Sports Activity After Short-Stem Hip Arthroplasty

Background: No data are available about the sports activity of patients with bone-conserving short-stem hip implants. Hypothesis: Patients can return to a good level of sports activity after implantation of a short-stem hip implant. Study Design: Case series; Level of evidence, 4. Methods: The sports activity level of 68 patients (76 hips) after short-stem hip arthroplasty was assessed for a minimum of 2 years after implantation. In addition to the clinical examination, a detailed evaluation of the patients’ sports pattern was obtained. Furthermore, the results were analyzed with regard to gender (female and male) and age (55 years). Results: After a mean of 2.7 years, patients showed a Harris Hip Score (HHS) of 93.6, a Western Ontario and McMaster Universities Arthritis Index (WOMAC) score of 9.5, and a University of California, Los Angeles (UCLA) activity score of 7.6, with each individual participating on average in 3.5 different disciplines after surgery compared with 3.9 before surgery. High-impact activities decreased significantly postoperatively, whereas low-impact activities increased significantly. The duration of the sports activities remained stable, while the frequency actually increased. In contrast, men participated preoperatively in more sports than women (4.3 men vs 3.3 women). However, because of a pronounced decrease in high-impact activities by men, both genders participated in an equal number of sports postoperatively (3.5 men vs 3.5 women). Finally, 45% (n = 31) reported at least one activity that they missed. Most of them were disciplines with an intermediate- or high-impact level. Conclusion: Patients with a short-stem hip implant can return to a good level of activity postoperatively. Participation in sports almost reached similar levels as preoperatively but with a shift from high- to low-impact activities. This seems desirable from a surgeon’s point of view but should also be communicated to the patient before hip replacemen

Revision of hip resurfacing arthroplasty with a bone-conserving short-stem implant: a case report and review of the literature

Introduction Suitable treatment of early failure of total hip replacement is critical in younger patients, as bone stock is lost and the functional outcome is impaired. Case presentation We report the case of a 56-year-old Caucasian woman with early failure of hip resurfacing arthroplasty. While revision is usually performed with a conventional hip implant, this case report describes for the first time a revision procedure with a bone-conserving short-stem hip implant. Conclusions Our approach allows further conservation of femoral bone stock and provides a long-term solution to the patient, which maintains the possibility of using a conventional hip implant should a second revision become necessary

Patients with Intolerance Reactions to Total Knee Replacement: Combined Assessment of Allergy Diagnostics, Periprosthetic Histology, and Peri-implant Cytokine Expression Pattern

We performed a combined approach to identify suspected allergy to knee arthroplasty (TKR): patch test (PT), lymphocyte transformation test (LTT), histopathology (overall grading; T- and B-lymphocytes, macrophages, and neutrophils), and semiquantitative Real-time-PCR-based periprosthetic inflammatory mediator analysis (IFN gamma, TNF alpha, IL1-beta, IL-2, IL-6, IL-8, IL-10, IL17, and TGF beta). We analyzed 25 TKR patients with yet unexplained complications like pain, effusion, and reduced range of motion. They consisted of 20 patients with proven metal sensitization (11 with PT reactions;9 with only LTT reactivity). Control specimens were from 5 complicated TKR patients without metal sensitization, 12 OA patients before arthroplasty, and 8 PT patients without arthroplasty. Lymphocytic infiltrates were seen and fibrotic (Type IV membrane) tissue response was most frequent in the metal sensitive patients, for example, in 81% of the PT positive patients. The latter also had marked periprosthetic IFN gamma expression. 8/9 patients with revision surgery using Ti-coated/oxinium based implants reported symptom relief. Our findings demonstrate that combining allergy diagnostics with histopathology and periprosthetic cytokine assessment could allow us to design better diagnostic strategies

Die Biegestabprothese: ein experimenteller Ansatz zur metaphysären Hüftendoprothetik

The aim of our study was to develop a femoral component for total hip arthroplasty that would exclusively anchor in the metaphysis of the femoral neck. To forego trochanteric fixation, the load needs to be transferred to the metaphysis at as many points as possible. A computer simulation model suggested that an implant with a central cylinder and 16 rods aligned along a thread would be the preferable solution. To evaluate primary implantation stability, 14 fresh frozen cadaver femora were used. A special instrument set was developed to allow for centered implantation of the prosthesis without the need to dissect the greater trochanter. For our tests, we used two prototype implants: one made from titanium and the other from a CoCrMo alloy. For the measurement of micromotions at the medial proximal femur, sinusoid dynamic loading with a force between 300 N and 1700 N and a frequency of 1 Hz was employed. In a neutral position of 16 degrees adduction and 9 degrees ante-torsion, the average micronnotions measured were 119 mu m. Despite these convincing in vitro results with regards to primary stability, circular cut-out of the implant, followed by aseptic osteonecrosis, loosening might still occur in a clinical situation. Animal experiments are therefore required to further evaluate this new implant design

