Relevant bibliographies by topics / Total hip replacement – Testing

Academic literature on the topic 'Total hip replacement – Testing'

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Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Total hip replacement – Testing"

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Attinger, D. F., W. Kipfer, and R. Ganz. "Testing hip abductor weakness in patients with unilateral total hip replacement using an isokinetic dynamometer." Journal of Biomechanics 18, no. 7 (January 1985): 549. http://dx.doi.org/10.1016/0021-9290(85)90809-7.

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Crowninshield, R. D., M. P. Laurent, J. Q. Yao, S. K. Bhambri, R. A. Gsell, L. N. Gilbertson, and D. F. Swarts. "Cross-Linking to Improve Thr Wear Performance." HIP International 12, no. 2 (April 2002): 103–7. http://dx.doi.org/10.1177/112070000201200211.

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Polyethylene wear and associated osteolysis can limit the longevity of total hip replacement. In recent years, many improvements have been made in the consolidation, manufacture, and sterilization of polyethylene acetabular components. These improvements provided reduced polyethylene wear and prolonged usefulness of total hip replacement. Recent advances in extensively cross-linking polyethylene offer the possibility to substantially further reduce wear in total hip replacement. Hip simulator wear testing demonstrates an order of magnitude reduction in wear resulting from cross-linking GUR 1050 polyethylene by exposure to 100 kGy of electron beam radiation followed by annealing to encourage cross-linking and to reduce residual free radicals. Clinical investigation will be required to validate the wear advantage of these materials in vivo.
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Nenova, Gergana, and Paraskeva Mancheva. "INDIVIDUAL KINESITHERAPEUTIC APPROACH IN PATIENTS WITH TOTAL HIP REPLACEMENT." Journal of IMAB - Annual Proceeding (Scientific Papers) 28, no. 3 (August 30, 2022): 4532–34. http://dx.doi.org/10.5272/jimab.2022283.4532.

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The individual kinesitherapeutic approach is increasingly required in rehabilitation practice due to the presence of concomitant diseases, social problems and psycho-emotional characteristics of the patients. Its effectiveness can be assessed by examining the level of satisfaction of patients with total hip arthroplasty with the work of the kinesitherapist. Purpose: to study and evaluate the effectiveness of the individual kinesitherapeutic approach on patients with total hip arthroplasty. Material and methods: Material: 60 patients who have undergone operative intervention for total hip replacement at the Orthopaedics and Traumatology Clinic at the University Hospital St. Marina, Varna for the period 2012–2019. The patients are divided into experimental (30 patients with a mean age of 56.17) and control groups (30 patients with a mean age of 55.53). Methods: Sociological method (questionnaire survey): questionnaire for satisfaction with the kinesitherapist's work on the Likert scale (α-Cronbach 0.823); Statistical method: statistical data grouping, Cronbach's test, descriptive method, testing of statistical hypotheses, correlation analysis. The data is processed with SPSS v.19.0 for Windows. Results and discussion: 83,3% of patients with total hip replacement answered that they have received answers to their questions from the kinesitherapist treating them. The patients in the experimental and control groups were equally aware of the need for kinesitherapy in their postoperative recovery period. 100% of the respondents in the control group believed that the kinesitherapist was very interested and inquired about concomitant diseases and problems that arose during the procedures. Patients with custom hip replacement report greater freedom "to a very large extent" and 26,7% to a large extent. Conclusion: the application of the individual kinesitherapeutic approach to patients with total hip arthroplasty leads to a faster and fuller functional recovery and to a higher level of satisfaction.
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Jeffers, Jonathan R. T., Martin Browne, Alexander B. Lennon, Patrick J. Prendergast, and Mark Taylor. "Cement mantle fatigue failure in total hip replacement: Experimental and computational testing." Journal of Biomechanics 40, no. 7 (January 2007): 1525–33. http://dx.doi.org/10.1016/j.jbiomech.2006.07.029.

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Khairunissa, Anna Maulidia, and Eko Budi Prasetyo. "PENATALAKSANAAN FISIOTERAPI PADA KONDISI “TOTAL HIP REPLACEMENT” DENGAN MODAL INFRA MERAH DAN TERAPI LATIHAN DI RS ORTHOPEDI DR. R. SOEHARSO SURAKARTA." Pena Jurnal Ilmu Pengetahuan dan Teknologi 34, no. 2 (October 5, 2020): 40. http://dx.doi.org/10.31941/jurnalpena.v34i2.1211.

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<p><em>Total Hip Replacement </em>is the replacement of both sufaces of the hip joint that are experiencing degeneration. This means that the joint are replaced (conventional) or trimmed and covered with metal caps (resurfacing). The post operative problems of <em>Total Hip Replacement </em>are pain, spasm, differences leg length, decreased joint motion, decreased muscle strength, and decreased functional ability activities. Physiotherapy examination of pain with Verbal Descriptive Scale, spasm with palpation, leg length differences with midline, scope of joint motion with goniometer, muscle strength with a <em>Manual Muscle Testing</em> scale, and functional ability activity with the <em>Oxford Hip Score </em>index. In this case the technology chosen was <em>Infra Red </em>and Exercise Therapy.</p><p>The purpose of this study was to determine the effect of physiotherapy management on post operative conditions <em>Total Hip Replacement </em>with <em>Infra Red </em>modality and Exercise Therapy. This research was conducted at RS Orthopedi Dr. R. Soeharso Surakarta with a descriptive analytic research design. Subjects were patients with post operative <em>Total Hip Replacement </em>with <em>Infra Red </em>and Exercise Therapy. Research instruments in the form of <em>Visual Descriptive Scale</em> (VDS), palpation, midline, goniometer, <em>Manual Muscle Testing</em> (MMT), and <em>Oxford Hip Score Scale</em>.</p>The results of the study were 2 times the following therapy : (1) there was a decrease in pain (2) there was a decrease in muscle spasm (3) there was no change in leg length (4) there was no increase in joint range of motion (5) there was no increase in muscle strength (6) there is no increase in the ability of functional activities. The conclusion of this study is that physiotherapy intervention with Infra Red modality and Exercise Therapy can reduce the problems that arise in the postoperative condition of <em>Total Hip Replacement.</em>
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Bogdanova-Bennett, Anna, Amit Sagi, Vipin Asopa, Richard E. Field, and David H. Sochart. "Nickel hypersensitivity and skin patch testing in total hip replacement surgery: a systematic review." EFORT Open Reviews 6, no. 10 (October 2021): 825–38. http://dx.doi.org/10.1302/2058-5241.6.210051.

