Impaction bone grafting (IBG) using a circumferential metal mesh is one of the options that allow restoration of the femoral bone stock and stability of the implant in hip arthroplasty. Here we examined the clinical and radiographic outcome of this procedure with a cemented stem and analyzed experimentally the initial stability of mesh–grafted bone–cemented stem complexes. We retrospectively reviewed 6 hips (6 patients) that had undergone femoral revisions with a circumferential metal mesh, impacted bone allografts, and a cemented stem. The mean follow-up period was 2.9 years (range, 1.4–3.8 years). Hip joint function was evaluated with the Japanese Orthopaedic Association hip score, and radiographic changes were determined from radiographs. The initial resistance of cemented stem complexes to axial and rotational force was measured in a composite bone model with various segmental losses of the proximal femur.Background
Methods
The purpose of this study is to compare using a novel cementing technique with hydroxyapatite granules at bone-cement interface with using the 3rd cementing technique on the acetabular component. Between 2005 and 2007, we performed 54 primary cemented THAs using the 3rd generation cementing technique with hydroxyapatite granules at bone-cement interface (Group A: 21 hips) or without them (Group B: 33 hips) in 49 patients with dysplastic hip (6 males, 43 female; mean age at operation, 67 years; age range, 48–84 years). Mean follow up was 5.3 years (range, 2.3–7.1 years), with none of the patients lost to follow up. According to Crowe's classification, subluxation was Group I in 31 hips, group II in 11 hips, group III in 8 hips, and group IV in 4 hips. We used Exeter flanged cup, Exeter stem with a 22-mm diameter metal head (Stryker, Benoist Girard, France) and Simplex-P bone cement (Stryker, Limerick, Ireland) in all hips. A posterolateral approach was performed for all patients. Bone graft was performed 25 hips (block bone graft: 11 hips; impaction bone grafting with a metal mesh: 13 hips) from autogeneic femoral head. Our 3rd cementing technique is to make multiple 6-mm anchor holes, to clean the the host acetabular bed with pulse lavage, to dry it with hydrogen peroxide and to use Exeter balloon pressurizer and Exeter flanged cup.Purpose
Patients and Methods
We report our mid-term results and risk factors of a two-stage revision using impaction bone grafting for an infected hip replacement. A two-stage revision using impacted cancellous allografs and cement was performed in 13 patients (7 total hip replacements, 6 femoral head replacements) with confirmed infection. The mean age of the patients at first stage operation was 63 years (range, 45–84 years). In the first stage, local antibiotics were added to customized cement beads and/or a cement spacer after removal of all components and radical debridement. In the second stage, impaction grafting was done using the X-change system (Exeter).Introduction
Methods
Exeter stem was introduced to Japanese market at 1996. Since then, owing to its excellent clinical results, the number of the stem used has been increased year by year and more than 2000 stems have been implanted during the year 2009. The present study aims to prove its efficacy for Japanese patients by evaluating short term results of four major dedicated hip centers. We present the short-term multi-center results of primary THA with Exeter stem combined with modern cementing technique in 881 patients (1000 hips). The average age of the patients at operation was 62.3years (ranging 23 to 89 years). Mean postoperative follow up period was 4.0 (ranging 2 to 9) years.Purpose
Method
We used the D-dimer level as a measure for the early diagnosis of deep vein thrombosis (DVT), which can cause fatal pulmonary thromboembolism (PTE), following total hip arthroplasty (THA). Recently, we have performed anticoagulation therapy, in addition to the use of elastic stocking and intermittent pneumatic compression, for the prevention of DVT. In the present study, we examined the effect of administration of anticoagulation drugs on the changes in the D-dimer level. Of 123 patients who had undergone THA between April 2003 and October 2007, 70 patients who were available for 3 or more measurements of the D-dimer level were included in this study. These 70 patients were divided into the following three groups: N group consisting of 30 patients who were not given anticoagulation drugs (4 males, 26 females; mean age 69 years (45–87 years); mean body mass index (BMI) 24.1 (15.8–28.5)), W group consisting of 23 patients who were administered dose-adjusted warfarin at a dose of 5 mg within 3 days after surgery and at 1–3 mg following 1-day rest (3 males, 20 females; mean age 62 years (48–83 years); mean BMI 24.1 (17.8–35.9)), and F group composed of 15 patients who were given fondaparinux (2.5 mg) between postoperative days 1 and 14 (6 males, 11 females; mean age 64 years (51–81 years); mean BMI 23.1 (18.2–31.6)). There was no significant difference in sex ratio and BMI between the three groups, while a significant difference in age was found between the N and F groups. The D-dimer level was measured on days 3, 7, 10, 14 and 21 and changes in the median D-dimer level were compared between groups. In the N group, the D-dimer level was around 8 μg/ml between postoperative days 3 and 10 and exceeded 10 μg/ml on postoperative day 14. In the W group, the D-dimer level was around 8 μg/ml between postoperative days 3 and 14 and decreased thereafter. In the F group, the D-dimer level was less than 3 μg/ ml on postoperative day 3, increased gradually thereafter until postoperative day 14, reaching the maximum level of approximately 8 μg/ml, and then decreased thereafter. The D-dimer level was significantly different between the N and F groups and between the W and F groups on day 3, between the N and F groups and between the W and F groups on day 7, and between the N and W groups on day 21. With regard to hemorrhagic adverse events, neither major nor minor bleeding event was observed in either the W or F group. The present study suggested that fondaparinux is effective for preventing DVT in an early postoperative period, with relatively low D-dimer levels observed between postoperative days 3 and 10. We expect that various types of anticoagulation drugs will be used in the future. Elucidating the effect of these drugs on the D-dimer level will help in the early diagnosis of DVT.
