To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention.A literature search was performed through Pub Med until September 20...To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention.A literature search was performed through Pub Med until September 2013.Search terms were"DAIR(debridement,antibiotics,irrigation,and retention)"alone and in combination with"hip"as well as"hip infection+prosthesis retention".A total of 11 studies reporting on 292 cases could be identified.Five different treatment modalities have been described with varying success rates(debridement-21%infection eradication rate;debridement+lavage-75%infection eradication rate;debridement,lavage,with change of modular prosthesis components-70.4%infection eradication rate;debridement,lavage,change of modular prosthesis components+vacuum-assisted closure-92.8%infection eradication rate;acetabular cup removal+spacer head onto retained stem-89.6%infection eradication rate).With regard to the postoperative antibiotic therapy,no general consensus could be drawn from the available data.Debridement,antibiotic therapy,irrigation,and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections.The current literature does not allow for generalization of conclusions with regard to thebest treatment modality.A large,multi-center study is required for identification of the optimal treatment of these infections.展开更多
Objective To analyze the cause of prosthesis loosening by observing the interface membranes harvested during the hip restoration operation. Methods A total of 28 specimens of interface membrane around the loose prosth...Objective To analyze the cause of prosthesis loosening by observing the interface membranes harvested during the hip restoration operation. Methods A total of 28 specimens of interface membrane around the loose prosthesis were harvested from 28 patients undergoing the restoration of total hip replacement. All the specimens underwent the observation of appearance, light microscopy and scanning electronic microscopy(SEM). Results All the gaps around the loose prosthesis were filled with interface membrane of different thickness. The color of the most interface membrane was madder red, and the other one third of membrane was black. The comparatively thicker membrane was similar to scar connective tissue while the thinner was similar to fiber membrane. A large number of wear debris, macrophages and foreign-body giant cells were found under light microscope. With SEM observation a large number of different diameter collagen fibra structures that looked like scar tissues were arranged disorderly in a great mass, foreign particles and bone debris of different size were distributed unevenly, and the fibroblast was distributed in the collagen fiber. Conclusion Wear debris is related to inflammatory cell response around the interface membrane of the loose prosthesis. The wear debris engulfed by macrophage stimulates the interface membrane to release bone resorption factors (such as TNF) which lead to osteolysis, and this is one of the most important causes of the prosthesis loosening.展开更多
The total hip replacement rationale, since 1960 when it was introduced by Sir Charnley, has been modified and evolved until nowadays thanks to laboratory research and clinical trials. This evolution followed a guideli...The total hip replacement rationale, since 1960 when it was introduced by Sir Charnley, has been modified and evolved until nowadays thanks to laboratory research and clinical trials. This evolution followed a guideline whose milestones are: 1) the surgical approach and implantation technique (ex: detachment of the greater trochanter);2) to use or not to use cement;3) the evolution of materials (titanium, ceramic, x-linked polyethylene);4) the identification of the debris-disease rather than the cement-disease;5) studies focused on bone-prosthesis interaction and biological phenomena related. Between those studies, the authors consider crucial the introduction of tissue sparing surgery and femoral neck preserving rationale, concepts to which they have devoted their scientific research and clinical experience for over the last 30 years, from 1980 to nowadays.展开更多
The objectives of this study are to evaluate the dosimetric impact of hip prosthesis using ELEKTA linac X-rays and compare the dose perturbations of metallic and nonmetallic hip prostheses. The local dose distribution...The objectives of this study are to evaluate the dosimetric impact of hip prosthesis using ELEKTA linac X-rays and compare the dose perturbations of metallic and nonmetallic hip prostheses. The local dose distributions of typical hip prostheses were calculated for 4, 8, and 15 MV beams by Geant4. Three prosthesis materials were selected in calculation to reveal the relation between material type and local dose perturbations of prostheses. Furthermore,the effect of nominal energy on prosthesis perturbation was also discussed and analyzed. Taking the calculated dose to the hip joint as reference, considerable differences were observed between prostheses and hip joints. In the prosthesis shadow region, the relative dose decreasing was up to 36, 21, and 16 % for the Co–Cr–Mo alloy, titanium alloy, and ceramic prostheses, respectively. In backscattering region, the relative dose increasing was about1–7 %. Overall, the results show that the dose perturbation effect of prostheses was mainly determined by material type, nominal energy, and density. Among these typical hip prostheses, ceramic prosthesis introduces the lowest dose perturbations.展开更多
Objective To explore the causes and management of prosthesis disocation after artificaial hip replacement (AHR).Methods Seventeen patients with prosthesis dislocation after AHR during January 2000 to July 2010 were st...Objective To explore the causes and management of prosthesis disocation after artificaial hip replacement (AHR).Methods Seventeen patients with prosthesis dislocation after AHR during January 2000 to July 2010 were studied展开更多
