High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures Zuurmond, R.G.; van, Wijhe W.; van Raay, J.J.; Bulstra, Sjoerd K. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Total hip arthroplasty (THA) is among the most successful operative procedures known to medicine, because of which the prevalence of this procedure is rapidly increasing. However, with the success the downside becomes increasingly important as well: the complications associated with THA. Although the number of serious complications on the long term is low, a serious complication is the periprosthetic fracture (PPF) of the femur. Often, these fractures occur in older, compromised patients, raising mortality rates. 10 The increase in the number of patients treated with THA, as well as people getting older, create a large population 'at risk'. In the literature, the increasing incidence of PPF has been reported by a number of study groups. 7,15Several retrospective studies have been published, however, with limited information on clinical outcomes. 1,11,16 Using the Swedish Arthroplasty Register, Lindahl et al. were able to report a large prospective series and identify risk factors for PPF (e.g., stem design). 8 Derived from questionnaires at follow-up, their patients showed an impaired hip function and low health status. We performed a retrospective study in two hospitals and included the Oxford hip score questionnaire and a review of the complete radiologic follow-up. According to clinical observations and literature reports, we expected high major complication rates, especially re-operations. Osteosynthesis performed for Vancouver type-B fractures were expected to have a high failure rate as previously described in literature reports. We posed the following research questions: Does the treated PPF population show a high complication rate? Do these patients show an impaired functional outcome and is this influenced by the method of treatment? Background:The purpose of this observational study was to determine the clinical results of the operative treatment of periprosthetic femoral fractures over a long period of time. Methods: The medical records of patients treated between 1993 and 2006 for a periprosthetic femoral fracture were obtained after a survey in two major hospitals. Radiographic evaluation was performed according to the Vancouver classification. All patients were contacted to fill out the Oxford hip score. Results: A total of 80 PPFs were identified in 79 patients. For 71 patients with 71 fractures, medical records and radiographs were available. The mean age at the time of fracture was 73.4 years (range: 38-95 years). The mean interv...

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Pseudotumor formation occurred in 28% of hips after an average follow-up of forty-one months. Most pseudotumors (72.5%) were asymptomatic. Larger pseudotumors were associated with more complaints. Survival analysis showed an implant survival of 87.5% at five years. Failure occurred in 5.6% (eight) of 143 hips because of a symptomatic pseudotumor.

The Oxford phase III unicompartmental knee replacement in patients less than 60 years of age Kort, Nanne P.; van Raay, Jos J. A. M.; van Horn, Jim J. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 11-05-2018Abstract Treatment of younger patients with medial unicompartmental disease of the knee joint remains a challenging therapeutic dilemma. With the refinement of implant design, fixation and the minimally invasive techniques employed with unicompartmental knee replacement, indications have expanded to include its use in young patients. A prospective cohort of 46 unicompartmental knee procedures were performed with a 2-year minimum and 6-year maximum followup, using the Oxford phase III unicompartmental knee arthroplasty, in the younger patient group (age 60 or younger). We conclude that the unicompartmental knee arthroplasty is an important option for the treatment of medial compartment disease for patients 60 years or younger. Obesity can cause technical difficulties, increased risk of complications and early failure of this prosthesis.

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Metal-on-metal hip arthroplasty is associated with elevated levels of cobalt and chromium ions. The effects of cobalt and chromium ions on cell number, activity, expression of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa B ligand (RANKL) and oxidative stress on human osteoblast-like cells were addressed. Saos-2 cells were supplemented with Co 2þ , Cr 3þ , or Co 2þ þ Cr 3þ (1:2) at 0, 1, 10, and 100 mg/L and incubated for 24, 48, 72, and 96 h. Cell activity was assessed by MTT-assay and cell number by Crystal Violet staining. RNA levels of OPG and RANKL were evaluated using real-time quantitative polymerase chain reaction (qPCR). Compared to controls Co 2þ reduced cell numbers: at 10 mg/L by 17 AE 8% after 48 h and at 100 mg/L after 24 h by 35 AE 8%. Cr 3þ decreased cell numbers at 10 mg/L after 48 and 72 h. Co 2þ þ Cr 3þ combined at 1 mg/L lowered cell numbers after 24 and 96 h (17 AE 13, resp. 13 AE 4%). The 10 and 100 mg/L concentrations reduced cell numbers significantly after 24, 48, and 96 h. Cr 3þ reduced osteoblast activity at 1, 10, and 100 mg/L at all incubation times. The strongest reduction (11 AE 1%) was seen at 100 mg/L after 96 h. The OPG/RANKL ratio was reduced after 72 h with almost all Co 2þ and Cr 3þ concentrations. After 96 h, glutathione, superoxide dismutase, and catalase levels were indicative for an oxidative stress response in all samples. In conclusion, cobalt and chromium ions reduce human osteoblast activity, reduce OPG/RANKL ratio and lead to oxidative stress. Keywords: metal-on metal; osteoblasts; oxidative stress; OPG; RANKL Total hip arthroplasty (THA) is a well-accepted therapy for hip osteoarthritis, with long lasting good clinical results. Survival rates of most THA's are documented at more than 95% over 10-15 years. Wear, osteolysis, and loosening have emerged as the dominant concerns among orthopedic hip surgeons. Polyethylene wear particles trigger a foreign body granulomatous reaction, inflammation, and immune reactions leading to the secretion of various bone resorbing agents (cytokines, prostaglandins). This results in peri-prosthetic bone loss, contributing to loosening and failure of the prosthesis.1 One of the key factors in peri-prosthetic osteolysis is receptor activator of nuclear factor kappaB ligand (RANKL) and strong correlations have been found between its expression and the amount of polyethylene wear debris and the degree of osteolysis. 3 also related the presence of polyethylene to RANKL expression. In general, osteoclastogenesis is largely regulated by receptor activator of nuclear factor kappaB (RANK), RANKL, and osteoprotegerin (OPG). RANKL stimulates differentiation of osteoclast precursor cells into mature osteoclasts and is required for osteoclast activity; in fact, RANKLtreated mice show increased bone resorbtion. On the other hand, OPG decreases the number of osteoclasts and mice treated with OPG exhibit lowered osteoclast activity and increased bone volume. 4 In order to avoid polyethylene wear-related loosening and t...

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Diagnostic study, Level III.