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Approximately 60,000 cemented femoral stems are implanted in the UK each year with the majority being manufactured from stainless steel containing 10–15% nickel. Nickel hypersensitivity has been reported in up to 13% of the general population and there is a concern that nickel hypersensitivity might adversely affect the outcome of total hip replacement (THR). We reviewed the current literature on the potential link between nickel hypersensitivity and THR complications, and the usefulness of patch testing. We conducted a literature search in PubMed, MEDLINE and EMBASE databases. The level of evidence and the quality of the selected studies were assessed using the Oxford Centre for Evidence-Based Medicine Criteria and the Methodological Index for Non-Randomised Studies tool, respectively. Twenty-six studies met the inclusion criteria, reporting on 1852 patients who underwent primary or revision THR. All studies detailed skin patch testing and recorded prevalence of nickel hypersensitivity from 1.5% to 33.3%. Five studies reported a rise in Nickel hypersensitivity following THR, while four reported a decreased prevalence post-operatively. Eight studies concluded that metal hypersensitivity could have developed following THR, while seven studies did not support a link between metal hypersensitivity and THR complications. Four of the studies recommended routine patch testing pre-operatively, but three others concluded that routine patch testing was not indicated. We have not identified a link between nickel hypersensitivity and THR complications, and the role of patch testing remains unclear. Further large-scale studies would be required to investigate this relationship and to clarify the role of patch testing in facilitating implant selection. Cite this article: EFORT Open Rev 2021;6:825-838. DOI: 10.1302/2058-5241.6.210051
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Dickinson, Alex, M. Browne, and Andy Taylor. "Modular Ceramic Bearings on a CFRP Total Hip Replacement Femoral Stem." Key Engineering Materials 361-363 (November 2007): 799–802. http://dx.doi.org/10.4028/www.scientific.net/kem.361-363.799.

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A modular ceramic femoral head was selected for use as the bearing on a novel carbon fibre reinforced plastic (CFRP) total hip replacement femoral stem. Mechanical testing was required to validate this novel combination of materials for load bearing implant application. The Ceramic Head-CFRP Stem Taper interface was tested under axial fatigue loads according to BS/ISO 7206-5, followed by static loading to failure. The assembly survived the fatigue loads and exceeded the required FDA post-fatigue strength by 50%. In parallel, the test was simulated in a Finite Element Analysis study, resulting in recommendations for the adhesive bonding technique used to attach the modular head to the CFRP stem to further improve its strength.
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Zietz, Carmen, Christian Fabry, Joern Reinders, Rebecca Dammer, Jan Philippe Kretzer, Rainer Bader, and Robert Sonntag. "Wear testing of total hip replacements under severe conditions." Expert Review of Medical Devices 12, no. 4 (June 5, 2015): 393–410. http://dx.doi.org/10.1586/17434440.2015.1050378.

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Worden, Natalie J., Kristian J. Ash, Nathaniel R. Ordway, Mark A. Miller, Kenneth A. Mann, Gretchen M. VanDeventer, Dominick M. Valenzano, Robert Hart, Mitsunori Kayano, and Kei Hayashi. "Radiographic and Biomechanical Assessment of Three Implant Designs for Canine Cementless Total Hip Replacement." Veterinary and Comparative Orthopaedics and Traumatology 33, no. 06 (September 24, 2020): 417–27. http://dx.doi.org/10.1055/s-0040-1715476.

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Abstract Objective The aim of this study was to evaluate the relationship between radiographic fit/fill measurements and biomechanical performance of three canine cementless total hip implant designs using an in vitro biomechanical testing protocol that replicates compression and torsion. Study Design Eighteen (six/group) canine cadaveric femurs were implanted with one of three cementless total hip implant designs: (1) collarless, (2) collared or (3) lateral bolt stems. Femoral length, canal flare index (CFI), canal fill, stem fit, stem level and stem angle were measured as independent variables. Biomechanical performance was tested using physiological, non-destructive gait loading (loading protocols) and destructive testing (failure protocols). Results During loading protocols, compressive stiffness was influenced by stem level (p < 0.05) and torsional stiffness was influenced by stem level and CFI for collarless stems (p < 0.05). During failure protocols, peak load was influenced by mediolateral (ML) stem angle (p < 0.05) and CFI (p < 0.01) for collarless stems and CFI for lateral bolt stems (p < 0.05). Peak torque was influenced by ML stem angle, craniocaudal stem angle and CFI for collarless stems (p < 0.05) and average ML fill for collared stems (p < 0.05). Conclusion Biomechanical performance of collarless stems in cementless hip arthroplasty is more impacted by radiographic fit/fill than lateral bolt and collared stems. As a result, collarless stems may be more dependent on preoperative fit and intraoperative precision.
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Li, Junyan, Anthony C. Redmond, Zhongmin Jin, John Fisher, Martin H. Stone, and Todd D. Stewart. "Hip contact forces in asymptomatic total hip replacement patients differ from normal healthy individuals: Implications for preclinical testing." Clinical Biomechanics 29, no. 7 (August 2014): 747–51. http://dx.doi.org/10.1016/j.clinbiomech.2014.06.005.

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Dissertations / Theses on the topic "Total hip replacement – Testing"

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Hussain, Azad. "Characterisation of wear particles genarated during accelerated testing of total hip replacement." Thesis, Queen Mary, University of London, 2004. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1783.

