Components anteversion in primary cementless THA using straight stem and hemispherical cup: a prospective study in 91 hips using CT-scan measurements.

Background: The recommended range of anteversion of the components in total hip arthroplasty (THA) is between 10 and 30°, but the intraoperative estimation of these versions may be inadequate.

Hypothesis: The components anteversion in primary cementless THA using straight stem and hemispherical cup is not significantly different from the native anteversion of the hip joint.

Objectives: To evaluate in a prospective manner the range of anteversion currently achieved in cementless THA.

Healing of long-term frozen orthotopic bone allografts is not affected by MHC differences between donor and recipient.

Background: The use of bone grafting in orthopaedic surgery has increased dramatically in recent years. However, the degree to which immune responses are important for the survival of the allograft is not fully understood. In particular it remains unclear whether differences in the major histocompatibility complex (MHC) influence incorporation of bone allografts and their subsequent biologic performance.

Impact of freezing on immunology and incorporation of bone allograft.

With an increasing clinical use of deep frozen allograft for bone reconstruction, it is important to understand the immunological and biological events of allograft incorporation. In this study, we have investigated the impact of deep freezing on immunology and biopotency for incorporation of bone allografts. Deep frozen bone grafts matched or mismatched for major histoscompatibilty complex (MHC) were implanted in an 8-mm segmental defect in the tibia in rats.

Immune depression in musculoskeletal trauma.

The immune responses after musculoskeletal trauma are physiological reactions of the organism to restore homeostasis. An imbalance between the early systemic inflammatory response syndrome and the later compensatory anti-inflammatory response syndrome may be responsible for organ dysfunction and increased susceptibility to infections. Cytokines are known to be integral components of the immune response, and the balance or imbalance of the different cytokines partly controls the clinical course in the patients.

Femoral shortening in total hip arthroplasty for high developmental dysplasia of the hip.

Background: When reconstructing a hip with developmental dysplasia with a high dislocation, placing the acetabular component in the anatomic position can result in a prosthetic hip that is difficult to reduce. Subtrochanteric femoral osteotomy and shortening makes reduction easier but can be associated with complications (eg, limp, sciatic nerve injury, nonunion of the osteotomy) or compromise long-term stem survival.

Questions/purposes: We therefore evaluated (1) the short-term complication rate, (2) functional scores, and (3) survivorship of prostheses in patients with high developmental dysplasia of the hip reconstructed with femoral shortening.

Thrombosis markers in hip versus knee arthroplasty: a pilot study.

Purpose: To compare the thrombosis markers for thrombosis and fibrinolysis in patients undergoing hip versus knee arthroplasty.

Methods: Seven women aged 38 to 61 years who underwent total hip arthroplasty (THA) and 7 women aged 57 to 67 years who underwent total knee arthroplasty (TKA) were studied. Thromboprophylaxis was given before and after surgery.

Effects of high-dose corticosteroids on post-traumatic inflammatory mediators.

Objective: Plasma concentrations of inflammatory mediators are substantially increased in major orthopaedic surgery. It was our hypothesis that corticosteroids would reduce the post-operative levels of inflammatory mediators in patients with ankylosing spondylitis, and we performed a single-centre randomised controlled trial.

Patients And Methods: In 20 consecutive patients, an osteotomy of the lumbar spine was done.

Differences in LPS and PepG induced release of inflammatory cytokines in orthopedic trauma.

Trauma is associated with immune paresis which may predispose to postoperative sepsis. We characterized the ex vivo cytokine responses to bacterial cell wall components in whole blood from 8 patients undergoing a major musculoskeletal trauma in the form of total hip replacement. Preoperatively, at the end of operation, and at days 1 and 6 postoperatively, patient blood was obtained, anticoagulated, and incubated at 37 degrees C in the presence of peptidoglycan (PepG) or lipopolysaccharide (LPS).

Time course of thrombosis and fibrinolysis in total knee arthroplasty with tourniquet application. Local versus systemic activations.

Background: Venous thrombosis is common in knee surgery, and it has been assumed that vein occlusion by tourniquet in itself may induce thrombogenic and fibrinolytic activity. Prophylactic treatment is used up to 12 h before or after surgery, and recent clinical trials suggest that the timing of initiating prophylaxis significantly influences antithrombotic effectiveness.

Materials And Methods: We studied the time course of coagulation and fibrinolysis locally and systemically during total knee arthroplasty.

Systemic and local cytokine kinetics in musculoskeletal injury: a prospective study in patients with ankylosing spondylitis.

Objective: Back surgery in patients with ankylosing spondylitis is a major trauma in individuals with tissue inflammation and joint destruction along the spine; we used surgery in these patients as a model in the study of systemic and local cytokine profiles in complicated trauma situations.

Material And Methods: Blood was sampled before, during and after surgery in 10 patients operated on with extending osteotomy of the lumbar spine. Samples of arterial blood and local wound blood were analysed for proinflammatory and anti-inflammatory cytokines.

Immunmodulation of serum in orthopaedic trauma.

Background: The aim of this study was to test the hypothesis that inhibitory substances circulating in the patient's serum after trauma might impair leukocyte function by evaluating the effect of such serum on cytokine release in a whole blood model.

Methods: Hip replacement surgery was considered a standardized musculoskeletal trauma, and seven women and three men undergoing elective total hip replacement were included in the study. Ex vivo lipopolysaccharide (LPS) and peptidoglycan (PepG) induced tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL-10) releases were measured in whole blood sampled preoperatively and added serum taken before, at the end of operation and at postoperative day 1 and 6.

