Outcome of a hemispherical porous-coated acetabular component with a proximally hydroxyapatite-coated anatomical femoral component

2019 ◽  
Vol 101-B (4) ◽  
pp. 378-385 ◽  
Author(s):  
E. García-Rey ◽  
R. Carbonell-Escobar ◽  
J. Cordero-Ampuero ◽  
E. García-Cimbrelo
Keyword(s):  
Bone Ingrowth ◽  
Long Term Results ◽  
Head Penetration ◽  
Kaplan Meier ◽  
Late Dislocation ◽  
Component Revision ◽  
Clinical And Radiological Results ◽  
Acetabular Osteolysis

Aims We previously reported the long-term results of the cementless Duraloc-Profile total hip arthroplasty (THA) system in a 12- to 15-year follow-up study. In this paper, we provide an update on the clinical and radiological results of a previously reported cohort of patients at 23 to 26 years´ follow-up. Patients and Methods Of the 99 original patients (111 hips), 73 patients (82 hips) with a mean age of 56.8 years (21 to 70) were available for clinical and radiological study at a minimum follow-up of 23 years. There were 40 female patients (44 hips) and 33 male patients (38 hips). Results All acetabular and femoral components were well fixed and showed signs of bone ingrowth. Nine acetabular components were revised due to wear-osteolysis-related problems and four due to late dislocation. The probability of not having component revision at 25 years was 83.2% (95% confidence interval (CI) 74.5 to 91.8; number at risk 41). Acetabular osteolysis was observed in ten hips. The mean femoral head penetration was 1.52 mm (sd 0.8) at 15 years and 1.92 mm (sd 1.2) at 25 years. Receiver operating characteristic (ROC) analysis revealed that mean femoral penetration with a value of 0.11 mm/year or more was associated with the appearance of osteolysis. The 25-year Kaplan–Meier survival with different endpoints was 89.9% for acetabular osteolysis (95% CI 83.3 to 96.5), 92.1% for proximal femoral osteolysis (95% CI 86.1 to 98.2), and 75.5% for femoral osteopenia (95% CI 66.5 to 84.5). Conclusion The Duraloc-Profile THA system showed excellent long-term bone fixation. Nevertheless, monitoring is recommended in order to detect wear and late dislocations in this population that was relatively young at the time of surgery. Cite this article: Bone Joint J 2019;101-B:378–385.

scholarly journals Clinical results of the Metha short hip stem: a perspective for younger patients?

2013 ◽  
Vol 5 (4) ◽  
pp. 34 ◽  
Author(s):  
Fritz Thorey ◽  
Claudia Hoefer ◽  
Nima Abdi-Tabari ◽  
Matthias Lerch ◽  
Stefan Budde ◽  
...  
Keyword(s):  
Bone Ingrowth ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Femoral Revision ◽  
Term Survival ◽  
Younger Patients ◽  
The Mean ◽  
Short Stems

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

Reinforcement Rings for Deficient Acetabular Bone in Revision Surgery: Long-Term Results

1997 ◽  
Vol 7 (2) ◽  
pp. 57-64 ◽  
Author(s):  
E. Garcia-Cimbrelo ◽  
J. Alonso-Biarge ◽  
J. Cordero-Ampuero
Keyword(s):  
Revision Surgery ◽  
Clinical Results ◽  
Long Term Results ◽  
Cumulative Probability ◽  
Metal Ring ◽  
Kaplan Meier ◽  
Medial Migration ◽  
Cemented Cup

