Journal articles: '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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Total Hip Replacement 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 Total Hip Replacement 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 Manual Muscle Testing scale, and functional ability activity with the Oxford Hip Score index. In this case the technology chosen was Infra Red and Exercise Therapy.The purpose of this study was to determine the effect of physiotherapy management on post operative conditions Total Hip Replacement with Infra Red 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 Total Hip Replacement with Infra Red and Exercise Therapy. Research instruments in the form of Visual Descriptive Scale (VDS), palpation, midline, goniometer, Manual Muscle Testing (MMT), and Oxford Hip Score Scale.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 Total Hip Replacement.

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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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Macdonald, W., L. V. Carlsson, N. Gathercole, and C. M. Jacobsson. "Fatigue testing of a proximal femoral hip component." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 217, no. 2 (February 1, 2003): 137–45. http://dx.doi.org/10.1243/09544110360579358.

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The Gothenburg Osseointegrated Titanium (GOT) implant is a novel total hip replacement including a metaphyseal loading proximal femoral component fixed in the retained femoral neck. Endurance testing was performed under conditions analogous to ISO 7206–4: 1989. The cement-free implant is not fixed distally within the intramedullary canal, so distal embedding (as specified in the standard) would have been unrealistic. Instead glass-fibre-reinforced epoxy (GFRE) bushings were used to model reduced bone support mid-length at the medial cortex and distally at the lateral cortex. Such support simulated proximal bone loss, realistically reproducing the effect of osteolysis or fixation failure. Under such conditions the component survived unbroken for 10 million cycles at 3.0 kN peak load.

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Kuo, Tony Y., John G. Skedros, and Roy D. Bloebaum. "Comparison of human, primate, and canine femora: Implications for biomaterials testing in total hip replacement." Journal of Biomedical Materials Research 40, no. 3 (June 5, 1998): 475–89. http://dx.doi.org/10.1002/(sici)1097-4636(19980605)40:3<475::aid-jbm19>3.0.co;2-i.

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Cortes, Vicente, Carlos A. Rodriguez Betancourth, Javier A. Ortega, and Hasina Huq. "Multidirectional Pin-on-Disk Testing Device to Evaluate the Cross-shear Effect on the Wear of Biocompatible Materials." Instruments 3, no. 3 (July 22, 2019): 35. http://dx.doi.org/10.3390/instruments3030035.

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One of the main causes of hip prostheses failure is the premature wear of their components. Multi-directional motion or “cross-shear” motion has been identified as one of the most significant factors affecting the wear rate of UHMWPE in total hip joint replacement prostheses. To better evaluate the effect of this cross-shear motion on the tribological behavior of different biomaterials, a new wear testing device has been designed and developed. This new instrument is capable to reproduce the “cross-shear” effect with bidirectional motion on bearing materials and to determine coefficient of friction (COF) between surfaces during testing. To validate the functionality of this new testing platform, alumina balls were articulated against Ti-6Al-4V ELI alloy disks in Ringer’s solution. Four different articulation patterns, all with identical path lengths per cycle, were tested. Gravimetric weight loss was converted to volumetric wear data in order to determine the effects of motion patterns on the wear. Worn surfaces were analyzed by scanning electron microscopy. This scientific approach to quantifying the tribological effects of cross-shear provides fundamental data that are crucial in evaluating potential biomaterials for use in knee and hip joint replacements.

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Putra, A. M. S., Muhamad Noor Harun, and Syahrom Ardiyansyah. "Study of Wear Prediction on Total Ankle Replacement." Advanced Materials Research 845 (December 2013): 311–15. http://dx.doi.org/10.4028/www.scientific.net/amr.845.311.

