Failure of the polyethylene after bipolar hemiarthroplasty of the hip. A report of five cases

Due to the difficulties in separating malignant and benign ovarian cysts by transvaginal ultrasound and other techniques, there is a need for biochemical markers in serum or cyst fluids. In the present study we have evaluated the levels of the chemokine interleukin-8 (IL-8) in ovarian cysts. IL-8 is known to be expressed in the normal ovary and to influence proliferation and angiogenesis of several nonovarian types of tumors. Cyst fluids from benign (n = 15) and malignant (n = 13) ovarian tumors were analyzed. The levels of IL-8 were found to be significantly (13-fold) higher in cyst fluids from malignant tumors (18.1 +/- 7.5 ng/ml; mean +/- SE) compared to benign cysts (1.3 +/- 0.7 ng/ml). The plasma levels of IL-8 were considerably lower (2.9 and 0.3% of levels in benign and malignant cyst fluids, respectively) than in cyst fluids. No difference in the plasma levels of patients with benign or malignant tumor could be detected. In contrast, the levels of CA 125 were significantly higher in plasma of patients with malignant disease with the inverse relation in cyst fluids. In conclusion, the levels of IL-8 are markedly elevated in cyst fluid from malignant tumors compared to benign. This specific increase indicates a role for this cytokine in ovarian tumor biology.     

Heterotopic ossification after cemented or uncemented bateman bipolar hemiarthroplasty

BACKGROUND: This is a retrospective study to evaluate the incidence of heterotopic ossification (HO) in cemented and uncemented femoral neck fractures treated with Bateman bipolar hemiarthroplasty. METHODS: From October 1985 to July 1990, there were 451 cases of displaced intracapsular fractures of the femoral neck treated with Bateman bipolar hemiarthroplasty (261 uncemented vs 190 cemented) at the Veterans General Hospital-Taipei. RESULTS: After an average follow-up of 46 months, there was more HO in the cemented group than in the uncemented group (p = 0.014, chi-squared test). The average surgical time was approximately 20 minutes longer and the average blood loss was approximately 160 ml more in the cemented Bateman bipolar hemiarthroplasty group. CONCLUSIONS: HO formation is more common in cemented Bateman bipolar hemiarthroplasty than in the uncemented procedure. The incidence of HO is not related to age or sex.     

Cup dissociation after reduction of a dislocated hip hemiarthroplasty]

The frequency of alcohol abuse in the soldiers of Herzegovinian corps of the Republic of Srpska Army during the 1992-1994 war, who took part in combat action was investigated by retrospective analysis of medical documentation. The same procedure was performed in the members of Yugoslav Army for the same period who did not take part in combat actions. By comparing the obtained results, it was concluded that the alcohol abuse was 3.7 times more frequent in participants of combat actions compared to those who did not have such assignment.     

Dislocation after total hip arthroplasty using the anterolateral abductor split approach

The three basic surgical approaches used most commonly in total hip arthroplasty are transtrochanteric, posterior, and anterolateral. Complications related to each of these surgical approaches have been reported including dislocation, trochanteric nonunion, heterotopic ossification, neurovascular damage, postoperative limp, and implant malalignment. The anterolateral abductor split approach previously has been reported to allow ease of access into the hip joint, optimum joint visualization, protection of neurovascular structures of the hip, and predictable results for postoperative hip function restoration. Reviewing a large consecutive series of primary total hip arthroplasty cases (1518), the authors report an overall dislocation rate less than 1% (12:1518; 0.79%). Stratified by preoperative diagnosis, patients undergoing total hip arthroplasty after trauma, or presenting with congenital dysplastic hip are at the highest risk for postoperative dislocation. Primary total hip arthroplasty using the anterolateral, abductor split approach can minimize the rate of postoperative dislocation in the prevailing preoperative diagnostic categories.     