This study analyzes the long-term results of 23 metal ring supports used in revision surgery since 1979. Only a metallic ring and a cemented cup were used in this series. Bone grafts and cementless cups were excluded from this study. One deep infection was excluded from the follow-up study. In the 22 cases analyzed, the mean follow-up period was 10 years for all cases and 12.2 years for unrevised cases. Bone defects according to the AAOS classification were: Grade 1, 1 case, Grade 2, 1 case, Grade 3, 10 cases, and Grade 4, 10 cases. A Müller ring was indicated in an anterior or medial wall defect (12 cases) and a Burch-Schneider ring was indicated in an anterior or posterior column defect or in pelvic discontinuity (10 cases). The clinical results were good in 8 cases, fair in 8 cases, and poor in 6 cases. Six cases were rerevised or removed, resulting in a total cumulative probability of rerevison or removal of 23.8% after 10 years according to the Kaplan-Meier analysis. Postoperatively, 18 cases had neutral rings, 2 cases had horizontal rings, and 2 cases had vertical rings. Radiological cup migration was found in 12 cases, resulting in a total cumulative probability of migration of 56.8% after 13 years according to the Kaplan-Meier analysis. Changes in the acetabular angle were present in 2 cases, vertical migration in 12 cases, and medial migration in 10 cases. Our data suggest that the metal ring and cemented cup alone could be used for salvage surgery in elderly patients and in low-demand patients. Possibly, adding bone graft could improve these results.

scholarly journals Arthroscopic Lift, Drill, Fill and Fix (LDFF) for Talar OCDs Stands the Test of Time: Mean 5 year Follow-Up Results in 25 Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Kaj Lambers ◽  
Nienke Altink ◽  
Jari Dahmen ◽  
Sjoerd Stufkens ◽  
Gino Kerkhoffs
Keyword(s):  
Rating Scales ◽  
Bone Ingrowth ◽  
Distal Tibia ◽  
Clinical Results ◽  
Long Term Results ◽  
Arthroscopic Fixation ◽  
Pain Symptoms ◽  
Pain At Rest

Category: Ankle, Arthroscopy Introduction/Purpose: The purpose of this study was to describe the long-term clinical and radiological outcome of a new arthroscopic fixation technique for primary osteochondral talar defects: Lift, Drill, Fill and Fix (LDFF). Methods: Twenty-five patients underwent an arthroscopic LDFF surgery for osteochondral talar defects. Two of these patients underwent surgery on both ankles. During the LDFF technique, the OCD was identified after which an osteochondral flap was created and lifted (lift-phase). The bone flake of the OCD as well as the osteosclerotic area of the bed was drilled (drill phase). Cancellous bone was harvested from the distal tibia and transported into the defect until there was sufficient substantial filling (fill phase). Finally, the osteochondral flap was fixed with an absorbable biocompression screw (fix phase). The mean follow-up was 63 months (SD 9.2). Pre- and postoperative clinical assessment included the Foot and Ankle Outcome Score (FAOS) and the numeric rating scales (NRS) of pain at rest and during walking. Remodeling and bone ingrowth after LDFF were analyzed on computed tomography scans during follow-up at one year after the surgery. Results: All patients were available for final follow-up. At final follow-up, LDFF led to a significant improvement of the NRS of pain during rest and the NRS of pain during walking in all patients. The FAOS significantly improved on all 5 subscales: pain, symptoms, activities of daily living, sport and recreation and quality of life. The NRS of pain at rest significantly improved from 2.3 to 1.0 (p = 0.01), and pain with walking significantly improved from 5.7 to 1.6 (p < 0.001). In total 24 out of 25 patients, and 26 out of 27 ankles, showed remodeling and bone ingrowth on CT scans 1 year after the arthroscopic fixation procedure. No complications occurred. Conclusion: Arthroscopic LDFF of an osteochondral talar defect shows good long-term results at 5 year follow-up after surgery. Although the radiological results at 1-year follow-up and the long-term clinical results are encouraging, more patients and long- term radiological follow-up is necessary in order to identify prognostic factors on outcomes.

scholarly journals Long-Term Results of Joint Arthroplasty with Total Prosthesis for Trapeziometacarpal Osteoarthritis in Patients over 65 Years of Age

Geriatrics ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 65
Author(s):  
Miguel Angel Martin-Ferrero ◽  
Jose Maria Trigueros-Larrea ◽  
Elsa Martin-de la Cal ◽  
Begoña Coco-Martin ◽  
Clarisa Simon-Perez
Keyword(s):  
Long Term Results ◽  
Joint Involvement ◽  
Kaplan Meier ◽  
Trapeziometacarpal Osteoarthritis ◽  
Prevalent Disease ◽  
Patient Selection Criteria ◽  
Clinical And Radiological Results ◽  
Surgical Treatments ◽  
Joint Arthroplasties

Trapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study.

scholarly journals Lesión compleja del codo pediátrico: fractura de cóndilo externo asociada a luxación posteromedial de codo.