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Total hip replacements have been in use for over 30 years, and have shown great improvement from design to surgery since the first generation of implants were introduced. The greater need for hip replacements has led to the development of test methods that can be applied in the lab, which can predict the lifetime of a particular implant. To achieve this aim this study has sought to investigate key parameters, which may affect wear and its subsequent effect upon the production of particles for various material combinations and bearing geometries, under high (jogging) and low (walking) loads, with concurrent assessment of wear reduction, particle size and morphology. The clinical use of cross-linked polyethylene (XLPE) has been shown to reduce wear and thereby the onset of osteolysis in total hip arthroplasty. Hip simulator studies have suggested that while XLPE generates low wear under smooth counterface bearing surfaces, there appears to be an increased sensitivity to scratched femoral head conditions which can occur in the patient. However, these simulator studies have not combined damaged articular surfaces with a severe gait model, representing the worst-case scenario for high-risk, active patients. This hip simulator study has shown that the size distribution of wear particles generated in tests on 5 MRads crosslinked polyethylene can be influenced by the degree of patient activity. Fast jogging showed a greater influence on the number of sub-micron-sized wear particles (5-fold increase compared to walking) than on volumetric wear rate (26 mm3/106 cycles compared to 29 mm3/106 cycles). Fast jogging also did not generate the largest wear particles (>I 0p m) produced by normal walking. Roughening of the Co-Cr-Mo femoral heads created a 1700-fold increase in the numbers of sub-micron PE particles under fast jogging. The clinical significance of this result suggests that highly active patients will generate high numbers of bioactive PE wear particles within the accepted bioactive range, 0.2-10μm. Metal-on-metal (MOM) hip arthroplasty has also seen rapid growth worldwide. However, there remains concern over their long-term biocompatibility due to systemic ion release. Therefore, the aim of this current investigation was to test the hypothesis that larger diameter MOM bearings (greater than 40 mm) will generate smaller Co-Cr-Mo wear particles compared to a 28 mm size bearing, and reduce the total wear particle surface area, and to test the hypothesis that `severe' gait conditions will greatly increase the size of Co- Cr-Mo wear particles, thereby causing a sizable increase in wear particle surface area. Walking with a 28 mm bearing produced the largest wear rate of at 0.92 mm3/106 cycles, whereas the 40 mm and 56 mm bearings, generated lower wear rates of 0.39 mm3/106 cycles and 0.32 mm3/106 cycles respectively. Simulated fast jogging created a 3-fold increase in the number of elongated (needle) wear particles compared to normal walking, and generated a 20-fold increase in total wear particle surface area per year of use compared to normal walking. The clinical significance of this result suggests that highly active patients with MoM implants will exhibit greater ion release, although this may be minimised by using larger diameter bearings for active or younger patients.
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Bowsher, John G. "Accelerated wear testing methodologies for total hip replacements." Thesis, Queen Mary, University of London, 2001. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1513.

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Over the last three decades tribological studies of polyethylene total hip replacements have been undertaken using a simplified model of normal walking. As hip prostheses are being implanted in younger and more active patients, coupled with the increased wear resistance of crosslinked polyethylene, such in vitro approximations in patient activity are limiting. Therefore an alternative wear testing methodology for total hip replacements has been proposed, measuring the influences of fast walking, stumbling and simulated jogging sequences, all at varying cycle speeds with both smooth and roughened femoral components. This hip simulator study has shown that the influence of femoral roughness on the wear of crosslinked polyethylene becomes significantly greater under increased patient activity, demonstrating that roughness may be a more influential factor than previously ascribed. The combined effects of high roughness (Re of 0.38 μm), high joint forces (4.5 kN max) and high sliding speed (1.75 Hz) generated excessive crosslinked polyethylene wear and high joint torque, with wear rates exceeding 3000 mm3/106 cycles (k = 50 x10-6 mm3/N m). Thus for more active patients, implant survival can be greatly increased by using harder and more damage resistant femoral heads compared to CoCrMo. Under smooth conditions however, the overall influence of a significant increase in patient activity showed a much weaker effect. It was found that with smooth heads and non-constraining socket fixtures, the occurrence of excessive stumbling at 1 Hz (5 kN max) had a negligible effect on the wear of crosslinked polyethylene, whilst simulated jogging at 1.75 Hz (4.5 kN max) only showed a median increase in wear volume of 40 % compared to normal walking. Fast walking produced the largest wear rate (53 mm3/106 cycles), and was consistently greater than for simulated jogging. Ignoring fixation and other factors, these results suggest that whilst preserving polished surfaces, short periods of increased patient activity, for example, aerobics, tennis etc, will not greatly reduce the survival of crosslinked polyethylene/metal implants. Sliding speed and the degree of socket clamping were shown to be the most influential factors under smooth conditions, with the results showing no significant differences in wear rate when testing in varying quantities of bovine serum, or using an inverted or physiological specimen orientation.
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Herrmann, Sven W. [Verfasser]. "Dynamic Testing of Total Hip and Knee Replacements under Physiological Conditions / Sven W. Herrmann." München : Verlag Dr. Hut, 2015. http://d-nb.info/1079767932/34.

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Townsend, Katy Louise. "The Use of Radiographs, Dual-energy X-ray Absorptiometry, Quantitative Computed Tomography and Micro-computed Tomography to Determine Local Cancellous Bone Quality in the Canine Proximal Femur." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1336769521.

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Ajemian, Stanley V. "Gait changes following total hip replacement." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/mq24641.pdf.

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Walter, William Lindsay School of Biomechanics UNSW. "Severe biomechanical conditions in total hip replacement." Awarded by:University of New South Wales. School of Biomechanics, 2006. http://handle.unsw.edu.au/1959.4/25968.

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Hip simulators are designed to reproduce the forces and motion patterns of normal walking. In vivo demands on total hip replacements, however, are varied and often more severe than normal walking conditions. It is these severe conditions that often lead to implant failure. This is clinically based research aimed at understanding some of the more severe conditions in hips and the effect that these have on the performance of the total hip replacement. The polyethylene liner can act as a pump in an acetabular component, forcing fluid and wear particles through the holes to the retroacetabular bone causing osteolysis. Ten patients were studied at revision surgery. Pressures were measured in retroacetabular osteolytic lesions while performing pumping manouvers with the hip. Two laboratory experiments were then designed to study pumping mechanisms in vitro. In patients with contained osteolytic lesions, fluid pressure fluctuations could be measured in the lesion in association with the pumping action. Patients with uncontained osteolytic lesions showed no such pressure fluctuations. In the laboratory we identified 3 distinct mechanisms whereby fluid can be pumped from the hip joint to the retroacetabular bone. These pumping effects could be mitigated by improved implant design. Loading of the femoral head against the edge of the acetabular component produces dramatically increased contact pressures particularly in hard-on-hard bearings. In an analysis of 16 retrieved ceramic-on-ceramic bearings we were able to characterise the mechanism of edge loading based on the pattern of edge loading wear on the bearing surface. Finally in a radiographic study of patients with squeaking ceramic-on-ceramic hips. Squeaking was found to be associated with acetabular component malposition. It seems that edge loading or impingement may be an associated factor in these cases.
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Warwick, David John. "Deep vein thrombosis after total hip replacement." Thesis, University of Bristol, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283969.

