The Current Concepts of Total Hip Arthroplasty

Lee, Joong-Myung

doi:10.5371/hp.2016.28.4.191

Cited by 35 publications

(20 citation statements)

References 71 publications

(79 reference statements)

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“…Vascular injuries associated with hip arthroplasty consist of distal ischaemia, vessel lacerations, pseudo aneurysms and arterio-venous fistulas (5,17). Complications are often related to cement incorporation of the iliac vessels, aggressive medial retraction, excessive traction on atherosclerotic vessels and improper technique in the preparation of the acetabulum (2, 3).…”

Section: Discussionmentioning

confidence: 99%

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Revision of migrated pelvic acetabular components in THA with or without vascular involvement

Cristea¹,

Prundeanu²,

Groseanu³

et al. 2016

J Clin Invest Surg.

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Purpose. The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience.Material and Methods. We performed eight (8) total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4) of these cases. Two (2) cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views), CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6) units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved.Results: The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace) in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications.Conclusions: Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions.

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Section: Discussionmentioning

confidence: 99%

“…The acetabular component that has migrated into the pelvis creates a fibrous tissue, which may be adherent to the pelvic organs, such as the uterus, rectum, bladder and ureter, and also to the common iliac vessels. As such, its removal can lead to uncontrollable bleeding (1), death or other severe complications (5).…”

Section: Introductionmentioning

confidence: 99%

Revision of migrated pelvic acetabular components in THA with or without vascular involvement

Cristea¹,

Prundeanu²,

Groseanu³

et al. 2016

J Clin Invest Surg.

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“…Controversy regarding the safety of metal-on-metal bearing surfaces still remains, particularly in relation to metal ion release and potential hypersensitivity reactions [152,153,154]. Ceramic-ceramic implants have been demonstrated to provide the lowest wear rates in comparison to other material options possible for ceramic-on-ceramic THA [9,98,155]. Trends in material development are also strongly influenced by the desire to improve hip function and stability through the use of increased head diameters [97].…”

Section: Conclusion and Future Prospectsmentioning

confidence: 99%

Materials for Hip Prostheses: A Review of Wear and Loading Considerations

2019

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Replacement surgery of hip joint consists of the substitution of the joint with an implant able to recreate the articulation functionality. This article aims to review the current state of the art of the biomaterials used for hip implants. Hip implants can be realized with different combination of materials, such as metals, ceramics and polymers. In this review, we analyze, from international literature, the specific characteristics required for biomaterials used in hip joint arthroplasty, i.e., being biocompatible, resisting heavy stress, opposing low frictional forces to sliding and having a low wear rate. A commentary on the evolution and actual existing hip prostheses is proposed. We analyzed the scientific literature, collecting information on the material behavior and the human-body response to it. Particular attention has been given to the tribological behavior of the biomaterials, as friction and wear have been key aspects to improve as hip implants evolve. After more than 50 years of evolution, in term of designs and materials, the actual wear rate of the most common implants is low, allowing us to sensibly reduce the risk related to the widespread debris distribution in the human body.

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“…The demand for total hip arthroplasty (THA) has significantly increased over recent years, especially with regard to healthy, active individuals in their 5th-6th decade of life who wish to maintain their level of activity despite undergoing joint replacement surgery. 1 Such expectation can be met via technological advances, less invasive surgical approaches and the evolution of key concepts in joint replacement, such as femoral stem fixation. 2,3 Against this background, [1][2][3] we chose to further optimise the functional outcome and bone-preserving qualities of currently available options for meta-epiphyseal fixation by designing a new short femoral component, whose features enable it to respect coxofemoral anatomy and physiology.…”

Section: Introductionmentioning

confidence: 99%

“…1 Such expectation can be met via technological advances, less invasive surgical approaches and the evolution of key concepts in joint replacement, such as femoral stem fixation. 2,3 Against this background, [1][2][3] we chose to further optimise the functional outcome and bone-preserving qualities of currently available options for meta-epiphyseal fixation by designing a new short femoral component, whose features enable it to respect coxofemoral anatomy and physiology. 1,3 The COLLOMIS stem (Lima Corporate, Udine, Italy) aims to completely preserve the femoral neck 4,5 without changing native cervical anteversion and cervico-diaphyseal (CCD) angle or lengthening the lower limb, while at the same time safeguarding meta-epiphyseal cancellous bone by impacting it laterally towards the greater trochanter to create a sturdy wall.…”

Section: Introductionmentioning

confidence: 99%

Mid-term results with a neck-preserving femoral stem for total hip arthroplasty

et al. 2018

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Introduction: This prospective study aims to evaluate the mid-term clinical and radiological performance of a new short, neck-preserving femoral stem in total hip arthroplasty (THA). Patients and methods: 178 consecutive patients (190 hips) underwent THA from November 2008 to July 2016. Mean follow-up is 62.4 months. Women make up 41% of the cohort at a mean age of 50 ± 4 years, with primary hip osteoarthritis as the main complaint. All patients underwent radiological evaluation using the modified Gruen method, and clinical assessment via the Harris Hip Score (HHS), preoperatively and at 1, 6, 12, 24, 60, 80 and 106 months post-op. Results: A mean HHS increase (from 50 ± 12 points preoperatively to 96 ± 4 at 62 months), together with painless articular improvement, was present at 6 months postoperatively indicating early functional recovery. Effective osteointegration and primary stability were present on radiographic analysis, without evidence of stress shielding or stem mal-positioning: subsidence amounting to <1 mm was present in 40% of implants immediately after surgery, with subsequent stabilisation within 6 months in all cases. Metaphyseal trabecular reorientation in absence of symptomatic cortical hypertrophy or progressive radiolucency indicates physiological load transfer in the proximal femur. Stemrelated revision surgery was necessary for 1.05% of all implants due to fracture and infection. No loosening, dislocations or mechanical failures were reported. Conclusions: All patients show excellent functional recovery and clinical outcomes at 62 months, demonstrating the role optimal primary stability and physiological joint reconstruction play in ensuring stable secondary fixation and longterm survival of a short, neck-preserving stem.

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The Current Concepts of Total Hip Arthroplasty

Cited by 35 publications

References 71 publications

Revision of migrated pelvic acetabular components in THA with or without vascular involvement

Revision of migrated pelvic acetabular components in THA with or without vascular involvement

Materials for Hip Prostheses: A Review of Wear and Loading Considerations

Mid-term results with a neck-preserving femoral stem for total hip arthroplasty

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