Dutch guideline on total hip prosthesis

Contains fulltext : 97840.pdf (publisher's version ) (Open Access

Quality of life before and after TVT, a prospective multicentre cohort study, results from the Netherlands TVT database

Objective To asses the long term outcome of tension-free vaginal tape procedure in women with isolated stress urinary incontinence (SUI). Design Prospective cohort study. Setting Twenty-eight teaching hospitals and 13 local hospitals, with 54 gynaecologists and urologists performing the surgery. Sample Eight hundred and nine participants. Methods The Incontinence Impact Questionnaire (lIQ-7) and the Urogenital Distress Inventory (UDI-6) were used to measure the results of the TVT procedure (pre-operative at 2, 6, 12 and 24 months post-operative). According the recommendation of the International Continence Society (ICS), the question `Do you experience urinary leakage during physical activity, coughing or sneezing?' was selected from the UDI to asses SUI. Main outcome measures Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6). Results Both IIQ and UDI mean scores decreased significantly after TVT, indicating an improvement in quality of life. Subjective improvement can improve for up to two years post-operatively. Conclusions This is the largest prospective study that used these validated disease-specific questionnaires to asses the long term outcome of the TVT procedure. This study shows a statistically significant and clinically relevant long term improvement of the quality of life after a TVT for women with SUI

Three-dimensional stress analysis of threaded cups – a finite element analysis

A three-dimensional model of the left acetabulum with inserted threaded cup has been generated, based on the finite element method, to calculate stress patterns in the standing phase during walking. In this study, a hemispherical cup with sharp threads, a parabolic cup with flat threads and a conical cup with sharp threads were analysed and compared. Stress patterns in both implant components and adjacent bony structures were calculated in a directly postoperative situation. The different cups were found to induce different stress patterns, deformations and shifting tendencies. The inlays deform notably and show characteristic rotational movement patterns together with the shell. The inclination angle increases in the hemispherical cup and decreases in the parabolic cup. The conical cup levers outward almost parallel to the bone stock by approximately 0.05 mm. The pole surfaces of the various cups – especially the very convex area next to the threads – induce increased compressive stress in the superior section of the acetabular base. This is increased by a factor of three in the conical cup in comparison to the hemispherical cup and less so in comparison to the parabolic cup. This study illustrates that three-dimensional stress calculations are suitable for procuring additional biomechanical information to augment clinical studies, for evaluating implants and for establishing stability prognoses, especially for newly developed prototypes

Long-term results of cementless primary total hip arthroplasty with a threaded cup and a tapered, rectangular titanium stem in rheumatoid arthritis and osteoarthritis

The aim of this study was to assess the outcome of primary cementless total hip arthroplasty in rheumatoid arthritis patients and to compare the results with osteoarthritis patients. Sixty-four patients (77 hips) with rheumatoid arthritis and 120 patients (135 hips) with osteoarthritis had a conical-shaped Zweymueller threaded cup and a tapered, rectangular Zweymueller stem implanted and were assessed after an average of 12.5 years. The endpoints for survival analysis were failure of one or both components due to radiographic loosening or revision. Revision was defined as exchange of cup, stem or both. When the PE-insert or the ceramic ball head were exchanged leaving cup and stem in place, e.g. for PE-wear or dislocation, this was not considered a revision but a re-intervention. No differences were found in survival rates; however, in the rheumatoid arthritis group there was an increased rate of malposition of the cup, avulsions of the greater trochanter, and increased bone resorption in the trochanteric region. This study shows that despite altered biomechanical properties of rheumatoid bone, mechanical stability and osseous integration of cementless prosthesis are not compromised and, although a higher complication rate did occur, long-term survival is excellent

Long-term results of the threaded Mecron cup in primary total hip arthroplasty: A 15–20-year follow-up study

In the 1970s, high failure rates of cemented acetabular components, especially in young patients, in the middle- and long-term prompted a search for alternatives. The Mecring was one of the most popular first generation uncemented, threaded cups widely used in the 1980s for arthroplasty of the hip. First generation threaded cups commonly had smooth surface treatment and showed unacceptably high failure rates in the mid-term. In a consecutive series of 209 patients, 221 threaded uncemented acetabular cups with smooth surface treatment (Mecring) had been implanted in combination with one type of uncemented stem. Patients were followed up clinically and radiographically. The mean time of follow-up was 17 (range 15–20) years. In 91 (41%) hips the acetabular component had been revised or was awaiting revision: two hips for infection and 84 (38%) for aseptic loosening. Five hips were awaiting revision. The survival rate for all revisions including hips awaiting revision was 49% (95% CI: 41–57%) at 17 years. These results support the view that smooth, threaded acetabular components do not provide satisfactory long-term fixation and should be abandoned. Patients with these components must be closely monitored as the failure rate remains high in the long-term

Long-term results of the threaded Weill cup in primary total hip arthroplasty : A 15–20-year follow-up study

Uncemented, threaded acetabular components with smooth surface treatment were widely used in continental Europe in the 1970s and 1980s for primary total hip arthroplasty (THA). Previously published studies showed high failure rates in the mid-term. In a consecutive series of 116 patients, 127 threaded cups with smooth surface treatment (Weill cup; Zimmer, Winterthur, Switzerland) were implanted in combination with one type of uncemented stem. Patients were followed up clinically and radiographically. Mean time of follow-up was 17 years (range 15–20). At the time of follow-up, the acetabular component had been revised or was awaiting revision in 30 hips (24%). Two hips were revised for infection and 23 for aseptic loosening. Four polyethylene liners were exchanged because of excessive wear. One hip was awaiting revision. The survival rate for all acetabular revisions including one hip awaiting revision was 75% (95%CI: 65–85%) at 17 years. These results support the view that smooth, threaded acetabular components do not provide satisfactory long-term fixation and should be abandoned. It is important to closely monitor patients with these components as the failure rate remains high in the long-term