2020 ◽  
pp. 56-60
Author(s):  
A DARAS-BALLESTER ◽  
NADIA JOVER-JORGE ◽  
PEDRO DOMENECH-FERNANDEZ
Keyword(s):  
Open Reduction ◽  
Elbow Dislocation ◽  
Complex Case ◽  
Long Term Results ◽  
K Wires ◽  
Condyle Fracture ◽  
Clinical And Radiological Results ◽  
Humeral Condyle

Background and aim: External humeral condyle fracture associated with a posteromedial elbow dislocation is a very rare entity, of which there are very few cases published. Our objective is to present a complex case treated in our Hospital, the diagnosis, the treatment we chose, and the follow-up at 9 weeks after the intervention. Clinical case: 5-year-old boy with a posteromedial elbow dislocation associated with an external humeral condyle fracture, which was diagnosed by CT and treated surgically using an anterior approach over the elbow, open reduction, and osteosynthesis with K-wires. Results: clinical and radiological results 9 weeks after the intervention were excellent, presenting a Radiographic consolidation of the fracture and an excellent range of joint mobility. Conclusion: early diagnosis and surgical treatment through open reduction and osteosynthesis of the external condyle is the gold standard on treatment for these injuries, since a bad reduction leads to poor long-term results.

Durable Responses to Lenalidomide (Revlimid®) in Patients with AL Amyloidosis: Follow Up of a Phase II Trial.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 192-192 ◽  
Author(s):  
David C. Seldin ◽  
Michael Rosenzweig ◽  
Kathleen T. Finn ◽  
Salli Fennessey ◽  
Anthony Shelton ◽  
...  
Keyword(s):  
Long Term Results ◽  
Plasma Cell Dyscrasia ◽  
High Dose ◽  
Al Amyloidosis ◽  
Treatment Protocols ◽  
Results Of Treatment ◽  
Kaplan Meier ◽  
High Dose Melphalan

Abstract AL amyloidosis is a clonal plasma cell dyscrasia in which misfolded immunoglobulin light chains deposit in tissues and produce organ failure and death. Untreated, median survival is short. Melphalan-based regimens can produce hematologic remissions and improvement in organ function; more than 20% of patients treated with high dose melphalan and autologous stem cell transplantation (HDM/SCT) have survived more than 10 years (Blood, in press). The combination of lenalidomide and dexamethasone can also produce partial and complete hematologic responses (Blood2007;109:492–496). Here we report on remission duration and long-term results of treatment in the original 34 patients and an additional 9 patients, with median follow up of 26.5 m. The median age of the 43 patients was 64 (range, 44–84), 70% were male, 67% were lambda isotype, 46% had multi-organ involvement, and 42% had cardiac involvement. 90% had received prior melphalan-based therapy; in 60% this was HDM/SCT. 14% of patients had received thalidomide and 5%, bortezomib. 10% had no prior treatment. Patients were begun at 15 mg lenalidomide per day for 21 days per month; the median tolerated dose was 10 mg. The response rate was 60% (24% CR, 36% PR); an additional 15% of patients had minor responses. Of the 8 patients who achieved a CR, 6 occurred at 3–6 months of treatment, but 2 were late (18m, 19m). 7 of 8 are alive; one died of cardiac allograft rejection. 3 of 8 have relapsed. 5 of 8 maintain remissions for 6–30 m, of which 4 of 8 continue in CR off therapy for 6–21m. Kaplan-Meier survival for all 43 patients is shown. 7 of 8 patients achieving CR had significant proteinuria: in 2 patients (29%), proteinuria resolved (2 g to 120 mg, 8.8 g to 140 mg); in 3 (43%) it improved by 50% or more; and in 2 there has been no change. Thus, lenalidomide can produce beneficial hematologic and organ responses in AL amyloidosis patients, and remissions can be durable off therapy. Further trials should be done to determine how and when to incorporate lenalidomide into treatment protocols for AL amyloidosis. Figure Figure

