Long-term survivorship of an exchangeable-neck hip prosthesis with a Ti-alloy/Ti-alloy neck-stem junction.

Introduction: Breakage of exchangeable-neck (EN) and adverse local tissue reactions (ALTRs) to neck-stem junction (NSJ) damage products are responsible for increasing the revision rate of EN hip prostheses. We investigated the survivorship of an EN hip prosthesis including a NSJ with both components made of titanium alloy (Ti-alloy/Ti-alloy) to assess whether, and to what extent, EN breakage and NSJ damage affected implant survivorship.

Materials And Methods: Using data from a hip replacement registry, we determined survivorship of 2857 EN prostheses.

Satisfactory clinical and radiologic outcomes with a new shorter and modular stem for end-stage hip osteoarthritis: an international prospective multicentre pilot study.

Introduction: This multicenter prospective cohort study aimed to assess the safety and clinical and radiologic performance of the CLS Brevius Stem with Kinectiv Technology.

Material And Methods: A total of 222 consecutive subjects, recruited in five different centers, qualifying for primary total hip arthroplasty (THA), were enrolled in the study. All the subjects received the CLS Brevius Stem with Kinectiv Technology.

Mid-term outcomes of a partial 2-stage approach in late chronic periprosthetic hip infections.

Introduction: Late chronic periprosthetic infections (LCPIs) are worrisome complications of primary hip arthroplasties. The gold standard procedure is the 2-stage revision. 1-stage exchange is gaining popularity in order to reduce the invasivity of the former technique.

What are the influencing factors on hip and knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties.

Background: Body mass index is used by the World Health Organization to classify obesity. While obesity influences the onset of arthritis and type-2 diabetes, its effect on implant survival is still open to debate, with conflicting results from clinical and registry studies, as well as meta-analyses. Other known factors such as gender or diabetes status could ponderate or mask the effect of BMI on implant survival.

Squeaking and other noises in patients with ceramic-on-ceramic total hip arthroplasty.

Introduction: Noise in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a potential symptom of abnormal bearing wear. Squeaking and other prosthetic hip noises are multi-factorial phenomena that can be analysed and may provide prognostic information.

Methods: 46 patients with noisy CoC bearings were investigated using X-ray, computed tomography and joint fluid analysis, and classified into either high or low risk of ceramic liner fracture groups according to previously published guidelines.

Ischemia-Modified Albumin Expression: Is there a Difference between Male and Female Subjects?

Background: Ischemia-modified albumin (IMA) derives from naive albumin, modified in the binding region of bivalent ions, as cobalt and iron. The cobalt, released from some types of hip prosthesis seems to be metabolized differently in males and females but the iron ion is more prevalent than cobalt and is detectable in the healthy population. Our aim was to verify if there are any gender- and age-related differences in IMA concentrations and if IMA correlates with cobalt and iron-related proteins.

Unilateral versus bilateral total knee arthroplasty: A registry study on survival and risk factors.

Background: Bilateral cases, representing at least 25% of total knee arthroplasties (TKA), could convey a statistical bias linked to dependency. Registries allow exploring this issue, susceptible to question surgeon validated protocols. Do bilateral total knee arthroplasties behave differently than unilateral knees in terms of implant survival?

Hypothesis: Bilateral TKA have a better survival than unilateral TKA.

Component positioning and ceramic damage in cementless ceramic-on-ceramic total hip arthroplasty.

Background: In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demonstrated to influence the bearing damage: however the connection between angles and clinical outcomes at long-term follow-ups is currently lacking. Aims of this study were: the computer tomography (CT) assessment of component positioning in CoC THAs; the correlation analysis between positioning and ceramic damage; the identification of safe zones.

Methods: 91 consecutive post-operative CT scans including two types of CoC implants, with a mean follow-up of 12 ± 4.

The influence of bearing surfaces on periprosthetic hip infections: analysis of thirty nine thousand, two hundred and six cementless total hip arthroplasties.

Purpose: Periprosthetic hip infection (PHI) is a devastating complication. The association between PHI and bearing surfaces as well as patient-related factors has been recently investigated, with contradictive outcomes. The dataset of Emilia-Romagna region Registry for Orthopaedic Prosthetic Implants (RIPO) has been assessed to investigate, if the bearing choice influenced the risk of septic loosening occurrence.

Cementless Total Hip Arthroplasty in Crowe III and IV Dysplasia: High Hip Center and Modular Necks.

Background: Total hip arthroplasty (THA) in severe developmental dysplasia of the hip (DDH) is a challenging procedure. The most used techniques involve anatomic cup positioning, augmentation femoral osteotomy. However, anatomic cup positioning is not always feasible in severe DDH and osteotomy nonunion may ensue.

Short Stems Versus Conventional Stems in Cementless Total Hip Arthroplasty: A Long-Term Registry Study.

Background: Short stems in total hip arthroplasty (THA) have recently gained increasing popularity, allowing mini-invasive exposures and bone-sparing approaches. However, long-term studies and recommendations for the routine use are not available. The aim of this report was to compare the survival rates and the reasons for revision of short stems versus conventional stems in cementless THAs, in a registry-based population.

Is Cross-Linked Polyethylene an Improvement Over Conventional Ultra-High Molecular Weight Polyethylene in Total Knee Arthroplasty?