Bipolar hemiarthroplasty for primary osteoarthritis of the hip

One hundred twenty-five bipolar hemiarthroplasties of the hip were performed at the authors' hospital. Although the procedure was performed for acute femoral neck fractures, rheumatoid arthritis, revision hemiarthroplasty, and primary osteoarthritis, only the latter is the subject of this review. A modified Harris hip score (HHS) was used to evaluate the patients both preoperatively and postoperatively. Radiographs were taken preoperatively as well as postoperatively at 2-, 4-, 6-, and 24-month intervals. A total of 68 patients underwent bipolar hemiarthroplasty for primary hip osteoarthritis. The mean preoperative HHS was 35.5 (SEM = 1.86); the mean postoperative score was 81.2 (SEM = 1.64) with an average improvement of 45.7 (SEM = 2.03). The results of this review were compared to a control group of conventional total hip arthroplasties performed at the same institution. The mean postoperative HHS for the group of conventional arthroplasties was 87.2 (SEM = 1.07). The results of this review indicate a good clinical result from bipolar hemiarthroplasty, but significantly less postoperative function when compared to conventional total hip arthroplasty.     

Revision of failed hemiarthroplasty for fractures at the hip

The fish melanophore has been considered the exemplar of microtubule-based organelle transport. In this system, a radial array of uniformly polarized microtubules [1] provides a framework on which dynein-related and kinesin-related motors drive pigment granules toward the minus or plus ends, respectively [2-4]. Stimulation of minus-end motors accounts satisfactorily for aggregation of granules at the cell center. Rapid dispersion is clearly microtubule-dependent; however, the uniform distribution of granules throughout the cytoplasm is paradoxical because stimulation of plus-end motors is predicted to drive the granules to the cell margin. This paradox suggested that the transport system was incompletely understood. Here, we report the discovery of a microtubule-independent motility system in fish melanophores. The system is based on actin filaments and is required for achieving uniform distribution of pigment granules. When it is abrogated, granules accumulate at the cell's margin as predicted for microtubule plus-end motors acting alone. The results presented here demonstrate the functional coordination of microtubule and actin filament systems, a finding that may be of general significance for organelle motility in cytoplasm.     

Dislocation in total hip arthroplasties

In a series of 1,443 total hip arthroplasties performed between 1970 and 1975, dislocation was the most frequent complication and its incidence was found to be increasing. Dislocatin was frequently associated with component malposition that the surgeon was not aware of at the time of surgery and was relatively frequent among less experienced surgeons. It was especially frequent if the patient had had previous hip surgery and was related to the difficulty of the surgery rather than the primary hip disease. Increasing incidence was associated with change in operative technique and less stringent patient selection. Dislocation was 2 1/2 times more frequent if trochanteric osteotomy was not performed. The tip of the greater trochanter was moved significantly closer to the center of the prosthetic head in the patients who dislocated. Traction for up to three weeks did not lower the incidence of subsequent dislocation compared with mobilization of the patients as soon as tolerated after dislocation. Surgery was effective in preventing further dislocations in patients with recurrent dislocation and component malposition. The use of an articulated prosthesis is not recommended.     

Dislocation and subluxation of the total hip replacement

In 502 total hip replacements, it was noted that 7 (1%) dislocated postoperatively in the first 6 weeks. This was usually related to improper positioning of the implant or to improper positioning of the implant or to unusual positioning of the patient postoperatively. There was no difference noted between the type of implant and the incidence of dislocations. Twenty-eight subluxations (5.5%) occurred. There was no statistical correlation with the percentage of nonunions and the type of prosthesis; however, 22 of the 28 subluxations were in Charnley prostheses. Ninety-three per cent of the subluxations were secondary to hyperflexing activities.     

Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly

This paper presents the short term results of an ongoing prospective randomized trial comparing a cemented unipolar with a cemented bipolar hemiarthroplasty for the treatment of displaced femoral neck fractures in the elderly. Forty-seven patients with an average age of 77 years completed 6-month followup. Outcomes at 6 weeks, 3 months and 6 months were assessed by completion of a patient oriented hip outcome instrument and by functional tests of walking speed and endurance. No differences in the postoperative complication rates or lengths of hospitalization were seen between the two groups. Patients treated with a bipolar hemiarthroplasty had greater range of hip motion in rotation and abduction and had faster walking speeds. However, no differences in hip rating outcomes were found. These early results suggest that use of the less expensive unipolar prosthesis for hemiarthroplasty after femoral neck fracture may be justified in the elderly.     

Dislocation and instability complicating low friction arthroplasty of the hip joint

Among the complications in a series of 1,400 consecutive Charnley low friction arthroplasty procedures, there were 8 dislocations, and 3 highly unstable hips. Three dislocations followed severe trauma, in 2 of the 3 there was only fibrous union of the greater trochanter. In all but 2 of the hips, more than one previous operation had been performed. More than one technical fault was evident in most dislocations. Six of the 8 dislocations required reoperation. Meticulous attention to the Charnley procedure, including soft tissue elements of the hip joint is necessary to avoid instability and dislocation following total hip arthroplasty.     

Pulmonary fat embolism during bipolar hip endoprosthesis

Two patients had fatal fat pulmonary embolism during bipolar hip endoprosthesis. Two women, 71-year-old and 76-year-old, with femoral neck fracture underwent bipolar hip endoprosthesis under combined lumbar epidural/general anesthesia. Soon after the placement of bone cement and a femoral stem with a bipolar endoprosthesis in the femoral shaft, the patients developed circulatory collapse. Immediate cardiopulmonary resuscitation did not restore adequate circulation and the patients died 3.5 hours and 1 hour thereafter, respectively. Pathological examination revealed the presence of fat particles within the entire pulmonary arteries, arterioles and capillaries. Main cause of the present pulmonary fat embolism may be an increase in the intramedullary pressure during cement pressurization and femoral stem placement. Anesthetists have to be aware of occurrence of this serious syndrome during bipolar hip endoprosthesis. For earlier detection of this serious complication we recommend to monitor central venous pressure and pulmonary artery pressure in patients undergoing bipolar hip endoprosthesis.     

Outcome after hemiarthroplasty for femoral neck fractures in the elderly

A prospective outcome study was performed on 270 patients, 65 years of age and older, who sustained a femoral neck fracture and underwent hemiarthroplasty. The treatment compared was the use of a noncemented unipolar versus either a cemented or a press fit bipolar prosthesis. The outcome variables assessed included the occurrence of a postoperative complication, length and cost of hospitalization, and function in various quality of life measurements. Patients who underwent bipolar hemiarthroplasty with either a cemented or a press fit prosthesis had better pain relief and function than patients who had a noncemented unipolar prosthesis at a minimum of 24 months after surgery. However, the mean hospitalization cost for patients who had a bipolar prosthesis was $12,290 compared with $8876 for a unipolar prosthesis.     

Ender nailing for ipsilateral femoral shaft fractures after Austin-Moore hemiarthroplasty

Some dentists have voluntarily chosen to leave the dental profession despite the considerable time, effort, and financial expenditures involved in their educations. The purpose of this study was to survey the entire population of dentists who had identified themselves as being principally employed in a career outside of clinical practice in the American Dental Association's 1991 Census. A four-page survey was mailed to 654 former dentists, with a total of 237 usable responses (36%). Analysis of major demographic variables showed no significant difference between the survey respondents and the 1992 ADA Survey of Dentists. Major reasons cited by respondents for entering dentistry included professional, financial, and independence factors. Respondents as a group rated their dental school experience as average in degree of difficulty. Clinical dental experience was varied, with a substantially smaller percentage (37%) choosing solo clinical positions than the 1992 ADA Survey of Dentists reported (69%). Reasons for leaving practice included financial, stress, and external regulation concerns. Current careers varied widely, with business, teaching, medicine, and investing being the most common. Respondents ranked their current careers as considerably more favorable on measures of perceived creativity, freedom, belonging, and whether they would choose the same career again. These findings indicate that there was a difference between the perception of a dental career and the reality of clinical practice for the study sample.     