Intraosseous ganglion cyst of olecranon

Intraosseous ganglia are benign cysts that usually can be seen in lower extremity; especially around ankle. These cysts have fewer incidences in upper extremity, mainly around the wrist. They are extremely rare in olecranon. These lesions are often asymptomatic. Patient was a 75-year-old man who had trauma many years ago. When he came to our clinic, he complained of severe pain around his elbow that he could not do ordinary activity. He had local tenderness in elbow and 30 degree limitation in extension. In radiography, lytic, multiloculated lesion existed in region of olecranon. After excisional biopsy was done, cavity was cleaned completely with curette and was filled with autogenous bone. At 10-year follow-up, the patient was completely asymptomatic. Control radiograph showed cavity filled completely by bone; there was no evidence of relapse

Revision of hip resurfacing arthroplasty with a bone-conserving short-stem implant: a case report and review of the literature

Abstract Introduction Suitable treatment of early failure of total hip replacement is critical in younger patients, as bone stock is lost and the functional outcome is impaired. Case presentation We report the case of a 56-year-old Caucasian woman with early failure of hip resurfacing arthroplasty. While revision is usually performed with a conventional hip implant, this case report describes for the first time a revision procedure with a bone-conserving short-stem hip implant. Conclusions Our approach allows further conservation of femoral bone stock and provides a long-term solution to the patient, which maintains the possibility of using a conventional hip implant should a second revision become necessary.</p

Recurrent hydatosis at the site of non-union humerus fracture

Hydatid disease is still endemic in several regions of the world and is caused by two species of tapeworms, Echinococcus granulosus and Echinococcus alveolaris. It primary involves liver and lung, and bone involvement is relatively rare (0.2-4%), where it is most commonly seen in the spine. The skeletal involvement is usually due to secondary extension such as hematogenous spread. The disease has usually a silent manifestation until a complication exists; so, many cases are diagnosed intraoperatively. Treatment of hydatid disease because of its bone involvement and spillage of fluid with subsequent contamination seeding is difficult, so it has a high mortality rate and many cases will recur. Therefore, we can prevent these occurrences if we treat hydatid disease completely and in the primary stage. Adjuvant medical treatment, if the diagnosis is known, prevents systemic spread and recurrence. Here, we present a primary recurrent hydatosis at the site of non-union humerus fracture. We have pointed out osseous hydatosis as one of the important differential diagnoses in destructive bone lesions and the necessity of its radical resection

Sports Activity After Short-Stem Hip Arthroplasty

Background: No data are available about the sports activity of patients with bone-conserving short-stem hip implants. Hypothesis: Patients can return to a good level of sports activity after implantation of a short-stem hip implant. Study Design: Case series; Level of evidence, 4. Methods: The sports activity level of 68 patients (76 hips) after short-stem hip arthroplasty was assessed for a minimum of 2 years after implantation. In addition to the clinical examination, a detailed evaluation of the patients’ sports pattern was obtained. Furthermore, the results were analyzed with regard to gender (female and male) and age (55 years). Results: After a mean of 2.7 years, patients showed a Harris Hip Score (HHS) of 93.6, a Western Ontario and McMaster Universities Arthritis Index (WOMAC) score of 9.5, and a University of California, Los Angeles (UCLA) activity score of 7.6, with each individual participating on average in 3.5 different disciplines after surgery compared with 3.9 before surgery. High-impact activities decreased significantly postoperatively, whereas low-impact activities increased significantly. The duration of the sports activities remained stable, while the frequency actually increased. In contrast, men participated preoperatively in more sports than women (4.3 men vs 3.3 women). However, because of a pronounced decrease in high-impact activities by men, both genders participated in an equal number of sports postoperatively (3.5 men vs 3.5 women). Finally, 45% (n = 31) reported at least one activity that they missed. Most of them were disciplines with an intermediate- or high-impact level. Conclusion: Patients with a short-stem hip implant can return to a good level of activity postoperatively. Participation in sports almost reached similar levels as preoperatively but with a shift from high- to low-impact activities. This seems desirable from a surgeon’s point of view but should also be communicated to the patient before hip replacemen

Patients with Intolerance Reactions to Total Knee Replacement: Combined Assessment of Allergy Diagnostics, Periprosthetic Histology, and Peri-implant Cytokine Expression Pattern

We performed a combined approach to identify suspected allergy to knee arthroplasty (TKR): patch test (PT), lymphocyte transformation test (LTT), histopathology (overall grading; T- and B-lymphocytes, macrophages, and neutrophils), and semiquantitative Real-time-PCR-based periprosthetic inflammatory mediator analysis (IFNγ, TNFα, IL1-β, IL-2, IL-6, IL-8, IL-10, IL17, and TGFβ). We analyzed 25 TKR patients with yet unexplained complications like pain, effusion, and reduced range of motion. They consisted of 20 patients with proven metal sensitization (11 with PT reactions; 9 with only LTT reactivity). Control specimens were from 5 complicated TKR patients without metal sensitization, 12 OA patients before arthroplasty, and 8 PT patients without arthroplasty. Lymphocytic infiltrates were seen and fibrotic (Type IV membrane) tissue response was most frequent in the metal sensitive patients, for example, in 81% of the PT positive patients. The latter also had marked periprosthetic IFNγ expression. 8/9 patients with revision surgery using Ti-coated/oxinium based implants reported symptom relief. Our findings demonstrate that combining allergy diagnostics with histopathology and periprosthetic cytokine assessment could allow us to design better diagnostic strategies