To test the agreement between a newly developed micro-magnetic resonance imaging (MRI) analysis of the subchondral bone and the micro-computed tomography (CT) approach.
Samples obtained from 10 ...patients with osteoarthritis undergoing total hip arthroplasty were scanned with a 7.0 T micro-MRI. Proton density-weighted images and proton density-weighted images with fat suppression were obtained. The results were validated with a micro-CT device. Micro-MRI and micro-CT scans of the same sample were aligned, and regions of interest were delineated on equal areas of the sample. Bone volume fraction was calculated by using in-house plugins. The agreement between the methods was tested with Bland-Altman analysis.
The agreement between the methods was good, with average difference of 2.167%. The differences between the methods were not significant (P=0.272, t test).
The novel micro-MRI approach could be used for subchondral bone analysis. With further optimization for clinical MRI machines, the approach can be also used in the diagnostics of hip osteoarthritis.
Hip arthroscopy is a minimally invasive, effective and innovative orthopedic procedure with a relatively low rate of complications. In our patient, residual cam deformity and a bone fragment that ...remained in the front hip capsule after hip arthroscopy performed three years before caused thigh numbness, muscle fasciculations, and paresthesia. It was assumed that the loose bony fragment remained following burring on prior procedure. During hip flexion, neural structures were compressed and caused the mentioned symptoms. Revision hip arthroscopy was performed and the loose fragment in addition to residual cam deformity was removed. Resolution of pain and anterior thigh numbness was reported after the revision surgery. Key words: Hip arthroscopy; Arthroscopy; Cam lesion; Loose fragment; Tigh numbness; Muscle fasciculations; Paresthesia Artroskopija kuka je minimalno invazivni, ucinkovit i inovativni ortopedski zahvat s niskim rizikom od komplikacija. Kod naseg bolesnika ostatna cam lezija i fragment kosti koji je zaostao u prednjem dijelu cahure kuka nakon artroskopije kuka izvedene tri godine ranije izazvao je utrnulost natkoljenice, fascikulacije misica i parestezije. Pretpostavljamo da je kostani ulomak zaostao kao komplikacija brusenja kosti u prethodnom zahvatu. Prilikom feksije kuka komprimirao je zivcane strukture i posljedicno izazivao spomenute simptome. Komplikacija je rijesena revizijskom artroskopijom kuka i uklanjanjem slobodnog fragmenta. Nakon revizijske operacije doslo je do smanjenja boli i prestanka utrnulosti prednjeg dijela bedra u naseg bolesnika. Kljucne rijeci: Artroskopija kuka; Artroskopija; Lezija cam; Slobodni fragment; Utrnulost bedra; Fascikulacije misica; Parestezije
Developmental dysplasia of the hip (DDH) represents a morphological abnormality characterized by the incongruity of femoral head and acetabulum. It ranges from mild dysplastic changes to complete ...dislocation. DDH has been associated with several hereditary and environmental risk factors, which could explain the incidence variability among different countries. Numerous genes may be involved in the disease etiology and progression. However, there are controversies in the literature regarding some of these genes. DDH-induced secondary osteoarthritis (OA) is characterized by changes in the macromolecule content of the cartilage and the expression of cartilage degradation markers. In addition, it exhibits a pattern of specific histological changes, with several reported differences between primary and DDH-induced secondary OA. The articular cartilage of patients with DDH shows specific radiological characteristics, including changes visible already in infancy, but also at pre-arthritic stages, early stages of OA, and in fully developed DDH-induced secondary OA. Although DDH has been extensively researched in different disease stages, the etiology of the disorder still remains uncertain. This review focuses on the current knowledge on the histomorphological status of the cartilage and the genetic background of DDH.