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Torabi, Kachousangi Ehsanollah. "Edge loading effect on total hip replacement." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/90967/.

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The most important hip post-surgery problem is named Edge Loading (EL). This phenomenon significantly increases the contact pressure on the ball and the socket of the hip prosthesis hence decreasing the lifetime of the hip prosthesis drastically. Nowadays millions of patients cannot go under total hip replacement surgery due to the short lifetime of the hip prostheses. This research mainly focuses on finding solution for reducing the effect of this phenomenon. In this research, reasons of EL are investigated and important factors in designing of the prosthesis are studied. Furthermore, a novel hip prosthesis is proposed. The model has been successfully patented with PCT number: PCT/GB2015/052933 and published with International Publication Number: “WO2016/055783Al”. In this study the proposed design is analysed using three methods and the results are compared with the best available hip prosthesis in the market. The key results of the proposed design are outlined below: -Comparison of the features of the proposed design with those of the available hip prosthesis suggests a promising outcome. This is mostly due to eliminating of the EL causes, in the new design. -According to Hertzian Contact Theory, the proposed design reduces contact pressure during EL by 99.7% in comparison with the best available prosthesis in the market. This represents an upper limit. -Finite element method simulation demonstrates up to 63% reduction (lower limit) of contact pressure during EL and also Neck-Rim/Ring impingement by the proposed design in comparison with the best available prosthesis in the market. Although reduction of contact pressure by the novel design is noticeable, aforementioned methods show different results. This is due to the limitation of every method in this study. In this regard the novel design expecting to reduce contact pressure during EL / Microseparation more than 63% but less than 99.7%. The novel design may open a new path for the total hip replacement surgery, and solve the EL problem forever.
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Malik, Khan Aamer. "Validation of computer navigation for total hip replacement." Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/384238.

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Introducción: Está demostrado que incluso los cirujanos de cadera con una elevada experiencia, mal-posicionan los implantes durante la artroplastia total de cadera, pudiendo colocar los implantes fuera de la zona segura en casi un 50% de los casos. Las consecuencias de la mal-posición de implantes serían el impingement, la luxación, el aflojamiento aséptico, el desgaste, la osteolisis y dolor, pudiendo producir unas consecuencias dramáticas en la calidad de vida y funcionalidad de los pacientes. Este tesis describe la validación de un sistema de navegación sin imágenes primero con un fantoma y también clínicamente, para la precisa colocación del implante acetabular y femoral durante la artroplastia total de cadera. La información obtenida mediante esta reconstrucción numérica cambio nuestra técnica tradicional de colocar primero el cótilo hacia un número diana, a preparar primero el fémur y después la cadera con una anteversion combinada adecuada a unos números diana, técnica que validamos al final del estudio. Materiales y Métodos: Primero, validamos nuestro sistema de navegación mediante un fantoma que diseñamos. Comparamos los resultados de la posición acetabular real del fantoma con las lecturas del sistema de navegación y de las imágenes de Tomografía Computarizada (TC) procesadas del fantoma. Esta información fue procesada mediante dos sistemas computarizadas de reconstrucción 3D de cadera independientes (HipNav® and Orthosoft®). Una vez la fiabilidad del sistema fue verificado, realizamos estudios clínicos sobre diferentes cohortes de pacientes sometidos a artroplastia total de cadera no-cementada con navegación. Comparamos la precisión del cirujano para colocación de implantes a la del sistema de navegación. Estos resultados fueron validados mediante TC postoperatorio. Resultados: El fantoma confirmó que el Sistema de Navegación sin imágenes Navitrack, tenía una precisión de 1° y un sesgo de 0.02° para la inclinación y una precisión de 1.3° con un sesgo de 0° para medidas de anteversion. Clínicamente, la precisión del sistema de navegación del acetábulo fue de 4.4° con un sesgo de 0.03° para la inclinación y 4.1° con un sesgo de 0.73° para la anteversion. La precisión de los cirujanos con mucha experiencia fue de 11.5° para la inclinación y 12.3° para la anteversion, mientras que los cirujanos con menos experiencia tenían una precisión de 13.1° para la inclinación y 13.9° para la anteversion del cótilo. Para la versión del implante femoral, al comparar los valores del navegador a los TC postoperatorios, su precisión era de 4.8° con un sesgo de 0.2°. Al comparar las estimas del cirujano al navegador, su precisión fue de 16.8° con un sesgo de 0.2°. Confirmamos que el navegador tiene una precisión con error de < 5° y sesgo de < 1° para la colocación de implantes y siempre fue superior a los cirujanos. La anteversion combinada medida mediante TC postoperatorio fue de 37.6° ± 7° (rango 19°–50°). La anteversion combinada con navegación estaba dentro del rango deseado de 25° a 50° en 96% de caderas. Conclusiones: Demostramos que el cirujano solo mediante su experiencia y intuición no puede colocar los implantes de una prótesis de cadera en la posición deseada. La artroplastia de cadera mediante la navegación es clínicamente precisa para la colocación del implante femoral y acetabular con un error de menos de 5°. La versión final del implante femoral no-cementado es muchísimo más variable de lo que se pensaba. Usando una herramienta precisa, previamente validada, para obtener información numérica intraoperatoria, llevamos a cabo una novedosa técnica de anteversion combinada para la reconstrucción de la artroplastia de cadera. Estudios a largo plazo que validen el coste efectividad y supervivencia de implantes con esta tecnología determinaran el papel de la navegación en nuestras cirugías de cadera de día a día.
INTRODUCTION Even vastly experienced high-volume hip surgeons have been shown to be inaccurate with implant positioning during total hip replacement. Surgeons position the acetabular implants inclination and version, and femoral implants version out of the safe zone in almost 50% of cases. Consequences of implant mal-position are impingement, dislocation, aseptic loosening, wear, osteolysis and pain. These have dramatic effects on the patients’ functional outcome and quality of life. This thesis outlines the validation of an imageless navigation system with a phantom model, and posteriorly clinically, for accurate acetabular and femoral implant positioning during total hip replacement. The information obtained with this numerical reconstruction shifted our traditional surgical technique of placing the acetabulum first towards target numbers, to a femur first combined anteversion technique, which is validated at the end of the study. MATERIALS AND METHODS First, we validated our navigation system with a phantom model which we designed. We compared the readings of the imageless navigation system, and processed Computer Tomography (CT) scanned images of the phantom, with the true values of the phantom models acetabulum. This data was processed using two independent computer based hip reconstruction systems (HipNav® and Orthosoft®). Once robustness of the system was confirmed, clinical studies were undertaken in different cohorts of patients undergoing non-cemented total hip replacement with computer navigation between 2004 and 2009. The surgeon’s accuracy for implant positioning was compared to that of the navigation system. These results were validated by postoperative CT-scans (gold standard for postoperative implant position validation). RESULTS The phantom model confirmed that the Navitack Imageless Computer Navigation System had a precision of 1° and a bias of 0.02° for inclination and a precision of 1.3° and a bias of 0° for anteversion measurements. Clinically, the accuracy of the navigation system for the acetabulum was a precision of 4.4° with a bias of 0.03° for inclination and 4.1° with a bias of 0.73° for anteversion. The experienced surgeons’ precision was 11.5° for inclination and 12.3° for anteversion, whereas the less experienced surgeons’ precision was 13.1° for inclination and 13.9° for anteversion. For the femur implants version, on comparing the navigation systems values to postoperative CT-scans, its precision was 4.8° and bias was 0.2°. On comparing surgeon’s estimates to navigation, their precision was 16.8° with a bias of 0.2°. The distribution of femoral stem version had a wide variability (far from the assumed 15°) from complete retroversion to high anteversion. We confirmed that computer navigation had a precision of less than 5 degrees and bias of less than 1 degree for hip implant positioning, and was always better than that of surgeons. Combined anteversion by postoperative computed tomography scan was 37.6° ± 7° (range, 19°–50°). The combined anteversion with computer navigation was within the safe zone of 25° to 50° in 45 of 47 (96%) hips. CONCLUSIONS We demonstrated that the surgeon, through experience and intuition alone, cannot place implants within the desired positions. Hip replacement using computer navigation is clinically accurate to within 5° for acetabular and femoral implant positioning. There is far greater variability in femoral version of non-cemented implants than previously estimated. Using an accurate validated tool for numerical intraoperative information, we undertook a novel hip reconstruction method described as the combined anteversion technique. We believe it will reduce the risk for impingement and its complications. Long-term studies that validate improved implant survival and cost effectiveness with this expensive technology will help determine its future role in our day-to-day hip surgery
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Crawford, Ross William. "Focal femoral osteolysis in cemented total hip replacement." Thesis, University of Oxford, 2000. http://ora.ox.ac.uk/objects/uuid:67914dbd-6405-41a3-b4d6-6baeb8bbf0bf.

