Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach

The aetiology of osteoporotic fractures is multifactorial, but little is known about the way to evaluate patients with a recent clinical fracture for the presence of secondary osteoporosis

Late Occurring Medial Migration of a Lag Screw in Gamma Nailing

An 81-year-old female was treated for a pertrochanteric multifragmentary fracture of the proximal femur with a third-generation Gamma nail. After 3 months she presented herself again with acute pain and inability to bear weight on the leg. Radiographs showed medial migration of the lag screw. She was treated with a total hip arthroplasty, after which she was successfully discharged. In this case report the possible causes of this late and unusual complication are discussed

5-year clinical and radiographic follow-up of the uncemented Symax hip stem in an international study

Abstract Background The uncemented Symax hip stem is developed through optimization of the uncemented Omnifit hip stem. The Symax stem design combines an anatomical anteverted proximal geometry with a straight distal section. The proximal part is coated with a biomimetic hydroxyapatite (HA) coating for improved osseointegration to enhance load transfer and to minimize proximal bone loss. The distal part is treated with an anodization surface treatment in order to prevent distal bone apposition, which is expected to prevent distal loading and reduce proximal stress shielding. Aim of this study is to report mid-term clinical performance and evaluate whether the radiographic features are in line with the design principles of the Symax hip. Methods The biomimetic hydroxyapatite-coated uncemented Symax hip stem was evaluated in 80 patients during a 5-year prospective clinical international study. Harris Hip Score (HHS), Oxford Hip Score (OHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were performed preoperatively and postoperatively at 6 months and 1, 2, 3 and 5 years. Anteroposterior radiographs of the pelvis and axial radiographs of the operated hips were evaluated immediately postoperative and at follow-up 6 months and 1, 2, 3, and 5 years. Wilcoxon signed-rank test was used to analyse whether clinical outcome scores changed statistically significant over time. The overall percentage of agreement between two radiology assessment teams was used to evaluate observer agreement of radiology results. The Cohen’s Kappa was evaluated as a measure of reliability to quantify the agreement between raters, corrected for chance agreement. Results Clinical outcome scores were excellent at 5 years with mean HHS of 98.1, mean OHS of 16.2 and mean WOMAC of 6.9. Only 2.7% of the patients had pain at rest or on weight-bearing, and mid-thigh pain was reported by 1.4% of the patients after 5 years. The percentage of agreement between radiology assessment teams was 94 to 100%, except for distal line formation (48%). Radiographic evaluation showed stable stems and signs of excellent progressive proximal fixation and favourable bone remodeling. Conclusions The excellent mid-term clinical and radiographic performances are in line with the design principles and coating properties of this new implant and earlier published results. Trial registration http://ClinicalTrials.gov, NCT03469687. Registered 19 March 2018 – Retrospectively registered

Early stabilization of the uncemented Symax hip stem in a 2-year RSA study

Background and purpose — The uncemented Symax hip stem has shown early proximal ingrowth as result of the BONIT-hydroxyapatite (HA) coating and the distal DOTIZE surface treatment. We evaluated 2-year postoperative radiostereometric analysis (RSA) migration of the Symax hip stem in THA patients. We also investigated the correlation between migration at 4 weeks and clinical outcomes after 2 years. Patients and methods — Patients in a 2-year clinical follow-up single-centre RSA randomized controlled trial were randomized to 2 different cup designs. All 45 patients received a Symax hip stem. RSA migration patterns of the Symax hip stem is presented here as a single cohort. RSA examinations were performed postoperatively, but before weight-bearing, and subsequently after 1, 3, 6, 12, and 24 months. Clinical outcomes and radiographic evaluations were assessed 3, 6, 12, and 24 months postoperatively. Results — During the first 4 weeks, the Symax hip stem subsided, rotated into retroversion, and translated posteriorly, after which the migration ceased and the prosthesis stabilized. All clinical outcomes improved from preoperatively to 2 years. There was no clinically or statistically significant correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years. Interpretation — RSA evaluation of the uncemented Symax hip stem confirms that the design principles and coating properties lead to early stabilization of the stem, as early as 4 weeks postoperatively. There was no correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years. Based on the predictive potential of the RSA technique, we anticipate excellent long-term survival of this hip stem

Results of total hip arthroplasties in the young patient; further evidence for a barrier against articular wear debris by hydroxyapatite coatings

We examined the hypothesis that the circumferential osseous apposition around HA-coated implants forms a protective barrier against articular wear debris. Sixty-five hydroxyapatite-coated total hip arthroplasties in 57 patients (age There was no correlation between PE-wear and osteolysis of the femoral zones or cup zones I and III. A strong Pearson correlation was found between polyethylene wear and osteolysis around cup zone II, where the cup only consisted of polyethylene (p The circumferential osseous apposition of the HA-coated implants possibly formed a protective barrier against articular wear debris. The use of cups with a backside gap resulted in PE-wear associated osteolysis in cup zone II and may be considered to be best avoided. (Hip International 2009; 19: 343-51

Results of total hip arthroplasties in the young patient; further evidence for a barrier against articular wear debris by hydroxyapatite coatings

We examined the hypothesis that the circumferential osseous apposition around HA-coated implants forms a protective barrier against articular wear debris. Sixty-five hydroxyapatite-coated total hip arthroplasties in 57 patients (age There was no correlation between PE-wear and osteolysis of the femoral zones or cup zones I and III. A strong Pearson correlation was found between polyethylene wear and osteolysis around cup zone II, where the cup only consisted of polyethylene (p The circumferential osseous apposition of the HA-coated implants possibly formed a protective barrier against articular wear debris. The use of cups with a backside gap resulted in PE-wear associated osteolysis in cup zone II and may be considered to be best avoided. (Hip International 2009; 19: 343-51