Background: Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) that is typically reserved for young active patients because it preserves bone. However, the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes.
Aim: To compare patient reported outcomes for conversion THA after HRA failure to primary THA.
Background: Up to 20% of patients are dissatisfied following total knee arthroplasty (TKA), most often due to pain and/or stiffness. The differential diagnosis includes immune reaction to the prosthesis. However, there is no consensus on diagnostic criteria for immune failure, an allergic reaction, to a TKA.
View Article and Find Full Text PDFBackground: An allergic reaction may rarely cause a painful or stiff total knee arthroplasty (TKA). However, no consensus diagnostic criteria for TKA immune failure exist. Lymphocyte transformation testing (LTT) measures immune sensitivity to various materials, but its role in diagnosing an allergic reaction to a TKA has not been established.
View Article and Find Full Text PDFMetal sensitivity is increasingly prevalent and is associated with negative outcomes after total knee arthroplasty (TKA). Currently, there is no consensus on diagnostic criteria for TKA failure from immune reaction. We present a patient who had pain and aseptic effusion 2 years after TKA.
View Article and Find Full Text PDFBackground: The utilization of lymphocyte transformation testing (LTT) has increased for diagnosing metal sensitivity associated with total knee arthroplasty (TKA), but its validity for the diagnosis of TKA failure due to an immune reaction has not been established. In this study, we sought to characterize the relationship of a positive LTT result to histopathologic findings and clinical and functional outcomes.
Methods: This was a retrospective study of 27 well-fixed, aseptic, primary TKA cases in which the patient had persistent pain and/or stiffness and underwent revision due to a suspected metal allergy to nickel, as determined on the basis of positive LTT.
Background: Cross-linked polyethylene (XLPE) has generally low rates of wear and osteolysis at 10 years, but component position may become important with longer follow-up. At 5-13 years, neither acetabular component lateral opening angle nor version were significantly correlated to wear. In the present study, we analyzed the effects of femoral anteversion and combined anteversion on XLPE wear.
View Article and Find Full Text PDFBackground: Cross-linked polyethylene (XLPE) has demonstrated significantly reduced wear and osteolysis into the second decade for total hip arthroplasty. There is a relative paucity of data with ≥36-mm bearings. Issues include potential effects of reduced liner thickness and component position on wear, osteolysis, and mechanical failure of the bearing.
View Article and Find Full Text PDFWe used a validated femoral resurfacing model to obtain measurements of pressure and temperature and quantify cement distribution as a function of inner geometry and cementing technique of five different femoral hip resurfacing components. The purpose was to investigate if manufacture cementing recommendations are reliable. ASR showed only with the recommended manual cementing technique low cement pressures of 58.
View Article and Find Full Text PDFBackground: Patient activity influences polyethylene wear. However, it is unclear how individual activity changes with patient aging after THA.
Questions/purposes: We quantified changes in individual gait cycles and gait speed, assessed age-related differences in these parameters, and determined their relationship to polyethylene wear.
The standard method for the evaluation of arthritis and postoperative assessment of arthroplasty treatment is observation and measurement from plain films, using the flm edge for orientation. A more recent employment of an anatomical landmark, the ischial tuberosity, has come into use as orientation for evaluation and is called the ischio-lateral method. In this study, the use of this method was evaluated as a first report to the literature on acetabular component measurement using a skeletal reference with lateral radiographs.
View Article and Find Full Text PDFBackground: Acetabular component position is associated with joint function and bearing wear. Current techniques for determining acetabular component version on standard radiographs lack reliability. Other, more consistent techniques are time-consuming and require additional equipment or software.
View Article and Find Full Text PDFTotal hip arthroplasty has shown excellent results in decreasing pain and improving function in patients with degenerative disease of the hip. Improvements in prosthetic materials, designs and implant fixation have now resulted in wear of the bearing surface being the limitation of this technology, and a number of hard-on-hard couples have been introduced to address this concern. The purpose of this article is to review the origins, development, survival rates and potential advantages and disadvantages of the following hard-on-hard bearings for total hip arthroplasty: metal-on-metal standard total hip arthroplasty; metal-on-metal hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty; and ceramic-on-metal bearings.
View Article and Find Full Text PDFWith experience in metal-metal resurfacing, several opportunities to improve resurfacing technology have been identified. There is a need for better education on hip resurfacing in residency training programs. The majority of short-term complications associated with resurfacing are related to surgical technique or component position.
