Aloinjerto triturado en revisión acetabular: 3-7 años de seguimiento

Se analizan 96 revisiones de cúpula cementadas y no cementadas, asociadas a injerto triturado, dependiendo del defecto óseo acetabular. En acetábulos con defecto menor del 30% (42 cúpulas) se implantó una cúpula sin cementar, mientras en cúpulas con defecto mayor del 30% (54 cúpulas) se utilizó injerto compactado con cemento. El seguimiento medio fue de 5,6 años. No hubo ninguna cadera revisada ni emigrada. Las líneas radiotransparentes fueron poco frecuentes. El estado del injerto, difícil de valorar mostraba reabsorción menor en ocho. Los resultados a medio plazo fueron favorables cuando se emplearon aloinjertos triturados asociados a una cúpula porosa sin cementar acetábulos con un defecto óseo menor del 30%, y cuando se compactan y cementan en defectos óseos mayores del 30%.We assessed 96 cases of revision surgery in cementless and cementad cups using morsellized allograft according to bone defect. A cementless porous hemispherical cup was used in acetabula with less than 30% bone defect (42 cups) while a cemented cup as used in hips with a defect greater than 30% (54 cups). The mean follow-up was 5.6 years. There were no further revised cups and no migration. Radiolucent lines were uncommon in both groups. Although graft remodelling was difficult to evaluate, only 8 hips showed minor resorption. Middleterm results are favourable with impacted allograft and cementless cup in acetabular bone defects of less than 30% and with impacted allograft and cemented all-polyethylene cup in defects greater than 30%

Historia natural del componente acetabular en la prótesis de Charnley: Factores de riesgo

Se analizan 452 cúpulas de Charnley con un seguimiento de 20 años. 75 cúpulas aparecían aflojadas. El 21% de las cúpulas mostraban emigración a los 20 años, y el 33% demarcación en todo su contorno. El grado inicial de demarcación se relacionó con la emigración (p<0.0001). El desgaste acetabular medio fue de 0,13 mm/año. Un desgaste anual mayor de 0.2 mm. Relacionó con una edad mayor de 50 años y con un peso mayor de 80 kgs. De las 75 cúpulas aflojadas, 35 aparecían antes de los 10 años (aflojamiento tardío). El aflojamiento precoz se relacionó con procesos que tenían déficit en el sustrato óseo, siendo frecuentes la emigración y el dolor. El aflojamiento tardío se relacionó con un desgaste acetabular mayor de 2 mm, siendo menores la emigración y la existencia de dolor..four hundred and fifty two Charnley cups were assessed with a mean follow-up period of 20 years. Seventy-five of them were loosed. Migration was observed in 21% and 33% showed demarcation in the whole contour of the cup. There was a statistically correlation between the grade of initial demarcation and migration (p<0.0001). the mean acetabular wear rate was 0,13 mm/years. Annual wear over 0,2 mm was related with an age under 50 years, and weight over 80 kg. Of the 75 loosened cups, 35 were diagnosed within 10 years of the operation (early loosening), and 40 after 10 years (late loosening). Early loosening was related to poor acetabular bone stock, with cup migration and pain as frequent findings. Late loosening was related with acetabular wear of more than 2 mm, with less incidence of migration and pain

Wear of hip prostheses increases serum IGFBP-1 levels in patients with aseptic loosening

The biological mechanisms involved in aseptic loosening include inflammation-associated and bone resorption-associated processes. Coordinated cellular actions result in biochemical imbalances with devastating consequences for the joint. Given that this condition is not known for showing systemic signs, we investigated whether circulating levels of inflammation-related proteins are altered in patients with aseptic loosening. Our study included 37 patients who underwent revision surgery due to hip osteolysis and aseptic loosening and 31 patients who underwent primary total hip arthroplasty. Using antibody arrays, we evaluated the serum levels of 320 proteins in four patients from each group. The results showed differences in insulin-like growth factor-binding protein 1 (IGFBP-1) concentrations, which we then quantified using enzyme-linked immunosorbent assay tests in all study patients. The results confirmed that serum IGFBP-1 concentrations were higher in the revision surgery patients than in the hip arthroplasty patients. In vitro studies showed that exposure of human osteoblasts to titanium particles induced an IGFBP-1 release that further increased when exposure to particles was performed in media conditioned by human M1 macrophages. These findings suggest that elevated serum IGFBP-1 levels in patients with aseptic loosening can arise from increased local IGFBP-1 production in the inflammatory environment of the periprosthetic bed.This work was supported by Grant RTI2018-095159-B-I00 from the Spanish Ministry of Science, Innovation and Universities (MCINN) and Grant PI18/00643 from Instituto de Salud Carlos III (ISCIII)-Fondo Europeo de Desarrollo Regional (FEDER) and the Spanish Ministry of Economy and Competitiveness (MINECO-AES). LS is supported by a Miguel Servet contract from ISCIII-MINECO-AES-FEDER-FSE. NV is supported by Program I2 from the Regional Government of Madrid. The authors are indebted to Fatima Bensiamar (IdiPAZ and CIBER-BBN) for her excellent technical assistance with the cell culture experiments and gene expression analysis and to the Cell Culture Core Facilities of IdiPAZ

Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1–12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70–98) in patients who underwent reimplantation and 56.8 (range, 32–76) in patients who underwent resection arthroplasty. Long cycles of combined oral antibiotics plus a two-stage surgical exchange appear a promising alternative for infections by highly resistant bacteria, methicillin-resistant Staphylococci, and polymicrobial infections