Cytokine Responses to Glucocorticoids and Surgery : A Randomized Controlled Trial.

Purpose: This prospective randomized study was designed to evaluate the implication of high preoperative doses of glucocorticoids on the cytokine responses after surgical correction in patients with ankylosing spondylitis.

Patients And Methods: In 20 consecutive patients an extending osteotomy of the lumbar spine was done by a wedge excision. In a random manner, 10 of the patients were given 10 mg/kg of methylprednisolone ("Solum-Medrol", Pharmacia & Upjohn, Stockholm, Sweden) preoperatively.

Impact of MHC mismatch and freezing on bone graft incorporation: an experimental study in rats.

Cortical bone graft failure develops for poorly defined reasons, and the effects of the immune responses on the incorporation of an allograft are less clear. In a rat model of tibial allotransplantation, we have studied biometric and histological changes of the graft and the humoral immune response against it. We have also compared fresh with prefrozen grafts to study putative effects of freezing on the healing of the graft and the immune response against it.

Postoperative serum attenuates LPS-induced release of TNF-alpha in orthopaedic surgery.

Studies with ex vivo stimulation of whole blood samples from injured patients have revealed a diminished production capacity for a broad range of secretory products, including inflammatory cytokines. Recent interest has focused on the release of mediators in serum that depress the cell-mediated immune response following trauma. The involvement of the lipid mediator prostaglandin E2 (PGE2) has been assumed because it is a potent endogenous immunosuppressor.

Staphylococcus aureus peptidoglycan impairs fracture healing: an experimental study in rats.

Staphylococcus aureus is the common organism causing musculoskeletal infections. Staphylococcus aureus peptidoglycan (SaPG) has been identified to increase the acute inflammatory response to wounding, increase reparative granulation tissue, and improve healing. The healing of bone fractures is a balanced process of granulation tissue that is calcified to obtain increasing stability.

Long-term results of HA coated threaded versus HA coated hemispheric press fit cups: 287 hips followed for 11 to 16 years.

Introduction: There are many studies on the short and medium term results of hydroxyapatite (HA) coated acetabular components, but information on survival in the longer run is sparse. In this paper, we report 11 to 16 years follow up results of HA coated threaded versus HA coated hemispherical press fit cups.

Patients And Methods: During the years 1988-1993, we performed 323 primary total hip replacements in 276 patients with an HA coated acetabular component.

Hydroxyapatite enhances long-term fixation of titanium implants.

The aim of this study was to evaluate osseous integration of hydroxyapatite coated titanium implants over time as compared to pure titanium. In 20 rats the medullary cavity of both femoral bones was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 2.

Bone ingrowths to press-fit and loose-fit implants: comparisons between titanium and hydroxyapatite.

The aim of this study was to investigate whether the coating of titanium (Ti) implants with hydroxyapatite (HA) might create a better fixation when titanium implants are implanted into a gap. In each of 16 rats, the medullary cavity of both femurs was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 1.

Excellent results with femoral revision surgery using an extensively hydroxyapatite-coated stem: 59 patients followed for 10-16 years.

Background: The outcome of femoral component revision with either cemented or proximally coated stems has been disappointing, but revision with extensively coated stems has been promising. We report long-term outcome of a grit-blasted titanium stem entirely plasma sprayed with hydroxyapatite (HA), in femoral revision surgery.

Patients And Methods: During 1988 to 1993, we performed 66 femoral revisions in 65 patients (49 women) aged mean 58 (28-86) years.

Lipopolysaccharide impairs fracture healing: an experimental study in rats.

Background: It has been shown that trauma causes translocation of lipopolysaccharide (LPS) endotoxins from the gut. LPS has been identified as a major bacterial bone resorbing factor. The effects of LPS on bone healing are therefore of clinical interest, as trauma involving fractures followed by sepsis is a clinical scenario.

Hydroxyapatite and carbon coatings for fixation of unloaded titanium implants.

The aim of this study was to investigate the interaction between bone and pure titanium, titanium coated with hydroxyapatite (HA), and titanium coated with carbon in a rat femur model. In 25 rats, the medullary cavity of both femurs was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 2.

Excellent results of HA coating on a grit-blasted stem: 245 patients followed for 8-12 years.

We report the outcome of a grit-blasted titanium stem designed for press-fit insertion and entirely plasma sprayed with HA. During the years 1988-1993, we performed 323 primary total hip replacements in 276 patients (189 women) with a HA-coated prosthesis. Their mean age was 48 (15-79) years.

Failure of HA coating on a gritblasted acetabular cup: 155 patients followed for 7-10 years.

We report the outcome of 191 acetabular gritblasted titanium cups with a hemispherical design for press-fit insertion and coated with hydroxyapatite. The prosthesis was made of gritblasted titanium entirely coated with hydroxyapatite. 155 patients aged 15-78 years were operated on during the years 1991-1993 and followed for 7-10 years.

Reduced tibial torsion in congenital clubfoot: CT measurements in 24 patients.

We determined leg torsion with CT scans through the femoral condyles and the ankle joints in 24 children (17 boys) with congenital clubfoot. In 16 cases, there was a bilateral clubfoot, in 5 cases it was left-sided and in 3 cases, it was on the right side. These children were compared to 17 healthy boys and 7 girls.