Hip international : the journal of clinical and experimental research on hip pathology and therapy
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Observational Study
The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up.
Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. ⋯ The mid-term results of the Ossis custom 3D-printed tri-flanged acetabular implant for the management of severe acetabular defects are encouraging. The improvement in functional scores and radiographic outcomes are comparable to similar designs. In addition, no cases have required revision for aseptic loosening.
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Ultra-high molecular weight polyethylene (UHMWPE) continues to be the gold standard bearing surface in total hip arthroplasty (THA) for nearly 5 decades. Highly cross-linked UHMWPE (HXLPE) was adapted for routine use in the early 2000s to reduce the revision rates related to wear, osteolysis, and aseptic loosening resulting from conventional UHMWPE wear. ⋯ Though retrieval studies have demonstrated evidence of in vivo oxidation and fatigue related damage at the rim of the first generation HXLPE liners, clinical significance of this remains to be seen. Second-generation sequentially annealed and vitamin E containing HXLPE liners demonstrate improved mechanical properties, resistance to oxidation, and equivalent wear rates in comparison to their first-generation counterparts, but long term success remains to be seen.
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Subsidence has been noted with both cemented and uncemented stems in hip arthroplasty. On most occasions, it's minimal (i.e. less than 2 mm) and stabilises at 1 year. However, when its progressive and significant, it causes loss of length and horizontal offset, and when symptomatic warrants a revision. ⋯ A fully hydroxyapatite (HA) coated collared stem, when used in elderly age group for elective THR, has only 2% risk of intraoperative periprosthetic fracture. There's a 4% risk of radiologically significant subsidence (i.e. ≥2 mm), however, it has not proven to be clinically significant in our study. Dorr canal type had no bearing on either risk of periprosthetic fracture or subsidence. Collared stems did not have a statistically significant difference in risk of subsidence and peri-prosthetic fracture in comparison to un-collared stem, although there was a non-significant trend in favour of collar use.
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The influence of obesity measured in terms of body mass index (BMI) on the complication rates following total hip arthroplasty (THA) is a matter of debate. ⋯ There is a significant impact of BMI on the occurrence of perioperative complications following THA. Compared to normal weight category, the overweight and obese class II patients had a lower likelihood of developing overall, especially cardiac complications. Length of operating time increases along with an increase in BMI.
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The efficacy of hip precautions in preventing dislocation post total hip arthroplasty (THA) has been questioned in recent literature. From 2014 our centre ceased routinely prescribing them due to lack of evidence. We investigate the effect of stopping these precautions on dislocation rate, patient satisfaction and Oxford hip score (OHS). ⋯ Cessation of prescribing routine hip precautions post primary THA does not appear to significantly affect overall dislocation rate, patient satisfaction or functional status at 1 year post-operatively.