View Article and Find Full Text PDFPurpose: In clinical and retrieval analyses, over-penetration of cement, incomplete seating of the prosthesis with a resultant polar cement mass, or both, have been associated with early femoral failures of resurfacing arthroplasties. We used human bone specimens to experimentally compare the initial stability of different cementing techniques.
Methods: Twenty-six pairs of fresh frozen femora were prepared for resurfacing using original instruments (DePuy ASR).
Background: Improvements in prosthetic materials, designs, and implant fixation for THA have led to bearing surface wear being the limitation of this technology. Hard-on-hard bearings promise decreased wear rates and increased survival. However, there may be different survival rates based on bearing materials, manufacturing technologies, and femoral component designs.
View Article and Find Full Text PDFThe purpose of this randomized, single-blind clinical trial was to compare a rotating platform (RP) total knee arthroplasty to a fixed-bearing (FB) total knee arthroplasty. Ninety-five knees in 69 patients were implanted by 2 surgeons. There were no significant differences in the preoperative demographics.
View Article and Find Full Text PDFA limited number of reports have detailed the cause of fracture of a highly cross-linked polyethylene liner. Typically, the fractures have occurred in a region of thin and/or unsupported polyethylene, in association with superiorly directed edge loading conditions secondary to an excessively inclinated acetabular component. This case report details an unusual fracture mechanism of a 5-mrad cross-linked liner caused by horizontal loading conditions.
View Article and Find Full Text PDFIn this single-surgeon series, both resurfaced hips in 1 woman and a total hip arthroplasty in another were revised for symptomatic pseudotumor (3 of 588 hips; 0.51% overall incidence; 2.2% in women).
View Article and Find Full Text PDFFor this technology overview, the tools of evidence-based medicine were used to summarize information on the indications, effectiveness, and failure rates of modern metal-on-metal hip resurfacing technology. The task was complicated by the fact that resurfacing arthroplasty is commonly offered only to a subset of patients who are candidates for total hip replacement, often prohibiting direct comparisons. Comprehensive literature searches were conducted to address four key questions addressing revision rates, patient characteristics, effectiveness of treatment, and whether improved technique, surgeon experience, and/or patient selection lead to improved outcomes.
View Article and Find Full Text PDFPeriprosthetic joint infection is now the leading cause of failure after a total knee arthroplasty, and Staphylococcus aureus, most commonly from the patient's own flora, typically is the infective agent. Several preoperative screening tests have been developed to identify patients who are carrying methicillin-resistant S aureus. Testing and decolonization programs have generally been effective in decreasing the incidence of surgical site infections, but the role of such programs in total joint arthroplasty has not been thoroughly investigated.
View Article and Find Full Text PDFIn clinical outcome studies, small component sizes, female gender, femoral shape, focal bone defects, bad bone quality, and biomechanics have been associated with failures of resurfacing arthroplasties. We used a well-established experimental setup and human bone specimens to analyze the effects of bone density on cement fixation of femoral hip resurfacing components. Thirty-one fresh frozen femora were prepared for resurfacing using the original instruments.
View Article and Find Full Text PDFCementing irregularities have been associated with femoral failures of resurfacing arthroplasties in retrieval studies. We used an in vitro model to measure pressure, temperatures, and cement penetration as a function of 6 different cementing techniques. Filling the component with cement can lead to overpenetration or increase the resistance to component seating with resultant polar cement mass.
View Article and Find Full Text PDFSeventy-seven patients implanted with unilateral resurfacing prosthesis were recruited from four centres. Serial whole blood samples were collected and ion levels were analysed. In most cases, the ion levels stabilized by 3 months.
View Article and Find Full Text PDFThere is no mystery regarding the allure of metal-metal bearings: high stability and low wear potential. The special risks associated with these bearings are coming into focus and include a macrophage response to excessive metal particles (metal reactivity) and a lymphocyte-dominated reaction (metal sensitivity). The most common presentation of an adverse local tissue reaction (ALTR) is persistent pain.
View Article and Find Full Text PDFThere are limited data to guide surgeon recommendations regarding activities after total joint arthroplasty. The present study aims to better clarify the current community standards. A questionnaire was distributed to the members of the American Association for Hip and Knee Surgeons attending the 2007 annual meeting inquiring about recommendations for 15 activities for patients with total hip arthroplasty or total knee arthroplasty.
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