Overestimation of the risk of revision with Kaplan-Meier presenting the long-term outcome of total hip replacement in older patients

2017 ◽  
Vol 28 (3) ◽  
pp. 246-253 ◽  
Author(s):  
Kalliopi Lampropoulou-Adamidou ◽  
Theofilos S Karachalios ◽  
George Hartofilakidis
Keyword(s):  
Cumulative Incidence ◽  
Older Patients ◽  
Relative Difference ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Total Hip ◽  
Kaplan Meier

Introduction: The purpose of the present study was (i) to review the long-term outcome of cemented Charnley total hip replacements (THRs) performed by 1 surgeon (GH), 20 to 42 years ago, in patients ≥60 years, using both the Kaplan-Meier (KM) and the cumulative incidence (CI) methods, and (ii) to compare the estimations of the 2 statistical methods. Methods: We evaluated the outcome of 306 consecutive primary cemented THRs that were performed in 265 patients. The final clinical, radiographic assessment and satisfaction of living patients were also included. The survivorship was estimated with the use of KM and CI methods and the relative difference between their estimations was calculated. Results: Living patients’ final clinical results were significantly improved in comparison with respective preoperative ones, and all the acetabular and 91% of femoral components considered as well fixed. 95% of these patients reported satisfaction. The risk of revision at 25 years, with revision for aseptic loosening for 1 or both components as the endpoint, with 21 hips at risk, assessed with KM analysis was 6.9% and with CI approach was 3.9%. The relative difference between KM and CI estimations was increasing during follow-up, reaching up to 76.8% at 25 years. Conclusions: We concluded that fixation of implants with cement in older patients had satisfactory long-term results and can serve as a benchmark with which to compare newer fixation methods (hybrid and uncemented) and materials. However, KM method, in studies that include older population with long-term follow-up, may significantly overestimate the risk of revision and clinicians could consider using besides the cumulative incidence of competing risk method.

Mid- and long-term results of femoral component revision using the cement-in-cement technique: Average 10.8-year follow-up study

2016 ◽  
Vol 21 (6) ◽  
pp. 810-814 ◽  
Author(s):  
Yaichiro Okuzu ◽  
Koji Goto ◽  
Kazutaka So ◽  
Yutaka Kuroda ◽  
Shuichi Matsuda
Keyword(s):  
Femoral Component ◽  
Long Term Results ◽  
Follow Up Study ◽  
Component Revision

scholarly journals Long-term results of cementless total hip arthroplasty for the treatment of ankylosed hip

2019 ◽  
Vol 27 (2) ◽  
pp. 230949901985803
Author(s):  
Goksel Dikmen ◽  
Vahit Emre Ozden ◽  
Fırat Gulagaci ◽  
I. Remzi Tozun
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Long Term Results ◽  
Cementless Fixation ◽  
Length Discrepancy ◽  
Kaplan Meier ◽  
The Mean