We retrospectively reviewed 40 hips in 36 patients who had undergone acetabular reconstruction using a titanium Kerboull-type acetabular reinforcement device with bone allografts between May 2001 and April 2006. Impacted bone allografts were used for the management of American Academy of Orthopaedic Surgeons Type II defects in 17 hips, and bulk bone allografts together with impacted allografts were used for the management of Type III defects in 23 hips. A total of five hips showed radiological failure at a mean follow-up of 6.7 years (4.5 to 9.3), two of which were infected. The mean pre-operative Merle d’Aubigné score was 10 (5 to 15) This clinical study indicates that revision total hip replacement using the Kerboull-type acetabular reinforcement device with bone allografts yielded satisfactory mid-term results.
At the revision surgery of the cemented Total hip arthroplasty (THA), complete removal of an old cement mantle of the femur without loosening is very difficult. It can be associated with complications, such as femoral fracture, perforation and femoral bone loss. Cement-within-cement technique (CWCT) of femoral revision is very useful and advantageous without those complications for special cases. We reviewed the experiential radiological outcomes using CWCT for the cemented femoral revision. Between 1999 and 2006, we performed seventeen of revision THA using CWCT in 17 patients. There were four men and 13 women, with an average age of 75 years (range 68 to 87), with an average follow up of 39 months (range 12 to 87). The reasons for revision surgery were eleven for cup loosening, 5 for recurrent dislocation and one technical failure of stem insertion intra-operatively. An original Charnley stem (Depuy, Leeds, England) was implanted in six cases, an Exeter femoral component (Stryker Benoist Girard, Herouville, Saint-Clair, France) was in 10 and another stem in one. Posterolateral approach without trochanteric osteotmy was performing for all patients. After the femoral component was removed, the cement mantle was examined in detail, to confirm cement-bone interface and cement fracture. The cement mantle was washed with a pulsatile lavage to clean and to be dried. If necessary, the surface of the cement mantle was reamed. A double mix of Simplex P cement (Stryker Limerick, Limerick, Ireland) in liquid phase was inserted within the cement mantle by a cement gun with a thin nozzle(Stryker Instruments Kalamazoo, US). Thereafter suction and pressuriser were used, and a femoral component was inserted. The results of this study were that the intra-operative complication was two fractures of the greater trochanter at the stem removed and was one shaft perforation at a new original Charnley stem inserted. The stem position was one valgus and 3 varus stem position of more than 2 degrees. Radiographic outcomes showed no stem loosening, no radiolucent line at the bone-cement interface, nor any osteolysis in the patients at final follow-up. We conclude that this cement-within-cement technique is good radiographic outcomes up to 87 months and this technique should be used with the thinner femoral component than the previous.
Despite extensive experience with prosthetic replacement for the reconstruction of limbs following juxta-articular resection of tumours, there are few reports of prosthetic replacement of the distal radius. We present two cases of massive bone defects of the distal radius in which alumina ceramic prosthetic replacements were used. We evaluated the patients more than ten years after the procedure. Both patients had degenerative changes to the wrist. This, however, was not associated with pain or decreased function, and both had returned to their previous occupation after surgery. When a patient has a massive defect of the distal radius, reconstruction using a ceramic prosthesis is a reasonable alternative to using autograft. This method of treatment results in little pain, a moderate range of movement and satisfactory function.
Multiple tumours of peripheral nerves are often seen in patients with neurofibromatosis of type 1 or 2. Multiple schwannomas may occur without other manifestations of neurofibromatosis. We have reviewed 12 patients with multiple schwannomas arising from peripheral lesions who did not fulfil the criteria for either type of neurofibromatosis. Four had spinal and one an intracranial lesion in addition to the peripheral tumours. Two patients had one and three The large size of tumours, the difficulties of histological diagnosis on biopsy, and the confusion with neurofibromatosis can lead to overtreatment. Malignant change seldom, if ever, occurs in patients with multiple schwannomas.