Objective:To study the stress distribution of the femoral hip prosthesis after the hip joint replacement.Methods:After the hip joint replacement,when the femur and prosthesis are considered as concentric cylinders wit...Objective:To study the stress distribution of the femoral hip prosthesis after the hip joint replacement.Methods:After the hip joint replacement,when the femur and prosthesis are considered as concentric cylinders with perfectly banded interface,a relatively perfect theoretical model of simulating the interfacial stress transfer is established.Results:The maximum interfacial shear stress occured at Z=0.At the cross-section of the femoral neck,interfacial shear stress decreased exponentially with the increases of the Z.Shear stress became very small at Z>0.1 m,which meant that the shear stress at the far end of the femoral hip prosthesis was very small.In order to avoid the stress concentration and femoral hip prosthesis sinking,interfacial stress must remain constant and balanced with the pressure load at Z=0.The radius of the femoral hip prosthesis changed with interfacial shear stress.The maximum value of the radius occured at Z=0,then it decreased at m.Specially,a=18.2 mm at Z=10 mm,a=5.36 mm at Z=98 mm,these are ideal radius.Conclusion:A theoretical model of simulating the interfacial stress is established when the femur and prosthesis are considered as concentric cylinders.The distributions of the interfacial shear and radial stresses with the axial positions are obtained.A theoretical reference for the design of the prosthesis is provided.展开更多
Pilot biomechanical design of biomaterials for artificial nucleus prosthesiswas carried out based on the 3D finite-element method. Two 3D models of lumbar intervertebral discrespectively with a real human nucleus and ...Pilot biomechanical design of biomaterials for artificial nucleus prosthesiswas carried out based on the 3D finite-element method. Two 3D models of lumbar intervertebral discrespectively with a real human nucleus and with the nucleus removed were developed and validatedusing published experimental and clinical data. Then the models with a stainless steel nucleusprosthesis implanted and with polymer nucleus prostheses of various properties implanted were usedfor the 3D finite-element biomechanical analysis. All the above simulation and analysis were carriedout for the L4/L5 disc under a human worst--daily compression load of 2000 N. The results show thatthe polymer materials with Young's modulus of elasticity E = 0.1-100 MPa and Poisson's ratio v=0.35-0.5 are suitable to produce artificial nucleus prosthesis in view of biomechanicalconsideration.展开更多
全髋关节置换术(total hip arthroplasty,THA)治疗终末期骨性关节炎及股骨头坏死等髋关节疾病有着较为显著的疗效,髋臼假体的准确定位成为手术的关键,诸多学者提出以髋臼横韧带为参考定位髋臼假体能降低术后脱位的发生率,这种定位方法...全髋关节置换术(total hip arthroplasty,THA)治疗终末期骨性关节炎及股骨头坏死等髋关节疾病有着较为显著的疗效,髋臼假体的准确定位成为手术的关键,诸多学者提出以髋臼横韧带为参考定位髋臼假体能降低术后脱位的发生率,这种定位方法无需额外器械辅助,具有简便、快速、经济的优点,能够避免高BMI及术中骨盆旋转对假体安置的影响,帮助初学者快速掌握全髋关节置换术中髋臼假体安置的技术要领。本文将阐述髋臼横韧带的基础解剖,并从髋臼假体的角度、覆盖率及旋转中心等方面对髋臼横韧带在全髋关节置换术中对髋臼假体的定位意义进行综述。展开更多
文摘To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention.A literature search was performed through Pub Med until September 2013.Search terms were"DAIR(debridement,antibiotics,irrigation,and retention)"alone and in combination with"hip"as well as"hip infection+prosthesis retention".A total of 11 studies reporting on 292 cases could be identified.Five different treatment modalities have been described with varying success rates(debridement-21%infection eradication rate;debridement+lavage-75%infection eradication rate;debridement,lavage,with change of modular prosthesis components-70.4%infection eradication rate;debridement,lavage,change of modular prosthesis components+vacuum-assisted closure-92.8%infection eradication rate;acetabular cup removal+spacer head onto retained stem-89.6%infection eradication rate).With regard to the postoperative antibiotic therapy,no general consensus could be drawn from the available data.Debridement,antibiotic therapy,irrigation,and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections.The current literature does not allow for generalization of conclusions with regard to thebest treatment modality.A large,multi-center study is required for identification of the optimal treatment of these infections.
文摘Objective To analyze the cause of prosthesis loosening by observing the interface membranes harvested during the hip restoration operation. Methods A total of 28 specimens of interface membrane around the loose prosthesis were harvested from 28 patients undergoing the restoration of total hip replacement. All the specimens underwent the observation of appearance, light microscopy and scanning electronic microscopy(SEM). Results All the gaps around the loose prosthesis were filled with interface membrane of different thickness. The color of the most interface membrane was madder red, and the other one third of membrane was black. The comparatively thicker membrane was similar to scar connective tissue while the thinner was similar to fiber membrane. A large number of wear debris, macrophages and foreign-body giant cells were found under light microscope. With SEM observation a large number of different diameter collagen fibra structures that looked like scar tissues were arranged disorderly in a great mass, foreign particles and bone debris of different size were distributed unevenly, and the fibroblast was distributed in the collagen fiber. Conclusion Wear debris is related to inflammatory cell response around the interface membrane of the loose prosthesis. The wear debris engulfed by macrophage stimulates the interface membrane to release bone resorption factors (such as TNF) which lead to osteolysis, and this is one of the most important causes of the prosthesis loosening.
