A csípőprotézis-választás nehézségeinek és felelősségének bemutatása egy eset kapcsán

2021 ◽  
Vol 162 (20) ◽  
pp. 800-805
Author(s):  
Dragos Schiopu ◽  
F. Pieter Reynders ◽  
S. Tamás Illés

Összefoglaló. A felszínpótló, fém a fémen csípőízületi protézisek reneszánszukat élték a 2000-es években. Elsősorban fiatal, aktív betegek esetében javasolták használni a remélt elméleti előnyök, mint a combfej csontállományának megőrzése, a csípőízület biomechanikájának fenntartása, a luxatio kockázatának csökkentése, a polietilén törmelékek és kopástermékek hiánya miatt. Bemutatunk egy beteget, akinél 19 éves korában kétszeri vesetranszplantációt követő, hosszan tartó szteroidkezelés következtében kialakult kétoldali combfejnekrózis miatt került sor felszínpótló, fém a fémen csípőprotézis beültetésére. A harmadik posztoperatív évtől mindkét csípőt érintő, fokozatosan súlyosbodó fájdalom, pszichés tünetek, valamint ismételt veseelégtelenség alakult ki. A tünetek hátterében kifejezetten magas Co-Cr szérumszintet, a csípőízület környezetében pszeudotumor-kialakulást, kiterjedt acetabularis cystákat, a combnyakak jelentős elvékonyodását találtuk, mely jobb oldalon periprotetikus combnyaktörést okozott. A revíziós műtétek során talált kiterjedt szöveti metallosis eltávolítását követően a felszínpótló protéziseket cement nélküli kerámia–kerámia totális protézisekre cseréltük. A revíziókat követően a lokális és pszichés tünetek megszűntek, a szérum Co-Cr szintje normalizálódott, ami lehetővé tette a harmadik vesetranszplantáció elvégzését is. Páciensünk csípőrevíziókat követő gyors javulása közvetett bizonyítékként szolgál a Co-Cr ionok negatív szerepére mind a helyi, mind a szisztémás szöveti reakciókban, így a transzplantált vese károsodásában. Esetünk tanulságai, hogy szervtranszplantációt követően kerülni kell a fém a fémen protézisek használatát, valamint hogy nem elég a csípőízületi protézis indikációjának felállítása és a legmodernebbnek tartott protézis használata. Különös gonddal és elmélyülten kell elemezni a beteg járulékos körülményeit, gyógyszerelését, társbetegségeit is ahhoz, hogy a legmegfelelőbb típusú protézist tudjuk kiválasztani, ami nem megkerülhető felelőssége az ortopéd sebészeknek. Orv Hetil. 2021; 162(20): 800–805. Summary. The surface replacement, metal on metal hip prostheses, experienced a renaissance in the 2000s. It has been recommended for use primarily in young, active patients due to expected theoretical benefits such as preserving femoral bone stock, maintaining hip joint biomechanics, reducing the risk of dislocation, and lacking polyethylene debris abrasion products. We present a patient who had resurfacing prosthesis because of bilateral femoral head necrosis due to long-term steroid treatment following double kidney transplantation at the age of 19. In the third postoperative year, progressive pain in both hips, psychiatric symptoms, and recurrent renal failure developed. We found extremely high serum Co-Cr levels, pseudotumor formation of the hip joint, extensive acetabular cysts, and significant thinning of the femoral neck, followed by a periprosthetic femoral neck fracture on one side. After removing the extensive tissue metallosis found during the revision surgeries, the surface replacement prostheses were replaced with cementless ceramic–ceramic total prostheses. Following the revisions, local and psychiatric symptoms resolved, and serum Co-Cr levels normalized, allowing a third kidney transplant to be performed. The rapid improvement of our patient after prosthesis revisions serves as indirect evidence for the negative role of Co-Cr ions in both local and systemic tissue reactions, including damage to the transplanted kidney. Our case report shows that the use of metal on metal prostheses after organ transplantation should be avoided and simply setting up an indication for hip prosthesis and use the most modern type of prosthesis is inadequate. Depth analysis of the patient’s ancillary conditions, medications, co-morbidities are required to select the most appropriate prosthesis type, which is an unavoidable responsibility of orthopedic surgeons. Orv Hetil. 2021; 162(20): 800–805.

Author(s):  
T. Kara ◽  
S. Takak ◽  
M. Ali ◽  
J. Hoffman

Hip implants have successfully been employed since the 1900’s. With the development of the total hip arthroplasty (THA) in 1960 by Sir John Charnley (Mohamed N. Rahaman, 2007), Since then the development of wear resistant materials has been extensive and improved the life time of hip prosthesis. (V. Banchet, 2007) THA wholly reconstructs the hip joint and enables joint kinematics. Components include an acetabulum liner and cup and femoral head and neck. Common combinations included metal on plastic, metal on metal, and ceramic on ceramic head and cup compnents.


1999 ◽  
Vol 81 (3) ◽  
pp. 400-3 ◽  
Author(s):  
HIROKAZU IIDA ◽  
EISHI KANEDA ◽  
HIDEAKI TAKADA ◽  
KANJI UCHIDA ◽  
KEIICHI KAWANABE ◽  
...  