Background: Reducing polyethylene (PE) wear by increasing the cross-linking encouraged surgeons to hope for increased total knee arthroplasty (TKA) survival rates. Different methods of manufacturing cross-linked polyethylene (XLPE) were introduced, following promising in vitro results. Is there a measurable effect of cross-linking on TKA survival?

Methods: A registry study was conducted, focusing on fixed tibial inserts in primary TKA.

Total Knee Replacement in Young Patients: Survival and Causes of Revision in a Registry Population.

Background: The incidence of total knee replacements (TKRs) in young patients is increasing. Few reports described encouraging results and acceptable survival rates. However, many concerns still persist, in particular about the high rates of infection and aseptic loosening.

3rd generation alumina-on-alumina in modular hip prosthesis: 13 to 18 years follow-up results.

Introduction: Ceramic-on-ceramic (CoC) couplings are alternative bearings surfaces that have been reported to reduce osteolysis, wear debris and aseptic loosening compared to the use of polyethylene. Early experiences with ceramics had poor results, but they have led to many improvements in the manufacture and design of subsequent implants.

Methods: We analysed medical files of 300 CoC total hip arthroplasty (THA) with a modular neck performed during period 1995-2000 by a single surgeon for a minimum follow-up of 13 years, evaluating clinical and radiological outcome.

Radiological identification of Zweymüller-type femoral stem prosthesis in revision cases.

Introduction: Since 1979 the number of patients treated with femoral stems has continued to grow, as well as the number of stems with features similar to the Zweymüller prosthesis produced by different companies. Identification can be problematic in case requiring revision. In the present paper, we present an overview of morphometric differences between the different stem designs, which can be useful for radiologic identification in revision cases.

In vivo response of heme-oxygenase-1 to metal ions released from metal-on-metal hip prostheses.

Metal ion release and accumulation is considered to be a factor responsible for the high failure rates of metal-on-metal (MoM) hip implants. Numerous studies have associated the presence of these ions, besides other factors, including a hypoxia‑like response and changes in pH due to metal corrosion leading to the induction of the oxidative stress response. The aim of the present study was to verify whether, in patients with a MoM hip prosthesis, mRNA and protein expression of HMOX‑1 was modulated by the presence of metal ions and whether patients without prostheses exhibit a different expression pattern of this enzyme.

Suturing the myotendinous junction in total hip arthroplasty: A biomechanical comparison of different stitching techniques.

Background: The repair of the myotendinous junction following total hip arthroplasty is challenging as this region is the weakest part of the muscle structure. This study investigated the mechanical behaviour and the mode of failure of different suturing techniques of the myotendinous junction. A new asymmetrical stitch was compared to two widely used techniques, i.

European Society of Biomechanics S.M. Perren Award 2014: Safety factor of the proximal femur during gait: a population-based finite element study.

It has been suggested that the mechanical competence of the proximal femur is preserved with respect to physiological loading conditions rather than accidental overloading, but the consequences of this adaptation for fracture risk in the elderly remain unclear. The goal of the present study was to analyse the safety factor of the human femur in the two most frequent daily activities, level walking and stair climbing, and to understand the dependence, if any, of this safety factor on age, volumetric bone mineral density (vBMD), and gender. To this aim, a finite element study was performed on 200 subjects (116 women and 84 men), spanning a large range of age (23-84 years) and vBMD levels (T-score from 0 to -3.

Unicompartmental knee arthroplasty: 11-year experience from 3929 implants in RIPO register.

Background: Since 2000, the Register of Prosthetic Orthopedic Implants (RIPO) has been following all hip, knee, and shoulder arthroplasties in the Emilia-Romagna region, comprising 4.5 million inhabitants, in northern Italy. The aim of the present analysis was to present the main figures of unicompartmental knee implants processed from the Registry.

Multiple loading conditions analysis can improve the association between finite element bone strength estimates and proximal femur fractures: a preliminary study in elderly women.

This is a preliminary case-control study on osteopenic/osteoporotic elderly women, testing the association of proximal femur fracture with minimum femoral strength, as derived from finite element (FE) analysis in multiple loading conditions. Fracture cases (n=22) in acute conditions were enrolled among low-trauma fractures admitted in various hospitals in the Emilia Romagna Region, Italy. Women with no history of low-trauma fractures were enrolled as controls (n=33).

Metal ion release: also a concern for ceramic-on-ceramic couplings?

BIOLOX delta is the newest ceramic composite material of the BIOLOX family and its use in hip devices represents a good alternative to Metal-on-Metal or Metal-on-Polyethylene coupling. Some Metal-on-Metal hip devices have shown chromium and cobalt release, which promoted toxic effects. Furthermore, the ceramic composite contains trivalent chromium, even if strongly bound to the alumina lattice.

Detection of cobalt in synovial fluid from metal-on-metal hip prosthesis: correlation with the ion haematic level.

Hip replacement with large metal-on-metal (MoM) coupling has recently been under attention for its metal ions release, inducing several disorders. Since the blood level toxicity threshold for cobalt is known, the aim of this work is to determine whether Co serum and blood levels correlate with the synovial fluid level. Beside this, the synovial fluid Co from patients without prosthesis has also been measured.