Dislocation damage in tantalum after cyclic loading

The dislocation distribution in tantalum foil after fatigue testing in the region of the yield point has been determined quantitatively using thin film electron microscopy. Changes in the measured microstructural parameters as a function of stress level, test temperature, and number of loading cycles have been related to a microscopic model of the fatigue process. The model leads to a consistent criterion for fatigue failure based on the gradual growth of impenetrable subboundary groups of immobile dislocation. Formerly, Instructor, Department of Materials Engineering, Technion-Israel Institute of Technology, Haifa, Israel     

Cartilage degeneration in relation to repetitive pressure: case study of a unilateral hip hemiarthroplasty patient

The mitochondrial, inner-membrane-associated, reversible NADPH-->NAD transhydrogenase of adult Hymenolepis diminuta physiologically couples matrix-localized, NADP-specific "malic" enzyme with NADH-dependent anaerobic electron transport. Employing submitochondrial particles (SMP) as the source of enzyme activity and both spectrophotometric and fluorometric assessments, the present study made evident that in its catalysis of transhydrogenation between NADPH and NAD, the cestode enzyme engages in the concomitant transmembrane translocation of protons. As assessed spectrophotometrically, the catalysis of NADPH-dependent NAD reduction by H. diminuta SMP was stimulated significantly by carbonyl cyanide 3-chlorophenylhydrazone (CCCP), carbonyl cyanide 4-(trifluoromethoxy) phenylhydrazone (FCCP), as well as by the protonophoric anthelmintic, niclosamide. In addition, N,N'-dicyclohexylcarbodiimide (DCCD) markedly diminished SMP-catalyzed hydride ion transfer between NADPH and NAD. The catalysis by SMP of concomitant, transhydrogenase-mediated proton translocation was evaluated more directly via fluorometric assays using 8-anilino-1-napthalenesulfonic acid (ANS) as the probe. These latter evaluations revealed a transhydrogenase-dependent enhancement of ANS fluorescence in accord with an intravesicular accumulation of protons. ANS fluorescence was quenched rapidly when the assay system was supplemented with CCCP, FCCP, or niclosamide. Consistent with the helminth transhydrogenase acting as a proton pump, transhydrogenase-mediated enhanced fluorescence also was inhibited by DCCD. Considered collectively, these data indicated, apparently for the first time for any invertebrate system, that the transhydrogenase, in catalyzing the NADPH-->NAD reaction, acts in the translocation of protons from the matrix to the intermembrane space mitochondrial compartment.     

Dislocation following total hip endoprosthesis. Association with surgical approach and other factors

During a period of eight years (1984 to 1992) we found 45 dislocations in 1734 patients treated by total hip arthroplasty. We compared this retrospectively evaluated group with a randomized control group of 61 patients. As a cause for an increasing number of dislocations in 1989 we found: age over 70 years, high CCD-stem-angle (142 degrees), dorsal approach, abduction of the acetabular component under certain circumstances (left side). Revision operations always are a high risk procedure. Acetabular anteversion, anaesthesia, way of component fixation did not induce an increased rate of dislocation. We now left the dorsal approach and use only stems with an CCD-angle of 135 degrees or less by now. Careful positioning of the acetabular components and a better patient-instruction helped to decrease the number of dislocations. Because of these measures we reduced the THA-dislocations rate from 5.6 to 0.17 per cent (first operations) and from 12.1 to 6.5 per cent (revision operations).     

Unipolar or bipolar prosthesis for the displaced intracapsular hip fracture? An unanswered question

Modular bipolar prostheses were developed to address the problems of loosening, cartilage wear, and protrusio which were seen with single unit endoprostheses. Modular unipolar prostheses address many of these problems and are significantly less expensive than the bipolar prosthesis. Recent data suggest that use of the modular unipolar prosthesis is indicated in elderly patients with low demands.