Abstract Periprosthetic infection is regarded as one of the most feared complications following total knee arthroplasty, developing in 0.4–2% of patients. Staphylococcus aureus and Staphylococcus ...epidermidis are credited for more than half of all infections. Cefazolin is the most commonly used antibiotic drug in arthroplasty antibiotic prophylaxis worldwide. Guidelines and studies recommend that prophylactic antibiotics should be completely infused within 60 min before the surgical incision. Cefazolin achieves highest peak bone concentrations 40 min after parenteral application with serum half-life of 108 min and bone half-life of 42 min. Respecting the given pharmacokinetics of cefazolin and theoretical mathematical model we hypothesise that parenteral application of cefazolin should be in time period not longer than 30 min before incision (tourniquet inflation) and not less than 10 min before tourniquet inflation if given in bolus. This new regime would provide maximal blood concentration of the cefazolin and almost maximal bone concentration of the cefazolin at the beginning of the operation and at the beginning of the tourniquet inflation.
Excessive metal femoral head wear has been described only as revision surgery complication after primary ceramic-on-ceramic total hip arthroplasty (THA). Here, we present the first case of metal ...femoral head wear after primary metal-on-polyethylene THA. A 56-year-old woman was referred to our outpatient clinic 17 years after primary right-sided THA, experiencing pain and decreased right hip range of motion. Radiographic examination revealed acetabular cup dislocation, eccentric femoral head wear, damaged titanium porous coating of femoral stem, metallosis, and pseudotumor formation. Endoprosthetic components were extracted, but further reconstruction was impossible due to presence of large acetabular bone defect. Macro- and micro-structure of extracted components were analyzed. Acetabular liner surface was damaged, with scratches, indentations, and embedded metal debris particles present on the entire inner surface. Analysis of metal debris by energy-dispersive spectroscopy showed that it consisted of titanium and stainless-steel particles. Femoral head was gravely worn and elliptically shaped, with abrasive wear visible under scanning electron microscope. No signs of trunnionosis at head/neck junction were observed. Microstructure of femoral head material was homogeneous austenitic, with microhardness of 145 HV 0.2, which is lower than previously described titanium hardness. In conclusion, detached titanium porous coating of femoral stem can cause stainless-steel femoral head wear in primary metal-on-polyethylene THA. As soon as such detachment becomes evident, revision surgery should be considered to prevent devastating complications.
Purpose
During total knee arthroplasty (TKA) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions. For ...blood loss management during TKA, pre-operative autologous blood donation (PABD) is still a standard of care. In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and, if yes, for which group of patients.
Methods
Patients were randomised to three groups. In group 1 patients did not donate autologous blood, in group 2 patients donated 1 dose 72 hours prior to TKA and in group 3 patients donated autologous blood 14 days prior to TKA. In all patients haemoglobin, haematocrit, thrombocyte and reticulocyte values, iron concentrations (Fe, unsaturated iron binding capacity, total iron binding capacity), activated partial thromboplastin time, prothrombin time, and intra-operative and post-operative blood loss were measured and compared.
Results
With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded, which significantly increased the cost of treatment for these patients. For patients undergoing TKA, PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion.
Conclusions
Results of our study showed that PABD in non-anaemic patients is not justified and is not economically feasible.
