BACKGROUND This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty(THA)construct.The constellation of patient symptoms and la...BACKGROUND This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty(THA)construct.The constellation of patient symptoms and laboratory findings contradict the expected elevated serum metal ion levels associated with the formation of pseudotumor.The presentation,lab trends,and imaging findings contribute to the growing base of knowledge surrounding the effects of corrosion in arthroplasty constructs with stem-neck modularity.CASE SUMMARY A 74-year-old man status post primary THA presented with left hip swelling and elevated serum metal ions five years after implantation of a modular stem-neck prosthesis.The swelling was diagnosed as pseudotumor based on laboratory trends and imaging findings and was treated with revision arthroplasty that completely resolved the initial hip swelling.The patient presented with recurrent hip swelling and recurrent pseudotumor findings on imaging in the same hip four months later.Non-operative management with ultrasound-guided hip aspiration resulted in symptom relief and resolution of the recurrent swelling.After one year of follow-up,the patient had no further recurrences of hip swelling.CONCLUSION This case of post-revision pseudotumor recurrence elucidates attributable patient,surgical,and implant factors with a discussion of diagnostics,management,and prognosis for patients with pseudotumor in non-metal-on-metal arthroplasty constructs.展开更多
BACKGROUND The uncemented ArcosTM Modular Femoral Revision System(ARCOS)is a new comprehensive,press-fit revision design.The modular design offers a wide range of possible combinations to accommodate different variati...BACKGROUND The uncemented ArcosTM Modular Femoral Revision System(ARCOS)is a new comprehensive,press-fit revision design.The modular design offers a wide range of possible combinations to accommodate different variations of anatomy and bone stock.The ARCOS is made by a proximal body and a distal stem.As probably the only ones worldwide we predominantly use a combination of body and stem which supports proximal fixation and load,since this mimics the concept of the primary total hip arthroplasty with proximal weight-bearing,leading to bone stock preservation and no stress shielding or thigh pain.AIM To evaluate the early results after femoral revision in a consecutive series of patients undergoing surgery over 3 years.METHODS We included 116 patients in the study.They were operated in the period August 2011 to December 2014 and we got a clinical mean observation time of 4(0.5-6)years.Clinical and radiographical follow-up included present function of the hip assessed by Harris Hip Score,Oxford Hip Score,and EQ5D(measure of health outcome).Of the 116 patients,17 died in the interim and were consequently included only in the implant survivorship analysis;46 patients attended the follow-up control.RESULTS In total 6(5%)hips were re-revised due to infection(n=3),fracture(n=2)or subsidence(n=1).No patient was re-revised due to aseptic loosening.The 1-,2-and 5-year probability of implant survival(95%CI)were 97%(93%-100%),97%(93%-100%)and 96%(92%-99%),respectively.In this cohort 95 patients received a combination of a proximal broach and a distal curved and slotted stem(BS),aiming for proximal fixation and load bearing;21 patients received a different combination.When comparing these two groups the