteoarthritis ; Osteolysis ; Osteonecrosis ; Prevalence ; Prospective Studies ; Tacrine ; Thigh ; Ursidae

Total hip arthroplasty (THA) can be a good treatment option for avascular necrosis (AVN) of the femoral head. However, because dislocation can frequently occur after surgery, THA is a concern in patients with a neuromuscular disease, such as cerebral palsy or poliomyelitis. In patients with poliomyelitis, only one case of AVN of the femoral head in the affected limb has been reported in the English literature. Here, the authors report on a case of AVN of the femoral head in a patient with poliomyelitis, who was treated with a large diameter femoral head metal-on-metal THA using a modified minimally invasive-2-incision technique.
Arthroplasty ; Cerebral Palsy ; Dislocations ; Extremities ; Head ; Hip ; Humans ; Necrosis ; Neuromuscular Diseases ; Poliomyelitis ; Tacrine

For several centuries, orthopaedic surgeons have been given the task of managing the pain, limp, and gait disturbance that develop in association with various trauma and diseases of the hip joint. Progress has been made in development of surgical methods for the hip joint, and a recent concept was determined by introduction of the 'Clean Air Operating Enclosure' system and 'low frictional arthroplasty' in total hip arthroplasty (THA) by John Charnley, in 1960. THA has been performed as an exclusive method for hip joint reconstruction. We report on understanding of the current status from the past, present, and future trends with an introduction of the prior method of THA and a discussion of the history.
Arthroplasty ; Friction ; Gait ; Hip ; Hip Joint ; Tacrine

Fractures of the femoral neck in elderly patients can be treated by internal fixation, hemiarthroplasty, or total hip arthroplasty (THA), and the treatment modality used should be determined on the basis of considerations of the degree of fracture displacement, age, functional demands, and the risk factors for surgery and anesthesia. We studied 85 active elderly patients who underwent minimally invasive two-incision THA or conventional bipolar hemiarthroplasty (BHA) within 2 weeks of injury for the treatment of acute displaced femoral neck fractures. Patients were followed up for a minimum of 24 months. The average operation times were 70 minutes in the THA group and 46 minutes in the BHA group (p=0.002), and average blood losses during the perioperative period were 921 cc and 892 cc, respectively (p=0.562). In the THA group, the average postoperative Harris hip score was 88.3 and the average Western Ontario and McMaster University score was 28.8, whereas in the BHA group the corresponding scores were 80.4 (p=0.006) and 32.5 (p=0.012), respectively. There were 2 cases of hip dislocation in the THA group, and 2 cases in the BHA group underwent conversion to THA. Our short-term follow-up results were better for minimally invasive two-incision THA than for conventional BHA for the treatment of acute displaced femoral neck fractures in active elderly patients.
Aged ; Anesthesia ; Arthroplasty ; Butylated Hydroxyanisole ; Displacement (Psychology) ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Hemiarthroplasty ; Hip ; Hip Dislocation ; Humans ; Ontario ; Perioperative Period ; Risk Factors ; Tacrine

PURPOSE: We reviewed the radiological outcomes and survival rate of the total hip arthroplasty (THA) with AML(R) (Anatomic Medullary Locking, DePuy, Warsaw, IN, USA) hip prosthesis on long-term follow-up. MATERIALS AND METHODS: From May 1988 to December 1990, 93 hip arthroplasties were performed on 77 patients in our hospital. In this study, 30 patients, of whom 41 hips underwent the procedure, were alive and able to be included. Follow-up was average of 21.4 years. The mean patient age was 45 years (35-60 years) at the time of operation. Of the hip procedures included in our study, the reasons for THA were osteonecrosis of the femoral head in 25 hips, rheumatoid arthritis in 3 and acetabular dysplasia in 2. We analyzed the wear rate of the polyethylene, osteolysis of the femur and acetabulum and stress shielding of the femur on the follow-up radiographs. In addition, we investigated the survival rate of the prosthesis and causes of revision in the last follow-up. RESULTS: The polyethylene wear rate of the surviving acetabular cup was 0.15 mm/yr. Acetabular osteolysis was detected in 33 hips and was mostly in zone 2 and 3. Femoral osteolysis was showed in 32 hips in zone 1 and 7. Stress shielding over grade 3 was found in 5 of 21 femoral stems in over 13.5 mm in diameter. The grade of stress shielding did not progress with follow-up. Of the 33 hips, 26 (63.4%) cups were revised for polyethylene wear and osteolysis. There were 6 (21%) femoral stems revised for osteolysis. CONCLUSION: The cause of a high revision rate of the prosthesis was polyethylene wear and osteolysis. We predict that THA using AML(R) prosthesis with wear-resistant bearing surfaces could increase the survival rate on long-term follow-up over 20 years.
Acetabulum ; Arthritis, Rheumatoid ; Arthroplasty ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Prosthesis ; Humans ; Osteolysis ; Osteonecrosis ; Polyethylene ; Prostheses and Implants ; Survival Rate ; Tacrine ; Ursidae

