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

BACKGROUND: Several studies have shown that better placement of the acetabular cup and femoral stem can be achieved in total hip arthroplasty (THA) by using the computer navigation system rather than the free-hand alignment methods. However, there have been no comparisons of the relevant clinical advantages in using the computer navigation as opposed to the manual intraoperative measurement devices. The purpose of this study is to determine whether the use of computer navigation can improve postoperative leg length discrepancy (LLD) compared to the use of the measurement device. METHODS: We performed a retrospective study comparing 30 computer-assisted THAs with 40 THAs performed using a simple manual measurement device. RESULTS: The postoperative LLD was 3.0 mm (range, 0 to 8 mm) in the computer-assisted group and 2.9 mm (range, 0 to 10 mm) in the device group. Statistically significant difference was not seen between the two groups. CONCLUSIONS: The results showed good equalization of the leg lengths using both computed tomography-based navigation and the simple manual measurement device.
Acetabulum/surgery ; Adult ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/instrumentation/*methods ; Body Weights and Measures ; Female ; Femur/surgery ; Humans ; Leg ; Leg Length Inequality/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Surgery, Computer-Assisted ; Young Adult

OBJECTIVETo investigate the feasibility of hip arthroplasty in the treatment of elderly patients with Evans I-III intertrochanteric fracture of femur by analyzing its biomechanics characters.

METHODSWe solved the CT digital image files with the graphics processing software Mimics at DICOM 3.0 standard, and reconstructed the three-dimensional entity of femur with CAD modeling software Unigraphics. Then the fracture line was defined in the model as the line between the tip of greater trochanter and inferior margin of small trochanter, above which the upper bone was removed. Afterwards the two prosthesises with different stem lengths (120 mm and 170 mm) were implanted into the fracture model respectively as hip arthroplasty with 3 mm bone cement layer between prosthesis and femur, and the bone defect was repatched with 5 mm bone cement layer. A three-dimensional finite element model was established with finite element analysis software ABAQUS 6.5. We formulated different material parameters under the stress condition standing with single leg to build the stress distribution map of the femur prosthesis, and took 5 loci of region of stress concentration to calculate the mean value of stress.

RESULTSThe stress distribution maps of the short and long stem length prothesises were similar. And there were two areas of stress concentration, including the upper portion and the lower portion close to the joint of the prosthesis stem, and the stress concentration in the junction part was obviously between the lower portion and the upper area of the small trachanter. The stress reached the first concentration area at the junction and then gradually reached the second concentration area at the interior terminal of the stem. While the stress gradually increased along the lateral prosthesis stem, and reached the stress concentration area at the end.

CONCLUSIONSThe stress distribution maps in the femur prosthesises are similar between hip arthroplasty in the treatment of intertrochanteric fracture of femur and the traditional hip arthroplasty surgery. The peak stress values are higher in the long stem prosthesis in the treatment of intertrochanteric fracture of femur than the short type, while they are under the rupture value of the metal.

Aged ; Arthroplasty, Replacement, Hip ; instrumentation ; methods ; Biomechanical Phenomena ; Bone Cements ; Computer Simulation ; Female ; Finite Element Analysis ; Hip Fractures ; surgery ; Hip Prosthesis ; Humans ; Image Processing, Computer-Assisted ; Software ; Stress, Mechanical

BACKGROUND: This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. METHODS: We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. RESULTS: The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. CONCLUSIONS: The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.
Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects/instrumentation/*methods ; *Ceramics ; Female ; Follow-Up Studies ; Hip Joint/radiography/surgery ; *Hip Prosthesis ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pain, Postoperative/etiology ; Prosthesis Failure ; Range of Motion, Articular

BACKGROUND: Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA. METHODS: Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks. RESULTS: The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively. CONCLUSIONS: The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.
Adult ; Aged ; Arthroplasty, Replacement, Hip/*instrumentation/*methods ; Female ; Femur/radiography/surgery ; Hip/radiography/surgery ; Hip Dislocation, Congenital/pathology/radiography/*surgery ; Hip Joint/pathology/radiography/surgery ; Hip Prosthesis ; Humans ; Ilium/radiography/surgery ; Male ; Middle Aged ; Orthopedic Fixation Devices ; Retrospective Studies ; Traction

Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy. Fluoroscopic navigation is good for trauma and spine surgeries, but its benefits are limited in the hip and knee reconstruction surgeries. Several studies have shown that the cup alignment with navigation is more precise than that of the conventional mechanical instruments, and that it is useful for optimizing limb length, range of motion, and stability. Recently, patient specific templates, based on CT images, have attracted attention and some early reports on cup placement, and resurfacing showed improved accuracy of the procedures. These various CAOS systems have pros and cons. Nonetheless, CAOS is a useful tool to help surgeons perform accurately what surgeons want to do in order to better achieve their clinical objectives. Thus, it is important that the surgeon fully understands what he or she should be trying to achieve in THA for each patient.
Arthroplasty, Replacement, Hip/instrumentation/*methods ; Humans ; *Robotics ; Stereotaxic Techniques ; *Surgery, Computer-Assisted

To contrast the methodology of measuring cup placement precision utilizing Mimics and Matlab programming, based on clinical CT images of primary THA cases with computer assisted navigated surgery (CANS) and with the traditional manual method (MANS). The method was applied and analyzed to measure cup anteversion, cup abduction of 50 clinical cases with CANS and MANSThe results show that, cup placement precision differences exits between primary THA cases with CANS and MANS; more cases with CANS are within the safe zone contrasting MANS, and there was less variation and less placement error in CANS cases. CANS can improve cup placement precision and reduce the chance of dislocation efficiently.
Arthroplasty, Replacement, Hip ; instrumentation ; methods ; Humans ; Surgery, Computer-Assisted ; methods

PURPOSE: We evaluated the results of more than 10 years of follow-up of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels. MATERIALS AND METHODS: One hundred five patients (129 hips) who underwent surgery between 1991 and 1996 for primary total hip arthroplasty using cementless straight distal fluted femoral stems were followed for more than 10 years. Ninety-four hips in 80 patients were available for clinical and radiologic analysis. The mean age at the time of surgery was 47 years, and the mean duration of follow-up was 14.3 years. RESULTS: The mean Harris hip scores had improved from 58 points to 88 points at the time of the 10-year follow-up. Activity-related thigh pain was reported in nine hips (10%). At the last follow-up, 93 stems (99%) were biologically stable and one stem (1%) was revised because of loosening. No hip had distal diaphyseal osteolysis. Proximal femoral stress-shielding was reported in 86 hips (91%). We found no significant relationship between collar-calcar contact and thigh pain, stem fixation status, or stress-shielding. The cumulative survival of the femoral stem was 99% (95% confidence interval, 98-100%) after 10 years. CONCLUSION: The long-term results of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels were satisfactory; however, the high rate of proximal stress-shielding and the minimal effect of the collar indicate the need for some changes in the stem design.
Adult ; Aged ; Arthroplasty, Replacement, Hip/*instrumentation/*methods ; Bone Cements ; Female ; Femoral Neck Fractures/radiography/*surgery ; Femur Head Necrosis/radiography/*surgery ; Follow-Up Studies ; *Hip Prosthesis ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip/radiography/*surgery ; Time Factors ; Treatment Outcome

OBJECTIVETo determine the clinical outcomes of two-staged cementless revision arthroplasty for the treatment of deep periprosthetic infection after total hip arthroplasty.

METHODSTwenty-three patients with deep periprosthetic infection treated with a standard protocol of two-staged cementless revision hip arthroplasty were enrolled in this study. There were 9 male patients and 14 female patients with an average age of 64 years (range, 52-78 years). In all cases, antibiotics-loaded cement spacers were implanted after removal of all the prosthetic components and thorough debridements had been done. All patients had a minimum of 2 weeks of intravenous antibiotics followed by 4 weeks of oral antibiotics after implant removal. After a mean interval of 6.7 months (3-28 months), revision arthroplasties were carried out with cementless femoral components followed by 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics.

RESULTSThe mean follow-up period was (4.3±3.5) years. There were 2 cases of recurrent infections in this study. Intraoperative periprosthetic fractures were observed in 3 patients. One patient had dislocation of the implanted spacer during the interval period and 2 patients had hip dislocation after reimplantation. Mild subsidence of femoral component occurred in 1 patient. There were no cases of loosening of femoral components and cementless acetabular components in patients without infection recurrence. The Harris hip score increased from a preoperative mean of 36±13 to 85±13 at 12 months after reimplantation.

CONCLUSIONSUsing cementless prostheses in two-staged revisions of hip periprosthetic infections can provide low rate of infection recurrence and good implant stability, but cautions must be taken when treating patients with infection caused by multidrug-resistant organisms.

Aged ; Anti-Bacterial Agents ; administration & dosage ; Arthroplasty, Replacement, Hip ; instrumentation ; methods ; Female ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Prosthesis-Related Infections ; surgery ; Retrospective Studies

Arthroplasty, Replacement, Hip ; Fracture Fixation, Internal ; Hip Fractures ; surgery ; Humans ; Precision Medicine ; instrumentation ; methods ; Preoperative Period