Purpose: The purpose of this study was to report the long-term results of total hip arthroplasty (THA) for the treatment of ankylosed hip. Methods: Twenty-nine consecutive THAs were performed in 26 patients. The mean age of the patients at the time of the operation was 43.3 years (range, 19–69 years). We used cementless fixation in all hips and the mean duration of follow-up was 10.1 years (range, 4.5–20 years). Radiological evaluation of components, osteolysis, radiolucent lines and loosening were assessed. The Harris Hip Score (HHS), range of motion (ROM), limb-length discrepancy and walking capacity with or without any support were used preoperatively and at final follow-up for clinical evaluation. Survivorship analysis was conducted using the Kaplan–Meier method using second revision for any reason as the endpoint. Results: The mean HHS was 85.6 (range, 55–98) points and mean ROM was 110.5° for flexion. The mean limb-length discrepancy improved from 4.1 cm to 1.1 cm. Positive Trendelenburg sign was recorded in 31% of the patients and 24% of patients needed any support for walking postoperatively. We observed surgical complications related to abductor arm in 25% of the patients. Radiolucency on the acetabular side was seen on one or more zones in 15 patients (16 hips). One aseptic acetabular component loosening was observed. On the femoral side, 11 patients demonstrated non-progressive radiolucent lines and osteolysis around the stem was seen in four hips but there was no aseptic stem loosening. The Kaplan–Meier survival rate considering revision for any reason as the endpoint was 81.5%, for aseptic loosening 91.3%, for a worst-case scenario of 66.4% at 10 years. Conclusion: Cementless fixation showed good to excellent results at 10 years. Preoperative and postoperative abductor status of the patient is critical for patient satisfaction.

scholarly journals PERsistent Sitagliptin treatment & Outcomes (PERS&O 2.0) study, long-term results: a real-world observation on DPP4-inhibitor effectiveness

2020 ◽  
Vol 8 (1) ◽  
pp. e001507
Author(s):  
Antonio Carlo Bossi ◽  
Valentina De Mori ◽  
Carlotta Galeone ◽  
Davide Pietro Bertola ◽  
Margherita Gaiti ◽  
...  
Keyword(s):  
Adverse Events ◽  
Real World ◽  
Repeated Measures ◽  
Long Term Results ◽  
Italian Population ◽  
Drug Survival ◽  
Kaplan Meier ◽  
Significant Difference

IntroductionSitagliptin is a dipeptidyl peptidase 4 inhibitor for the treatment of type 2 diabetes (T2D). Limited real-world data on its effectiveness and safety are available from an Italian population.Research design and methodsWe evaluated long-term clinical data from the single-arm PERsistent Sitagliptin Treatment & Outcomes (PERS&O) study, which collected information on 440 patients with TD2 (275 men, 165 women; mean age 64.1 years; disease median duration: 12 years) treated with sitagliptin ‘add-on’. For each patient, we estimated the 10-year cardiovascular (CV) risk using the UK Prospective Diabetes Study (UKPDS) Risk Engine (RE). Drug survival was evaluated using Kaplan-Meier survival curves; repeated measures mixed effects models were used to evaluate the evolution of glycated hemoglobin (HbA1c) and CV risk during sitagliptin treatment.ResultsAt baseline, most patients were overweight or obese (median body mass index (BMI) (kg/m2) 30.2); median HbA1c was 8.4%; median fasting plasma glucose: 172 mg/dL; median UKPDS RE score: 24.8%, being higher in men (median 30.2%) than in women (median 17.0%) as expected. Median follow-up from starting sitagliptin treatment was 5.6 years. From Kaplan-Meier curves, the estimated median drug survival was 32.8 months when considering discontinuation for any cause and 58.4 months when considering discontinuation for loss of efficacy. A significant improvement in HbA1c was evident during treatment with sitagliptin (p<0.01): the reduction was rapid (median HbA1c after 4–6 months: 7.5%) and continued at longer follow-up. When comparing patients treated with sitagliptin versus those stopping sitagliptin and switching to another antihyperglycemic drug, we detected a significant difference in the evolution of HbA1c in favor of patients who continued sitagliptin treatment. The UKPDS RE score at 10 years and the BMI significantly improved during treatment with sitagliptin (p<0.001). Adverse events were relatively uncommon.ConclusionPatients with T2D treated with sitagliptin achieved an improvement in metabolic control and a reduction in CV risk and did not experience relevant adverse events.

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