文摘The total hip replacement rationale, since 1960 when it was introduced by Sir Charnley, has been modified and evolved until nowadays thanks to laboratory research and clinical trials. This evolution followed a guideline whose milestones are: 1) the surgical approach and implantation technique (ex: detachment of the greater trochanter);2) to use or not to use cement;3) the evolution of materials (titanium, ceramic, x-linked polyethylene);4) the identification of the debris-disease rather than the cement-disease;5) studies focused on bone-prosthesis interaction and biological phenomena related. Between those studies, the authors consider crucial the introduction of tissue sparing surgery and femoral neck preserving rationale, concepts to which they have devoted their scientific research and clinical experience for over the last 30 years, from 1980 to nowadays.
基金supported by Heilongjiang Province Natural Science Foundation (No. A200805)the Education Department of Heilongjiang Province (No. 12521425)the postdoctoral research start-up funds of Heilongjiang Province (No. LBHQ11013)
文摘The objectives of this study are to evaluate the dosimetric impact of hip prosthesis using ELEKTA linac X-rays and compare the dose perturbations of metallic and nonmetallic hip prostheses. The local dose distributions of typical hip prostheses were calculated for 4, 8, and 15 MV beams by Geant4. Three prosthesis materials were selected in calculation to reveal the relation between material type and local dose perturbations of prostheses. Furthermore,the effect of nominal energy on prosthesis perturbation was also discussed and analyzed. Taking the calculated dose to the hip joint as reference, considerable differences were observed between prostheses and hip joints. In the prosthesis shadow region, the relative dose decreasing was up to 36, 21, and 16 % for the Co–Cr–Mo alloy, titanium alloy, and ceramic prostheses, respectively. In backscattering region, the relative dose increasing was about1–7 %. Overall, the results show that the dose perturbation effect of prostheses was mainly determined by material type, nominal energy, and density. Among these typical hip prostheses, ceramic prosthesis introduces the lowest dose perturbations.
文摘Objective To explore the causes and management of prosthesis disocation after artificaial hip replacement (AHR).Methods Seventeen patients with prosthesis dislocation after AHR during January 2000 to July 2010 were studied
文摘Objective:To study the stress distribution of the femoral hip prosthesis after the hip joint replacement.Methods:After the hip joint replacement,when the femur and prosthesis are considered as concentric cylinders with perfectly banded interface,a relatively perfect theoretical model of simulating the interfacial stress transfer is established.Results:The maximum interfacial shear stress occured at Z=0.At the cross-section of the femoral neck,interfacial shear stress decreased exponentially with the increases of the Z.Shear stress became very small at Z>0.1 m,which meant that the shear stress at the far end of the femoral hip prosthesis was very small.In order to avoid the stress concentration and femoral hip prosthesis sinking,interfacial stress must remain constant and balanced with the pressure load at Z=0.The radius of the femoral hip prosthesis changed with interfacial shear stress.The maximum value of the radius occured at Z=0,then it decreased at m.Specially,a=18.2 mm at Z=10 mm,a=5.36 mm at Z=98 mm,these are ideal radius.Conclusion:A theoretical model of simulating the interfacial stress is established when the femur and prosthesis are considered as concentric cylinders.The distributions of the interfacial shear and radial stresses with the axial positions are obtained.A theoretical reference for the design of the prosthesis is provided.
文摘Pilot biomechanical design of biomaterials for artificial nucleus prosthesiswas carried out based on the 3D finite-element method. Two 3D models of lumbar intervertebral discrespectively with a real human nucleus and with the nucleus removed were developed and validatedusing published experimental and clinical data. Then the models with a stainless steel nucleusprosthesis implanted and with polymer nucleus prostheses of various properties implanted were usedfor the 3D finite-element biomechanical analysis. All the above simulation and analysis were carriedout for the L4/L5 disc under a human worst--daily compression load of 2000 N. The results show thatthe polymer materials with Young's modulus of elasticity E = 0.1-100 MPa and Poisson's ratio v=0.35-0.5 are suitable to produce artificial nucleus prosthesis in view of biomechanicalconsideration.
文摘全髋关节置换术(total hip arthroplasty,THA)治疗终末期骨性关节炎及股骨头坏死等髋关节疾病有着较为显著的疗效,髋臼假体的准确定位成为手术的关键,诸多学者提出以髋臼横韧带为参考定位髋臼假体能降低术后脱位的发生率,这种定位方法无需额外器械辅助,具有简便、快速、经济的优点,能够避免高BMI及术中骨盆旋转对假体安置的影响,帮助初学者快速掌握全髋关节置换术中髋臼假体安置的技术要领。本文将阐述髋臼横韧带的基础解剖,并从髋臼假体的角度、覆盖率及旋转中心等方面对髋臼横韧带在全髋关节置换术中对髋臼假体的定位意义进行综述。