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As implant survival extends into the second and third decades focal osteolysis around cemented femoral components in total hip replacement is emerging as an important failure mechanism. Whilst the problem of focal osteolysis is well recognised, there are many aspects of its development which are poorly understood. The broad aim of this thesis is to try to provide some insights into how, why and where focal osteolysis develops around the cemented femoral component. There are broadly two sections to this thesis, chapters 2-5 present clinical and geometrical studies and chapters 6-10 a series of experimental studies. The aim of the first section was to establish what is observed in clinical practice, the aim of the second to try to explain these findings. A mid-term clinical study showed that focal osteolysis is more common with rough than polished stems that differed in no aspect other than their surface finish. Further studies established that focal osteolysis is probably always associated with defects in the cement mantle. These defects occur anteriorly at the mid-stem of the prosthesis and posteriorly at the component tip. The distribution of focal osteolysis and its strong association with cement mantle defects suggests the importance of the stemcement interface as a pathway for fluid and debris to reach the distal femur. However, at 15-25 years, osteolysis rarely develops with the polished Exeter stem even in the presence of confirmed defects in the cement mantle, suggesting that the stem seals the stem-cement interface against fluid and debris. In an attempt to explain the clinical findings a series of bench top experiments were undertaken. These studies showed that the behaviour of fluid and dye at the stemcement interface was significantly influenced by component surface finish. Bonded and debonded stem-cement interfaces of rough stems provided an incomplete barrier to fluid movement along this interface. In contrast, polished stems both bonded and debonded were able to provide a seal at the stem-cement interface. The seal at this interface was improved with component subsidence in the presence of rotational stability. It is believed that this thesis provides a rationale explanation for why focal osteolysis rarely develops around the Exeter stem in clinical practice. It also explains how, where, and why osteolysis develops around certain designs of cemented femoral components used in total hip replacement.
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Books on the topic "Total hip replacement – Testing"

1

European Federation of National Associations of Orthopaedics and Traumatology. Congress. Tribology in total hip arthroplasty. Edited by Knahr Karl. Heidelberg: Springer, 2011.

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1956-, Jacobs Joshua J., Craig Thomas L. 1947-, and Symposium on Alternative Bearing Surfaces in Total Joint Replacement (1997 : San Diego, Calif.), eds. Alternative bearing surfaces in total joint replacement. West Conshohocken, PA: ASTM [American Society for Testing and Materials], 1998.

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Knahr, Karl. Total Hip Arthroplasty: Tribological Considerations and Clinical Consequences. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013.

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Lampropoulou-Adamidou, Kalliopi, and George Hartofilakidis. Total Hip Replacement. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-53360-5.

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Ochsner, Peter Emil, ed. Total Hip Replacement. Berlin, Heidelberg: Springer Berlin Heidelberg, 2003. http://dx.doi.org/10.1007/978-3-642-55679-1.