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110122
Author(s):  
Wenlu Liu ◽  
Huanyi Lin ◽  
Xianshang Zeng ◽  
Meiji Chen ◽  
Weiwei Tang ◽  
...  

Objective To compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C). Methods Patient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter. Results The mean follow-up was 84.12 (67–100) months for UTR and 84.23 (66–101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR). Conclusion In the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.


2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Tim W. Rattay ◽  
Torsten Kluba ◽  
Ludger Schöls

AbstractA 53-year old male with a history of progressive visual impairment, hearing loss, peripheral neuropathy, poorly controlled diabetes mellitus, cardiomyopathy, and weight loss was referred to the rare disease center due to the suspicion of mitochondrial cytopathy. In line with mitochondrial dysfunction, lactate in CSF was increased. Genetic testing by whole-exome sequencing and mitochondrial DNA did not reveal a likely cause. The case remained unsolved until he developed pain in his right hip, where he had received total hip arthroplasty 12 years earlier. An orthopedic evaluation revealed substantial shrinkage of the head of the hip prosthesis. Due to metal-on-metal wear, debris chromium and cobalt levels in serum were massively increased and significantly improved with multisystemic impairment after exchanging the defective implant.


2020 ◽  
pp. 112070002097927
Author(s):  
Kevin C Ilo ◽  
Harry S Hothi ◽  
John A Skinner ◽  
Alister J Hart

Background: Modularity of metal-on-metal (MoM) implants has come under scrutiny due to concerns regarding additional sources of metal debris. This study is a retrieval analysis of implants from the same manufacturer with the same MoM bearing surface. The difference between the implants was presence or absence of modular junctions. Methods: This is a retrospective study of 31 retrieved implants from 31 patients who received a Conserve Wright Medical MoM hip prosthesis. The 31 implants consisted of 16 resurfacings and 15 implants with modular junctions; 4 conventional THAs and 11 modular-neck THAs. Results: 43% of pre-revision MRI scans performed on resurfacing implants and 91% performed on the modular implants illustrated evidence of an adverse local tissue reaction. There was no difference in pre-revision blood metal ion levels or bearing surface wear between the resurfacings and modular implants. The neck-head tapers of the modular group showed low levels of material loss. However, the neck-stem tapers showed increased severity of corrosion and material loss Conclusions: The modular implants had an increased incidence of adverse local tissue reaction. This could be related to the presence of modular junctions, particular the neck-stem junction which showed increased susceptibly to corrosion


2015 ◽  
Vol 42 (2) ◽  
pp. 106-110
Author(s):  
Vania Regina Goveia ◽  
Isabel Yovana Quispe Mendoza ◽  
Bráulio Roberto Gonçalves Marinho Couto ◽  
Jose Antonio Guimarães Ferreira ◽  
Edson Barreto Paiva ◽  
...  

OBJECTIVE: to characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. METHODS: we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State - MG, Brazil. Data were analyzed using descriptive statistics. RESULTS: orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82%) was femoral neck fracture by low-energy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%), peri-prosthetic fracture (15%) and aseptic loosening (15%). The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. CONCLUSION: patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.


2021 ◽  
Vol 11 (9) ◽  
pp. 875-885
Author(s):  
Ihor Venher ◽  
Sviatoslav Kostiv ◽  
Dymytrii Khvalyboha

Background. Important part of orthopaedic surgery is endoprosthetics of hip joints, which eliminates pain syndrome, restores the amplitude of movements and the support ability of the lower limb. But there is a number of complications; venous thromboembolism among them occupies a leading place. Material and methods. 219 patients with a mean age of 64.7 ± 3.8 years were operated. In 137 (62.1%) observations, total cement hip replacement was performed for osteoarthritis. 82 (37.4%) patients received total and unipolar cement hip replacement for cervical femoral neck fractures. Results. Clinical manifestations of non-specific connective tissue dysplasia were detected in 83 (37.9%) patients, which were confirmed by the laboratory determination of the level of general, bound and free oxyproline. In the postoperative period, the thrombotic process in the venous system of the inferior vena cava was diagnosed in 23 (10.5%) observations. Operative intervention on the hip joint in patients with nonspecific dysplasia of connective tissue in 11 (13.3%) cases was complicated by the development of venous thrombosis. In patients without non-specific connective tissue dysplasia, postoperative thrombosis in the system of the inferior vena cava was diagnosed in 12 (8.8%) observations. Conclusions. Patients with osteoarthrosis of the hip joint and the femoral neck fracture accompanied by the non-specific dysplasia of the connective tissue are characterized by expressed levels of endothelial dysfunction and increased activity of the blood-coagulation system.


2009 ◽  
Vol 27 (11) ◽  
pp. 1473-1480 ◽  
Author(s):  
Jan Philippe Kretzer ◽  
Jennifer A. Kleinhans ◽  
Eike Jakubowitz ◽  
Marc Thomsen ◽  
Christian Heisel

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