Total hip arthroplasty implies proper orientation of both acetabular and femoral components with a range of 25-40degrees of combined anteversion. The aim of the study was to examine resistance to ...periprosthetic fracture of the axially loaded cross section rectangular femoral stem (Zw-eymiiller) with respect to different degrees of anteversion, implanted in the artificial bone model, in laboratory conditions. Femoral bone models with implanted femoral stems were divided into 3 groups depending on the degree of stem anteversion (A, control group 13-17degrees; B, stem retroverted 0degrees-4degrees; and C, stem anteverted 26-30degrees). The amount of axial load leading to periprosthetic fracture (PPFx) of the artificial bone model was determined experimentally for each construct. The results showed that the load at which the PPFx occurred significantly increased with the increase of the endoprosthesis anteversion angle. In our clinical practice, we are often unable to place the acetabular component in an ideal grade of anteversion for intraoperatively determined reasons. The results of this experimental study suggested that increasing rectangular femoral (Zweymuller) stem anteversion lowered the risk of PPFx. This study was limited by experimental design (laboratory conditions, artificial bone) and should be clinically verified. Key words: Total hip arthroplasty; Periprosthetic fracture; Artificial bone model Potpuna zamjena kuka podrazumijeva pravilnu orijentaciju acetabularne i femoralne komponente u rasponu od 25degrees-40degrees kombinirane anteverzije. Cilj ovoga istrazivanja bio je ispitati otpornost na periprotetski prijelom aksijalno opterecene femoralne komponente endoproteze kuka tipa Zweymuller, pravokutnog poprecnog presjeka s obzirom na razlicite iznose kutova anteverzije, ugradene u model umjetne kosti pri laboratorijskim uvjetima. Modeli femura s ugradenim endoprotezama podijeljeni su u tri skupine ovisno o stupnju anteverzije endoproteze (A, kontrolna skupina 13degrees-17degrees; B endoproteza u retroverziji 0degrees-4degrees; C, endoproteza u anteverziji 26degrees-30degrees). Iznos aksijalnog opterecenja koje dovodi do periprotetskog prijeloma umjetne kosti odreden je eksperimentalno za svaki sklop. Rezultati su pokazali da se opterecenje pri kojem je doslo do periprotetskog prijeloma znatno povecalo s povecanjem kuta anteverzije. U nasoj klinickoj praksi cesto nismo u mogucnosti pozicionirati acetabularnu komponentu u idealan stupanj anteverzije iz intraoperativno odredenih razloga. Rezultati ove eksperimentalne studije pokazuju da povecanjem anteverzije pravokutne femoralne (Zweymuller) endoproteze dolazi do smanjenja rizika od periprotetskog prijeloma. Ova studija je ogranicena eksperimentalnim dizajnom (laboratorijski uvjeti, umjetna kost) i trazi klinicku verifikaciju. Kljucne rijeci: Umjetni zglob kuka; Femoralna komponenta Zweymuller; Anteverzija; Periprotetski prijelom
Total hip arthroplasty implies proper orientation of both acetabular and femoral components with a range of 25-40° of combined anteversion. The aim of the study was to examine resistance to ...periprosthetic fracture of the axially loaded cross section rectangular femoral stem (Zweymüller) with respect to different degrees of anteversion, implanted in the artificial bone model, in laboratory conditions. Femoral bone models with implanted femoral stems were divided into 3 groups depending on the degree of stem anteversion (A, control group 13-17°; B, stem retroverted 0°-4°; and C, stem anteverted 26-30°). The amount of axial load leading to periprosthetic fracture (PPFx) of the artificial bone model was determined experimentally for each construct. The results showed that the load at which the PPFx occurred significantly increased with the increase of the endoprosthesis anteversion angle. In our clinical practice, we are often unable to place the acetabular component in an ideal grade of anteversion for intraoperatively determined reasons. The results of this experimental study suggested that increasing rectangular femoral (Zweymüller) stem anteversion lowered the risk of PPFx. This study was limited by experimental design (laboratory conditions, artificial bone) and should be clinically verified.
Total hip arthroplasty implies proper orientation of both acetabular and femoral components with a range of 25-40° of combined anteversion. The aim of the study was to examine resistance to ...periprosthetic fracture of the axially loaded cross section rectangular femoral stem (Zweymüller) with respect to different degrees of anteversion, implanted in the artificial bone model, in laboratory conditions. Femoral bone models with implanted femoral stems were divided into 3 groups depending on the degree of stem anteversion (A, control group 13-17°; B, stem retroverted 0°-4°; and C, stem anteverted 26-30°). The amount of axial load leading to periprosthetic fracture (PPFx) of the artificial bone model was determined experimentally for each construct. The results showed that the load at which the PPFx occurred significantly increased with the increase of the endoprosthesis anteversion angle. In our clinical practice, we are often unable to place the acetabular component in an ideal grade of anteversion for intraoperatively determined reasons. The results of this experimental study suggested that increasing rectangular femoral (Zweymüller) stem anteversion lowered the risk of PPFx. This study was limited by experimental design (laboratory conditions, artificial bone) and should be clinically verified.
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