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Postel, Michel, Marcel Kerboul, Jacques Evrard, and Jean Pierre Courpied, eds. Total Hip Replacement. Berlin, Heidelberg: Springer Berlin Heidelberg, 1987. http://dx.doi.org/10.1007/978-3-642-69597-1.

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E, Padgett Douglas, ed. Atlas of total hip replacement. New York: Churchill Livingstone, 1995.

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E, Steinberg Marvin, and Garino Jonathan P, eds. Revision total hip arthroplasty. Philadelphia: Lippincott Williams & Wilkins, 1999.

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K, Bawari R., ed. Total hip replacement surgery: (principles and techniques). New Delhi: Jaypee Brothers Medical Pub., 2010.

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Total hip arthroplasty. Saint Louis: Mosby, 1993.

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Book chapters on the topic "Total hip replacement – Testing"

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Kaddick, Christian. "Simulator Testing of Total Knee Replacements." In Tribology in Total Hip and Knee Arthroplasty, 37–40. Berlin, Heidelberg: Springer Berlin Heidelberg, 2014. http://dx.doi.org/10.1007/978-3-642-45266-6_4.

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Hadley, M., C. Hardaker, S. Williams, Z. Jin, G. Isaac, and J. Fisher. "Development of a Stop-Dwell-Start (SDS) Protocol for In Vitro Wear Testing of Metal-on-Metal Total Hip Replacements." In Metal-On-Metal Total Hip Replacement Devices, 271–91. 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959: ASTM International, 2013. http://dx.doi.org/10.1520/stp156020120032.

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Nambu, Satya, Richard Obert, Michael Roark, Eleonora Delvechhio, Doug Linton, Scott Bible, and Jon Moseley. "Accelerated Fretting Corrosion Testing of Modular Necks for Total Hip Arthroplasty." In Modularity and Tapers in Total Joint Replacement Devices, 237–58. 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959: ASTM International, 2015. http://dx.doi.org/10.1520/stp159120140132.

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Penrose, Dina. "Total hip replacement." In Occupational Therapy for Orthopaedic Conditions, 28–39. Boston, MA: Springer US, 1993. http://dx.doi.org/10.1007/978-1-4899-3085-9_2.

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Patel, Vijay, Kamen Vlassakov, and David R. Janfaza. "Total Hip Replacement." In Anesthesiology, 341–46. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-50141-3_44.

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Liska, William, and Jonathan Dyce. "Total Hip Replacement." In Complications in Small Animal Surgery, 778–833. Chichester, UK: John Wiley & Sons, Ltd, 2017. http://dx.doi.org/10.1002/9781119421344.ch113.

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Häfliger, Susanna, and Peter Emil Ochsner. "Documentation." In Total Hip Replacement, 1–4. Berlin, Heidelberg: Springer Berlin Heidelberg, 2003. http://dx.doi.org/10.1007/978-3-642-55679-1_1.

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Ferrat, Pia. "Limping." In Total Hip Replacement, 147–53. Berlin, Heidelberg: Springer Berlin Heidelberg, 2003. http://dx.doi.org/10.1007/978-3-642-55679-1_10.

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Thomann, Yves, and Hans Rudolf Stöckli. "Neurological Complications." In Total Hip Replacement, 155–74. Berlin, Heidelberg: Springer Berlin Heidelberg, 2003. http://dx.doi.org/10.1007/978-3-642-55679-1_11.

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Vaeckenstedt, Joachim. "Periarticular Ossification." In Total Hip Replacement, 175–84. Berlin, Heidelberg: Springer Berlin Heidelberg, 2003. http://dx.doi.org/10.1007/978-3-642-55679-1_12.

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Conference papers on the topic "Total hip replacement – Testing"

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Petrella, Anthony J., and Mark C. Miller. "A General Adhesive Wear Simulation for Total Joint Replacements: Application to the Patellofemoral Joint." In ASME 2001 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2001. http://dx.doi.org/10.1115/imece2001/bed-23088.

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Abstract Advances in design, materials, and fixation have increased the longevity of total joint replacements and significantly reduced the incidence of mechanical failure or loosening of implant components. Wear of the ultra-high molecular weight polyethylene (UHMWPE) bearing material used in most implants is now among the most important problems in total joint replacement. Wear tests in joint simulators are the gold standard for evaluation of wear resistance and are performed on a routine basis in many research laboratories. Physical wear testing, however, is labor intensive and time consuming. Numerical wear simulations have been developed and applied to the hip joint to evaluate adhesive wear of polyethylene liners [1,2]. The purpose of this project was to develop a general adhesive wear simulation applicable to any articulating joint with arbitrary geometry and subject to arbitrary relative motion. Validation of the model was established through application to the patellofemoral joint of a total knee replacement.
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Williams, Sophie, Zhongmin M. Jin, Martin H. Stone, Eileen Ingham, and John Fisher. "The Effect of Different Lubrication Regimes and Lubricants on the Friction Hard-on-Hard Total Hip Replacements." In World Tribology Congress III. ASMEDC, 2005. http://dx.doi.org/10.1115/wtc2005-63330.

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The wear of hip replacements can be dependent on serum protein levels and the swing-phase load during the gait cycle. We hypothesise that these effects may be associated with changes in the lubrication and friction of the joint. The aim of this study was to assess the effect of the lubrication regime and lubricant on the friction of metal-on-metal (MOM) and ceramic-on-ceramic (COC) THRs. Increasing the swing-phase load led to decreased fluid film thickness and an increase in friction, in both MOM and COC bearings. Increasing the protein concentration of the lubricant, decreased the friction of MOM THRs. Friction testing of COC bearings demonstrated an increase in friction as the protein concentration increased. The change in lubricating film thickness explains differences in friction and wear as the swing-phase load is changed for a given lubricant. However, when we change the lubricant composition, protein boundary lubrication effects dominate, this influences friction and wear differently in MOM and COC THRs.
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Venturoli, A., G. Conoscenti, and R. Chiesa. "Driving Factors on the Fatigue Resistance for Titanium Plasma Sprayed Coated Samples." In ITSC2022. DVS Media GmbH, 2022. http://dx.doi.org/10.31399/asm.cp.itsc2022p0493.