BS-group had a 5-year implant survival probability(95%CI)of 97%(93%-100%)compared with the group of other combinations with a 5-year implant survival probability(95%CI)of 90%(78%-100%)(P=0.3).Our regression analysis showed that periprosthetic fracture as an indication for the ARCOS operation was the only significant negative outcome predictor.The mean Harris Hip Score result(100 points being best)was 83(range 5-98).The mean Oxford Hip Score result(48 points being best)was 40(range 19-48).CONCLUSION The early results of the ARCOS are promising compared with similar studies.We encourage the use of the BS combination whenever the bone stock proximally is adequate.展开更多
目的总结S-ROM(Sivash-range of motion femoral modular stem)假体设计及生物力学特点,以及在髋关节发育不良(developmental dysplasia of hip,DDH)的关节置换及髋关节翻修术中的应用进展。方法广泛查阅近年S-ROM假体的相关文献,并进...目的总结S-ROM(Sivash-range of motion femoral modular stem)假体设计及生物力学特点,以及在髋关节发育不良(developmental dysplasia of hip,DDH)的关节置换及髋关节翻修术中的应用进展。方法广泛查阅近年S-ROM假体的相关文献,并进行综合分析。结果 S-ROM假体利用其组配性可以在股骨近端与远端同时达到紧密压配,适用于存在股骨解剖差异以及需行股骨截骨矫形的DDH人工全髋关节置换,以及伴骨缺损的髋关节翻修。结论 S-ROM假体组配结合部增大了假体折断及产生金属磨屑的可能,其远期疗效需进一步随访明确。展开更多
目的 探讨应用锥形股骨近端组配式股骨柄假体行人工全髋关节置换（total hip arthroplasty,THA）治疗发育性髋关节发育不良（developmental dysplasia of the hip,DDH）的近期疗效。方法 2010年10月-2012年5月,采用锥形股骨近端组配式...目的 探讨应用锥形股骨近端组配式股骨柄假体行人工全髋关节置换（total hip arthroplasty,THA）治疗发育性髋关节发育不良（developmental dysplasia of the hip,DDH）的近期疗效。方法 2010年10月-2012年5月,采用锥形股骨近端组配式股骨柄假体行THA治疗28例（31髋）DDH伴继发性骨关节炎。男2例,女26例;年龄47～77岁,平均61岁。单髋25例,双髋3例。根据Crowe分型标准：Ⅰ型22髋,Ⅱ型8髋,Ⅲ型1髋。术前患者双下肢均不等长,相差（1.6±0.8）cm。髋关节活动度：屈曲（76.1±12.8）°、外展（14.5±6.7）°、内收（9.0±4.5）°、内旋（13.1±6.4）°、外旋（11.7±7.0）°。髋关节Harris评分为（44.7±11.1）分。结果 术中2例（2髋）发生股骨颈截骨面处骨裂,给予钢丝固定后愈合。术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间12～32个月,平均20个月。末次随访时,患者双下肢不等长相差（1.0±0.5）cm,与术前比较差异有统计学意义（t=—3.512,P=0.002）。髋关节活动度：屈曲（102.9±10.1）°、外展（32.9±6.0）°、内收（19.2±4.3）°、内旋（34.4±4.2）°、外旋（32.3±5.1）°,与术前比较差异均有统计学意义（P〈0.05）。髋关节Harris评分为（90.3±6.1）分,与术前比较差异有统计学意义（t=21.263,P=0.000）。X线片示2髋假体1年内出现进行性下沉（〈2 mm）;其余假体均无下沉、松动及断裂。髋臼假体无骨溶解或松动。2髋发生异位骨化。结论 采用锥形股骨近端组配式股骨柄假体行THA治疗DDH近期疗效满意,中远期疗效需进一步观察。展开更多
文摘BACKGROUND This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty(THA)construct.The constellation of patient symptoms and laboratory findings contradict the expected elevated serum metal ion levels associated with the formation of pseudotumor.The presentation,lab trends,and imaging findings contribute to the growing base of knowledge surrounding the effects of corrosion in arthroplasty constructs with stem-neck modularity.CASE SUMMARY A 74-year-old man status post primary THA presented with left hip swelling and elevated serum metal ions five years after implantation of a modular stem-neck prosthesis.The swelling was diagnosed as pseudotumor based on laboratory trends and imaging findings and was treated with revision arthroplasty that completely resolved the initial hip swelling.The patient presented with recurrent hip swelling and recurrent pseudotumor findings on imaging in the same hip four months later.Non-operative management with ultrasound-guided hip aspiration resulted in symptom relief and resolution of the recurrent swelling.After one year of follow-up,the patient had no further recurrences of hip swelling.CONCLUSION This case of post-revision pseudotumor recurrence elucidates attributable patient,surgical,and implant factors with a discussion of diagnostics,management,and prognosis for patients with pseudotumor in non-metal-on-metal arthroplasty constructs.
