Cement migration after THR. A comparison of charnley elite and exeter femoral stems using RSA.
Studies using roentgen stereophotogrammetric analysis (RSA) have shown that the femoral components of cemented total hip replacements (THR) migrate distally relative to the bone, but it is not clear whether this occurs at the cement-implant or the cement-bone interface or within the cement mantle. Our aim was to determine where this migration occurred, since this has important implications for the way in which implants function and fail. Using RSA we compared for two years the migration of the tip of the stem with that of the cement restrictor for two different designs of THR, the Exeter and Charnley Elite. We have assumed that if the cement restrictor migrates, then at least part of the cement mantle also migrates. Our results have shown that the Exeter migrates distally three times faster than the Charnley Elite and at different interfaces. With the Exeter migration was at the cement-implant interface whereas with the Charnley Elite there was migration at both the cement-bone and the cement-implant interfaces. (+info)
Induction of macrophage C-C chemokine expression by titanium alloy and bone cement particles.
Particulate wear debris is associated with periprosthetic inflammation and loosening in total joint arthroplasty. We tested the effects of titanium alloy (Ti-alloy) and PMMA particles on monocyte/macrophage expression of the C-C chemokines, monocyte chemoattractant protein-1 (MCP-1), monocyte inflammatory protein-1 alpha (MIP-1alpha), and regulated upon activation normal T expressed and secreted protein (RANTES). Periprosthetic granulomatous tissue was analysed for expression of macrophage chemokines by immunohistochemistry. Chemokine expression in human monocytes/macrophages exposed to Ti-alloy and PMMA particles in vitro was determined by RT-PCR, ELISA and monocyte migration. We observed MCP-1 and MIP-1alpha expression in all tissue samples from failed arthroplasties. Ti-alloy and PMMA particles increased expression of MCP-1 and MIP-1alpha in macrophages in vitro in a dose- and time-dependent manner whereas RANTES was not detected. mRNA signal levels for MCP-1 and MIP-1alpha were also observed in cells after exposure to particles. Monocyte migration was stimulated by culture medium collected from macrophages exposed to Ti-alloy and PMMA particles. Antibodies to MCP-1 and MIP-1alpha inhibited chemotactic activity of the culture medium samples. Release of C-C chemokines by macrophages in response to wear particles may contribute to chronic inflammation at the bone-implant interface in total joint arthroplasty. (+info)
The inadequacy of standard radiographs in detecting flaws in the cement mantle.
Radiological assessment of the cement mantle is used routinely to determine the outcome of total hip replacement. We performed a simulated replacement arthroplasty on cadaver femora and took standard postoperative radiographs. The femora were then sectioned into 7 mm slices starting at the calcar, and high-resolution faxitron radiographs were taken of these sections. Analysis of the faxitron images showed that defects in the cement mantle were observed up to 100 times more frequently than on the standard films. We therefore encourage the search for a better technique in assessing the cement mantle. (+info)
Total knee replacement: should it be cemented or hybrid?
OBJECTIVE: To compare the complication rates associated with total knee arthroplasty against the types of fixation (hybrid or cemented), using a single total knee design (the anatomic modular knee [AMK] prosthesis). DESIGN: A prospective, nonrandomized, controlled trial. SETTING: University Hospital in London, Ont., a tertiary care teaching centre. PATIENTS: Two groups made up of 484 knees in 395 patients (89 bilateral). INTERVENTIONS: In 260 knees a hybrid configuration (cemented tibia and noncemented femur) was used (group 1). In 224 knees the femoral and tibial components were cemented (group 2). All patellae were cemented in both groups. MAIN OUTCOME MEASURES: Clinical results were assessed by The Knee Society Clinical Rating Scores at 3 months, 6 months and yearly intervals. Radiographic results were determined by 3-foot standing radiographs and at each follow-up visit standing knee radiographs, lateral and skyline views. Radiographs were analysed for alignment, presence or absence of radiolucent lines or changes in the position of the implant. All reoperations and nonoperative complications were recorded. RESULTS: At an average follow-up of 4.8 years, 8 knees (1.6%) required reoperation. An analysis of the complications leading to reoperation demonstrated no difference between the 2 groups. CONCLUSIONS: There was no difference in outcome whether the femoral component was cemented or not. Medium-term results of the AMK are excellent with a very low reoperation rate. (+info)
Massive pelvic and femoral pseudotumoral osteolysis secondary to an uncemented total hip arthroplasty.
A 51 year-old man developed an extensive osteolytic response to wear debris in an uncemented porous-coated total hip arthroplasty, with metal/polyethylene interface, which had been implanted eighteen years previously. This reaction, which involved the upper femur and the ilium, produced a mass which compressed the pelvic viscera. (+info)
Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty.
A pulmonary embolus of acrylic cement was present in a 41-year-old woman with Langerhans' cell vertebral histiocytosis (LCH) after percutaneous vertebroplasty. Chest radiograph and CT confirmed pulmonary infarction and the presence of cement in the pulmonary arteries. She was treated with anticoagulants, and responded favorably. This rare complication occurred because perivertebral venous migration was not recognized during vertebroplasty. Adequate preparation of cement and biplane fluoroscopy are recommended for vertebroplasty. (+info)
More failures of uncemented acetabular screw-rings than of cemented polyethylene cups in total hip arthroplasties.
The results of 498 total hip arthroplasties were prospectively studied. In 329 patients a cemented acetabular polyethylene cup was inserted. In 169 patients a threaded socket without cement was introduced. Follow-up ranged from 6 to 8 years and follow-up rate was over 90%. Of the 169 threaded sockets 8 required revision (4.7%), and 3 acetabular components were seen to be loose on X-ray. Of the cemented cups, only 2 (0.6%) required revision and none were considered loose on X-ray. (+info)
Mid-term migration of a cemented total hip replacement assessed by radiostereometric analysis.
We have previously reported the short-term migration of cemented Hinek femoral components using radiostereometric analysis (RSA). We now report the mid-term migration. During the first 2 years after implantation the prosthesis subsided into varus and rotated internally. Between years 3 and 8 the prosthesis continued to rotate internally with the head moving posteriorly (0.07 mm/year, P=0.004). It also continued to fall into varus with the tip moving laterally (0.07 mm/year, P=0.04). The head (0.06 mm/year, P<0.0001), shoulder (0.04 mm/year, P=0.0001) and tip (0.04 mm/year, P=0.001) continued to migrate distally. There were two cases of failure due to aseptic loosening during the follow-up period. During the second year both of these had posterior head migration, which was abnormally rapid (>2 SD from the mean). We have demonstrated that a cemented implant has slow but significant levels of migration and rotation for at least 8 years after implantation. Our study confirms that implants with abnormally rapid posterior head migration during the second year are likely to fail. (+info)