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Abstract The aim of this work is to study the effects of the titanium plasma spray (TPS) coating process on the fatigue resistance of a titanium-6Al-4V substrate. The combination of TPS processes and Ti alloy substrate is widely applied on components intended for cementless total hip replacement (THR). In order to understand the coating process mechanism behind the implants’ fatigue resistance decrease, one air-developed coating (Ti-APS) and one controlled atmosphere developed coating (Ti-CAPS) were considered. The effects of the most representative parameters of the plasma spray process on the fatigue resistance were analysed: the sandblasting process, the plasma and the coating powder. Fatigue resistance studies were performed by means of rotating bending fatigue testing. After fatigue failure specimens underwent morphological analyses both on the primary crack surface and on the cross-sectional area complemented by of the metallographic analyses of the coating. The titanium substrate fatigue resistance decreased after being blasted with direct relationship with the grain size. Ti-CAPS process showed a relatively limited further influence on the fatigue resistance reduction with respect to only sandblasted samples. By contrary a remarkable fatigue limit decreased was seen for Ti-APS coated samples against Ti-CAPS and simply sandblasted samples. The experiment pointed out the critical importance of cracks oxidation as a fatigue failure driving factor.
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Shapi'i, Azrulhizam, Anton Satria Prabuwono, Mohammad Khatim Hasan, Riza Sulaiman, Abdul Yazid Mohd Kassim, and Nor Hazla Mohamed Hafla. "Design of Total Hip Replacement digital templating software." In 2011 International Conference on Electrical Engineering and Informatics (ICEEI). IEEE, 2011. http://dx.doi.org/10.1109/iceei.2011.6021568.

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Downing, M. R. "Automated femoral measurement in total hip replacement radiographs." In 6th International Conference on Image Processing and its Applications. IEE, 1997. http://dx.doi.org/10.1049/cp:19971015.

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Schimpf, Kl, H. H. Brackmann, D. Bock, G. Landbeck, E. Lechler, and H. Vinazzer. "NO ANTI-HIV SEROCONVERSION AFTER REPLACEMENT THERAPY WITH STEAM-TREATED FACTOR VIII CONCENTRATE. A STUDY OF 60 PATIENTS WITH HEMOPHILIA A AND VON WILLEBRAND'S DISEASE." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644054.

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Transmission of hepatitis viruses and HIV has proven to be a risk of replacement therapy. Since Dec. 1983 factor VIII concentrates in which viruses are inactivated by steam-treatment (Factor VIII TIM 3 or S-TIM 3) are available for therapy. As they are manufactured by 80% from US plasma it was necessary to prove that they do not transmit HIV. For ethical reasons it is not possible to treat control groups of patients with non-virus- inactivated concentrate. Non-transmission of HIV can, therefore, only be proven if anti-HIV seroconversion does not occur in larger groups of patients treated with this type of product. We collected data from 60 patients, who were “virgin” (24) or, if pre-treated, anti-HIV seronegative. Therapy with Factor VIII TIM 3 or S-TIM 3 was started between Sept. 1984 and April 1986. The median length of observation till the last anti-HIV testing was 12 (6 - 24) months. The median total dosage of Factor VIII was 56,500 (500 - 427,500) IU, the median patient age was 20 (1 - 61) years. In none of the patients anti-HIV seroconversion (ELISA test) was observed. According to the rule ofthree the upper 95% confidence limit for random sample of 60 cases with zero events would be 3/60 or 5%.
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Vina, ER, M. Kallan, A. Collier, C. Nelson, and S. Ibrahim. "THU0707 Race & rehabilitation destination after total hip replacement." In Annual European Congress of Rheumatology, 14–17 June, 2017. BMJ Publishing Group Ltd and European League Against Rheumatism, 2017. http://dx.doi.org/10.1136/annrheumdis-2017-eular.2168.

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Jimenez, J. C., Natalia Romero, and David Keyson. "Capturing patients’ daily life experiences after Total Hip Replacement." In 5th International ICST Conference on Pervasive Computing Technologies for Healthcare. IEEE, 2011. http://dx.doi.org/10.4108/icst.pervasivehealth.2011.246022.

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Donaldson, Finn E., and James C. Coburn. "Stochastic Simulation of Modular Connections in Total Hip Replacement." In ASME 2013 Conference on Frontiers in Medical Devices: Applications of Computer Modeling and Simulation. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/fmd2013-16078.

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Several modern Total Hip Arthroplasty (THA) implants have been associated with increased release of metallic debris through combined mechanical fretting wear and chemical corrosion. These particles can lead to painful Adverse Reaction to Metallic Debris, often requiring early revision [1]. While much research has focused on improving the performance of bearing surfaces, the key parameters driving release of metallic debris at modular junctions remains unclear.
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Schimpf, K. l., B. Kraus, W. Kreuz, H. H. Brackmann, F. Haschke, and W. Schramm. "NO ANTI-HIV SEROCONVERSION AFTER REPLACEMENT THERAPY WITH PASTEURIZED F VIII CONCENTRATE. A STUDY OF 151 PATIENTS WITH HEMOPHILIA A OR VON WILLEBRAND'S DISEASE." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643973.

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Transmission of hepatitis viruses and HIV has proven to be a risk of replacement therapy in hemophilia. As regards F VIII products a concentrate (Hemate HS or P) in which viruses are inactivated by heat-treatment over 10 hours at 60° C in aqueous solution is available since 1979. Our clinical studies have shown that this product does not transmit HBV and HNANBV. As the product was manufactured by 80% from US plasma it was necessary to prove that it also does not transmit HIV. As it is, for ethical reasons, not possible to treat a control group with non-virus-inactivated F VIII, non-transmission of HIV can only proven if anti-HIV seroconversion does not occur in larger groups of patients treated exclusively with this virus-inactivated product.We collected data from 151 patients treated with Hemate HS (P) who had never before received blood or blood products. Therapy was started between Feb. 1979 and Jan. 1986 (median July 7,1983). The median length of observation till the last anti-HIV testing was 24 (3 - 83) months. 112 patients were observed longer than 13 months. The median total dosage was 17,000 (500 -2,155,375) IU of F VIII, the median patient age was 6 (0,5 - 68) years. In none of these patients anti-HIV seroconversion (ELISA test) was observed. According to the rule of three, the upper 95% confidence limit for a random sample of 60 cases with zero events would be 3/60 or 5%. For greater numbers of n cases, as in our study, the range of confidence narrows increasingly. The period of observation of this study is hitherto the longest.
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Reports on the topic "Total hip replacement – Testing"

1

Han, Zhe. Risk factors and prevalence of DVT after total hip replacement A protocol for meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, November 2020. http://dx.doi.org/10.37766/inplasy2020.11.0112.

