Acetabular components in total hip arthroplasty: is there evidence that cementless fixation is better?

BACKGROUND: The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade. Most total hip arthroplasties being performed in North America currently use cementless acetabular components. The objective of this systematic review and meta-analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty. METHODS: A primary literature search in PubMed identified 3488 articles, of which 3407 did not meet the inclusion criteria and were excluded. Only English-language articles on either the survivorship or revision rate of primary total hip arthroplasty at a minimum of ten years of follow-up were included. The present study analyzed forty-five articles reporting the long-term outcome of cementless acetabular components, twenty-nine reporting the outcome of cemented acetabular components, and seven comparing cemented and cementless acetabular components. Meta-analysis (with a random-effects model) was performed on the data from the seven comparative studies, and study-level logistic regression analysis (with a quasibinomial model) was performed on the pooled data on the eighty-one included articles to determine a consensus. The studies were weighted according to the number of total hip arthroplasties performed. RESULTS: The meta-analysis did not reveal any effect of the type of acetabular component fixation on either survivorship or revision rate. The regression analysis revealed the estimated odds ratio for survivorship of a cemented acetabular component to be 1.60 (95% confidence interval, 1.32 to 2.40; p = 0.002) when adjustments for factors including age, sex, and mean duration of follow-up were made. CONCLUSIONS: The preference for cementless acetabular components on the basis of improved survivorship is not supported by the published evidence. Although concerns regarding aseptic loosening of cemented acetabular components may have led North American surgeons toward the nearly exclusive use of cementless acetabular components, the available literature suggests that the fixation of cemented acetabular components is more reliable than that of cementless components beyond the first postoperative decade

Femoral impaction bone grafting in revision hip arthroplasty: 705 cases from the originating centre.

Femoral impaction bone grafting was first developed in 1987 using morselised cancellous bone graft impacted into the femoral canal in combination with a cemented, tapered, polished stem. We describe the evolution of this technique and instrumentation since that time.Accepted manuscript 12 month embarg

Mortality following hip arthroplasty--inappropriate use of National Joint Registry (NJR) data

Mortality following hip arthroplasty is affected by a large number of confounding variables each of which must be considered to enable valid interpretation. Relevant variables available from the 2011 NJR data set were included in the Cox model. Mortality rates in hip arthroplasty patients were lower than in the age-matched population across all hip types. Age at surgery, ASA grade, diagnosis, gender, provider type, hip type and lead surgeon grade all had a significant effect on mortality. Schemper's statistic showed that only 18.98% of the variation in mortality was explained by the variables available in the NJR data set. It is inappropriate to use NJR data to study an outcome affected by a multitude of confounding variables when these cannot be adequately accounted for in the available data set

Evidence of VX nerve agent use from contaminated white mustard plants

The Chemical Weapons Convention prohibits the development, production, acquisition, stockpiling, retention, transfer or use of chemical weapons by Member States. Verification of compliance and investigations into allegations of use require accurate detection of chemical warfare agents (CWAs) and their degradation products. Detection of CWAs such as organophosphorus nerve agents in the environment reliesmainly upon the analysis of soil.We now present a method for the detection of the nerve agent VX and its hydrolysis products by gas chromatography and liquid chromatography mass spectrometry of ethanol extracts of contaminated white mustard plants (Sinapis alba) which retained the compounds of interest for up to 45 days. VX is hydrolysed by the plants to ethyl methylphosphonic acid and then to methylphosphonic acid. The utility of white mustard as a nerve agent detector and remediator of nerve agent-polluted sites is discussed. The work described will help deter the employment of VX in conflict

The results of acetabular impaction grafting in 129 primary cemented total hip arthroplasties.

Between 1995 and 2003, 129 cemented primary THAs were performed using full acetabular impaction grafting to reconstruct acetabular deficiencies. These were classified as cavitary in 74 and segmental in 55 hips. Eighty-one patients were reviewed at mean 9.1 (6.2-14.3) years post-operatively. There were seven acetabular component revisions due to aseptic loosening, and a further 11 cases that had migrated >5mm or tilted >5° on radiological review - ten of which reported no symptoms. Kaplan-Meier analysis of revisions for aseptic loosening demonstrates 100% survival at nine years for cavitary defects compared to 82.6% for segmental defects. Our results suggest that the medium-term survival of this technique is excellent when used for purely cavitary defects but less predictable when used with large rim meshes in segmental defects.RD&E staff can access the full-text of this article via OpenAccess. Click on the ‘Additional Link’ above to access the full-text and log in with NHS OpenAthens if propted

Cement-in-cement femoral component revision in the multiply revised total hip arthroplasty: results with a minimum follow-up of five years.

We present the clinical and radiological results at a minimum follow-up of five years for patients who have undergone multiple cement-in-cement revisions of their femoral component at revision total hip arthroplasty (THA)

Cement-in-cement femoral component revision in the multiply revised total hip arthroplasty: results with a minimum follow-up of five years.

We present the clinical and radiological results at a minimum follow-up of five years for patients who have undergone multiple cement-in-cement revisions of their femoral component at revision total hip arthroplasty (THA)

Detection of the organophosphorus nerve agent VX and its hydrolysis products in white mustard plants grown in contaminated soil

he Chemical Weapons Convention (CWC) aims to prohibit the development, production, acquisition, stockpiling, retention, transfer or use of chemical weapons by States Parties. Verification of compliance or investigations into allegations of use requires accurate detection of chemical warfare agents (CWAs) and their breakdown products. Detection of CWAs such as organophosphorus nerve agents in the environment relies mainly upon the analysis of soil. Here we present a novel method for the detection of the nerve agent VX and its hydrolysis products through analysis using a combination of gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) of ethanol extracts of contaminated vegetation (white mustard, Sinapis alba), which localised the compounds of interest, and in this study retained them in an extractable form longer than the soil