PURPOSE: The purpose of this study was to evaluate the early results of total hip arthroplasty (THA) performed using large diameter femoral head against with highly cross-linked polyethylene as a bearing surface in patients less than sixty years of age. MATERIALS AND METHODS: Seventy patients were enrolled and retrospectively reviewed. The mean age of patients at index surgery was 49 years and the mean follow-up period was 61 months. Clinical follow-up involved implementing the Harris hip score (HHS) and a radiographic evaluation that included linear radiolucency, osteolysis, and loosening. An annual wear rate was performed at 6 weeks; at 3, 6, and 12 months; and on a yearly basis thereafter. RESULTS: The average HHS at last follow-up was 94 (range: 82-98). Radiographically, no osteolysis in the pelvis or proximal femur was observed in any patient. No acetabular cup or femoral stem failed due to aseptic loosening. No eccentric wear was observed on any liner, and no liner fracture occurred. However, one patient experienced hip dislocation. The average femoral head penetration rate during the first postoperative year was 0.077+/-0.026 mm/year, and the average steady-state wear rate was 0.033+/-0.023 mm/year. CONCLUSION: THA with a large diameter femoral head of highly cross-linked polyethylene in patients younger than 60 years of age was found to produce results comparable to previous in vitro laboratory hip simulation studies. In particular, patient satisfaction was high due to no limitation in range of motion or hip posture during the early post-operative period. Longer-term follow-up is required to demonstrate the clinical benefits of this new material more comprehensively.
Arthroplasty ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Dislocation ; Humans ; Osteolysis ; Patient Satisfaction ; Pelvis ; Polyethylene ; Posture ; Range of Motion, Articular ; Retrospective Studies ; Tacrine ; Ursidae

In normal rat forebrain, the NR1/NR2A and NR1/NR2B dimmers are the main constitutional forms of NMDA receptors. The present study was carried out to determine the functional properties of the heteromeric NMDA receptor subunits and their inhibition by bis(7)-tacrine (B7T). Rat NR1, NR2A and NR2B cDNAs were transfected into human embryonic kidney 293 cells (HEK-293). The inhibition of NMDA-activated currents by B7T was detected in HEK-293 cell expressing NR1/NR2A or NR1/NR2B receptors by using whole-cell patch-clamp techniques. The results showed that in HEK-293 cells expressing NR1/NR2A receptor, 1 μmol/L B7T inhibited 30 μmol/L NMDA- and 1000 μmol/L NMDA-activated steady-state currents by 46% and 40%, respectively (P>0.05; n=5), suggesting that the inhibition of B7T on NR1/NR2A receptor doesn't depend on NMDA concentration, which is consistent with a non-competitive mechanism of inhibition. But for the NR1/NR2B receptor, 1 μmol/L B7T inhibited 30 μmol/L NMDA- and 1000 μmol/L NMDA-activated steady-state currents by 61% and 13%, respectively (P<0.05; n=6), showing that B7T appears to be competitive with NMDA. In addition, simultaneous application of 1 μmol/L B7T and 1000 μmol/L NMDA produced a moderate inhibition of peak NMDA-activated current, followed by a gradual decline of the current to a steady state. However, the gradual onset of inhibition produced by B7T applied simultaneously with NMDA was eliminated when B7T was given 5 s before NMDA. These results suggested that B7T inhibition of NMDA current mediated by NR1/NR2B receptor was slow onset, and it did not depend on the presence of the agonist. With holding potentials ranging from -50 to +50 mV, the B7T inhibition rate of NMDA currents didn't change significantly, and neither did the reversal potential. We are led to conclude that the NR1/NR2B recombinant receptor can serve as a very useful model for studying the molecular mechanism of NMDA receptor inhibition by B7T.
Cell Line ; HEK293 Cells ; Humans ; N-Methylaspartate ; pharmacology ; Receptors, N-Methyl-D-Aspartate ; genetics ; Tacrine ; analogs & derivatives ; pharmacology

PURPOSE: The purpose of this study is to report clinical and radiographic results over a period of two 2 years after cementless total hip arthroplasty (THA) with fourth generation ceramic-on-ceramic articulation. MATERIALS AND METHODS: We studied 22 patients, 23 cases which were followed up for two years among 25 patients, 26 patients who underwent cementless THA with the fourth generation ceramic between April 2009 and December 2009. The average age of the patients was 55.9 years old(22 to 72 years old), and the average follow-up duration was 28 months(24 to 32 months). A clinical evaluation was performed using the Harris hip score (HHS), and radiologic evaluation was based on acetabular cups and osteolysis of the femoral stems, instability, distance, angle, and so on. RESULTS: HHS showed an increase, from 54 for before-surgical treatment, to 91 at the last follow-up. Inguinal pain was observed in one case, and femoral pain was observed in two cases. Stable fixation was achieved in all cases, and no instability, osteolysis, or movement of acetabular cups and femoral stems was observed. CONCLUSION: Clinical and radiological short-term results for use ofthe fourth generation ceramic-on-ceramic cementless THA have favorable so far. Further follow-up study should be performed for evaluation of the long-term results.
Arthroplasty ; Ceramics ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Tacrine

A series of tacrine-methoxybenzene hybrids (5a-5i) were designed, synthesized and evaluated as inhibitors of cholinesterases (ChEs). All the compounds had better ChEs inhibitory activities than tacrine with IC50 values at the nanomolar range. Compound 5h exhibited the strongest inhibition on acetylcholinesterase (AChE) with an IC50 value of 6.74 nmol x L(-1) and compound 5f showed the most potent inhibition on butyrylcholinesterase with IC50 value of 3.83 nmol x L(-1). Kinetic and molecular modeling studies showed that these hybrids targeted both the catalytic active site and the peripheral anionic site of AChE.
Acetylcholinesterase ; metabolism ; Anisoles ; chemical synthesis ; chemistry ; pharmacology ; Binding Sites ; Butyrylcholinesterase ; metabolism ; Catalytic Domain ; Cholinesterase Inhibitors ; chemical synthesis ; chemistry ; pharmacology ; Drug Design ; Inhibitory Concentration 50 ; Tacrine ; chemical synthesis ; chemistry ; pharmacology