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A. Komnos, Georgios, Antonios Papadopoulos, Efstratios Athanaselis, Theofilos Karachalios, and Sokratis E. Varitimidis. Migrating Periprosthetic Infection from a Total Hip Replacement to a Contralateral Non-Operated Osteoarthritic Knee Joint. Science Repository, January 2023. http://dx.doi.org/10.31487/j.ijscr.2022.03.02.

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Introduction: There is a paucity of published data on whether a treated infected arthroplasty is a risk factor for infection in another, non-operated joint. Contamination of a primary, arthritic, non-operated joint from an infected arthroplasty is a relatively rare entity. Case: We report a case of migration of a pathogen (Enterococcus faecalis) from an infected prosthetic joint (hip) to the contralateral native joint (knee). Identification of the pathogen was made with PCR, by obtaining cultures during the implantation of the primary knee prosthesis. Conclusion: Contamination of a primary, arthritic, non-operated joint from an infected arthroplasty has not been widely reported. Management of such cases is extremely challenging and without clear and established guidelines. Our experience shows that tissue samples should be taken intraoperatively and sent for cultures, so as to exclude contamination in those cases.
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Hao, Dongsheng, and Junjie Wang. Efficacy of applying vitamin E-diffused highly cross-linked polyethylene cups in total hip replacement: A meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, September 2021. http://dx.doi.org/10.37766/inplasy2021.9.0042.

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Gandhi, Naline, Amatullah Sana Qadeer, Ananda Meher, Jennifer Rachel, Abhilash Patra, Jebamalar John, Aiswarya Anilkumar, Ambarish Dutta, Sarit Kumar Rout, and Lipika Nanda. A systematic review of cost effectiveness of total knee replacement vs non-surgical management among 40 years and above population with knee osteoarthritis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, September 2022. http://dx.doi.org/10.37766/inplasy2022.9.0044.

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Review question / Objective: Clinically, knee is the most common site of OA, followed by the hand and hip. The main research question is what are different costing methodologies used and its quality in studies related to cost effectiveness of TKR compared to non-surgical treatment procedures. Based on this review question, the following objectives are proposed: 1. To assess different methodologies, scope and quality of studies related to cost effectiveness of TKR compared to non-surgical management. 2. To synthesize evidence of TKR cost and compare the variations across different countries. Information sources: All sources with information on TKR, economic evaluations and non-surgical management namely journals, handbooks, internet sources, published conference abstracts, thesis, and electronic databases will be searched extensively.
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Konnyu, Kristin J., Louise M. Thoma, Monika Reddy Bhuma, Wagnan Cao, Gaelen P. Adam, Shivani Mehta, Roy K. Aaron, et al. Prehabilitation and Rehabilitation for Major Joint Replacement. Agency for Healthcare Research and Quality (AHRQ), November 2021. http://dx.doi.org/10.23970/ahrqepccer248.

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Objectives. This systematic review evaluates the rehabilitation interventions for patients who have undergone (or will undergo) total knee arthroplasty (TKA) or total hip arthroplasty (THA) for the treatment of osteoarthritis. We addressed four Key Questions (KQs): comparisons of (1) rehabilitation prior (“prehabilitation”) to TKA versus no prehabilitation, (2) comparative effectiveness of different rehabilitation programs after TKA, (3) prehabilitation prior to THA versus no prehabilitation, (4) comparative effectiveness of different rehabilitation programs after THA. Data sources and review methods. We searched Medline®, PsycINFO®, Embase®, the Cochrane Register of Clinical Trials, CINAHL®, Scopus®, and ClinicalTrials.gov from Jan 1, 2005, to May 3, 2021, to identify randomized controlled trials (RCTs) and adequately adjusted nonrandomized comparative studies (NRCSs). We evaluated clinical outcomes selected with input from a range of stakeholders. We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. Meta-analysis was not feasible, and evidence was synthesized and reported descriptively. The PROSPERO protocol registration number is CRD42020199102. Results. We found 78 RCTs and 5 adjusted NRCSs. Risk of bias was moderate to high for most studies. • KQ 1: Compared with no prehabilitation, prehabilitation prior to TKA may increase strength and reduce length of hospital stay (low SoE) but may lead to comparable results in pain, range of motion (ROM), and activities of daily living (ADL) (low SoE). There was no evidence of an increased risk of harms due to prehabilitation (low SoE). • KQ 2: Various rehabilitation interventions after TKA may lead to comparable improvements in pain, ROM, and ADL (low SoE). Rehabilitation in the acute phase (initiated within 2 weeks of surgery) may lead to increased strength (low SoE) but result in similar strength when delivered in the post-acute phase (low SoE). No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period following TKA. Compared with various controls, post-acute rehabilitation may not increase the risk of harms (low SoE). • KQ 3: For all assessed outcomes, there is insufficient (or no) evidence addressing the comparison between prehabilitation and no prehabilitation prior to THA. • KQ 4: Various rehabilitation interventions after THA may lead to comparable improvements in pain, strength, ADL, and quality of life. There is some evidence of no increased risk of harms due to the intervention (low SoE). • There is insufficient evidence regarding which patients may benefit from (p)rehabilitation for all KQs and insufficient evidence regarding comparisons of different providers and different settings of (p)rehabilitation for all KQs. There is insufficient evidence on costs of (p)rehabilitation and no evidence on cost effectiveness for all KQs. Conclusion. Despite the large number of studies found, the evidence regarding various prehabilitation programs and comparisons of rehabilitation programs for TKA and THA is ultimately sparse. This is a result of the diversity of interventions studied and outcomes reported across studies. As a result, the evidence is largely insufficient or of low SoE. New high-quality research is needed, using standardized intervention terminology and core outcome sets, especially to allow network meta-analyses to explore the impact of intervention attributes on patient-reported, performance-based, and healthcare-utilization outcomes.
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