文摘BACKGROUND The uncemented ArcosTM Modular Femoral Revision System(ARCOS)is a new comprehensive,press-fit revision design.The modular design offers a wide range of possible combinations to accommodate different variations of anatomy and bone stock.The ARCOS is made by a proximal body and a distal stem.As probably the only ones worldwide we predominantly use a combination of body and stem which supports proximal fixation and load,since this mimics the concept of the primary total hip arthroplasty with proximal weight-bearing,leading to bone stock preservation and no stress shielding or thigh pain.AIM To evaluate the early results after femoral revision in a consecutive series of patients undergoing surgery over 3 years.METHODS We included 116 patients in the study.They were operated in the period August 2011 to December 2014 and we got a clinical mean observation time of 4(0.5-6)years.Clinical and radiographical follow-up included present function of the hip assessed by Harris Hip Score,Oxford Hip Score,and EQ5D(measure of health outcome).Of the 116 patients,17 died in the interim and were consequently included only in the implant survivorship analysis;46 patients attended the follow-up control.RESULTS In total 6(5%)hips were re-revised due to infection(n=3),fracture(n=2)or subsidence(n=1).No patient was re-revised due to aseptic loosening.The 1-,2-and 5-year probability of implant survival(95%CI)were 97%(93%-100%),97%(93%-100%)and 96%(92%-99%),respectively.In this cohort 95 patients received a combination of a proximal broach and a distal curved and slotted stem(BS),aiming for proximal fixation and load bearing;21 patients received a different combination.When comparing these two groups the BS-group had a 5-year implant survival probability(95%CI)of 97%(93%-100%)compared with the group of other combinations with a 5-year implant survival probability(95%CI)of 90%(78%-100%)(P=0.3).Our regression analysis showed that periprosthetic fracture as an indication for the ARCOS operation was the only significant negative outcome predictor.The mean Harris Hip Score result(100 points being best)was 83(range 5-98).The mean Oxford Hip Score result(48 points being best)was 40(range 19-48).CONCLUSION The early results of the ARCOS are promising compared with similar studies.We encourage the use of the BS combination whenever the bone stock proximally is adequate.
文摘目的 探讨应用锥形股骨近端组配式股骨柄假体行人工全髋关节置换（total hip arthroplasty,THA）治疗发育性髋关节发育不良（developmental dysplasia of the hip,DDH）的近期疗效。方法 2010年10月-2012年5月,采用锥形股骨近端组配式股骨柄假体行THA治疗28例（31髋）DDH伴继发性骨关节炎。男2例,女26例;年龄47～77岁,平均61岁。单髋25例,双髋3例。根据Crowe分型标准：Ⅰ型22髋,Ⅱ型8髋,Ⅲ型1髋。术前患者双下肢均不等长,相差（1.6±0.8）cm。髋关节活动度：屈曲（76.1±12.8）°、外展（14.5±6.7）°、内收（9.0±4.5）°、内旋（13.1±6.4）°、外旋（11.7±7.0）°。髋关节Harris评分为（44.7±11.1）分。结果 术中2例（2髋）发生股骨颈截骨面处骨裂,给予钢丝固定后愈合。术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间12～32个月,平均20个月。末次随访时,患者双下肢不等长相差（1.0±0.5）cm,与术前比较差异有统计学意义（t=—3.512,P=0.002）。髋关节活动度：屈曲（102.9±10.1）°、外展（32.9±6.0）°、内收（19.2±4.3）°、内旋（34.4±4.2）°、外旋（32.3±5.1）°,与术前比较差异均有统计学意义（P〈0.05）。髋关节Harris评分为（90.3±6.1）分,与术前比较差异有统计学意义（t=21.263,P=0.000）。X线片示2髋假体1年内出现进行性下沉（〈2 mm）;其余假体均无下沉、松动及断裂。髋臼假体无骨溶解或松动。2髋发生异位骨化。结论 采用锥形股骨近端组配式股骨柄假体行THA治疗DDH近期疗效满意,中远期疗效需进一步观察。