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Pre-clinical experimental wear testing is very effective to evaluate new ankle replacement in the aspect of design and material used. However, both cost and time can be one of the constraints factors, particularly in the early stage of design or analysis. Numerical method has been addressed as an alternative to predict wear on ankle replacement. The computational wear simulation has been widely used on the hip and knee but very less found in study related to wear analysis of the ankle. The purpose of this research is to develop computational simulation to predict wear on total ankle replacement (TAR). Three dimensional (3D) models of the right ankle TAR were developed using BOX total ankle replacement model. Mobile bearing device was developed consisting of three components tibial, bearing and talar. Each component has different design and purposes representing its physiological behaviour of the ankle. The ankle load applied was based on the joint reaction force profile at the ankle joint. This is to determine the distribution of contact stress on the meniscal bearing surfaces contact with talar component for 25 discrete instant during stance phase of gait cycle. The sliding distance was obtained from predominates motion of plantar/dorsi flexion. The computed linear wear depth and cumulative volumetric wear were 0.01614 mm per million cycles and 30.5 mm3, respectively. The values obtained were proven to be consistent with the previous in vitro result.

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Strukov, R. N., E. S. Koneva, A. A. Pesotskaya, S. M. Konev, T. V. Shapovalenko, K. V. Lyadov, E. N. Zhumanova, I. V. Sidyakina, S. N. Kolbakhova, and Timur Khaptagaev. "Current trends in the organization of rehabilitation care for patients after total hip replacement." Fizioterapevt (Physiotherapist), no. 5 (October 6, 2022): 68–80. http://dx.doi.org/10.33920/med-14-2210-08.

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The pandemic caused by the novel coronavirus infection COVID-19 dramatically increased the burden on healthcare, which led to the repurposing and limitation of the bed stock in rehabilitation centers. That served as the basis for the search for new approaches to the treatment and routing of patients, including using remote-controlled rehabilitation. The aim of the study was to evaluate the effectiveness and safety of motor rehabilitation in patients after hip replacement with the use of telerehabilitation technologies. Materials and methods: In a retrospective study, 32 patients aged 40 to 75 years who underwent rehabilitation after hip replacement using telemedicine technologies were examined. After discharge from the surgical hospital, all patients were offered a link to receive a program of motor rehabilitation, including exercise therapy complexes and a video clip on the technique of performing these exercises. In addition, online classes with a physical therapy instructor were conducted for patients with technical capabilities. The rehabilitation program started from the first day after surgery and lasted 90 days. To assess the effectiveness of rehabilitation, all patients underwent testing, including questionnaires and mobility tests, which were conducted on the second day and 3 months after surgery. Results: Rehabilitation with the use of telemedicine for patients after hip replacement demonstrates a positive clinical effect, assessed by mobility tests (TUG and the 6‑minute walk test), the EQ-5D quality of life scale, the SF-36 questionnaire and State-Trait Anxiety Inventory test. Conclusion: The criteria for patient inclusion developed by us, special physical therapy programs, and a routing model with remote rehabilitation treatment can become an effective alternative to the full-time rehabilitation, in case of paramedical difficulties for its implementation.

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Affatato, Saverio, Massimiliano Merola, and Alessandro Ruggiero. "Development of a Novel in Silico Model to Investigate the Influence of Radial Clearance on the Acetabular Cup Contact Pressure in Hip Implants." Materials 11, no. 8 (July 25, 2018): 1282. http://dx.doi.org/10.3390/ma11081282.

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A hip joint replacement is considered one of the most successful orthopedic surgical procedures although it involves challenges that must be overcome. The patient group undergoing total hip arthroplasty now includes younger and more active patients who require a broad range of motion and a longer service lifetime of the implant. The current replacement joint results are not fully satisfactory for these patients’ demands. As particle release is one of the main issues, pre-clinical experimental wear testing of total hip replacement components is an invaluable tool for evaluating new implant designs and materials. The aim of the study was to investigate the cup tensional state by varying the clearance between head and cup. For doing this we use a novel hard-on-soft finite element model with kinematic and dynamic conditions calculated from a musculoskeletal multibody model during the gait. Four different usual radial clearances were considered, ranging from 0 to 0.5 mm. The results showed that radial clearance plays a key role in acetabular cup stress-strain during the gait, showing from the 0 value to the highest, 0.5, a difference of 44% and 35% in terms of maximum pressure and deformation, respectively. Moreover, the presented model could be usefully exploited for complete elastohydrodynamic synovial lubrication modelling of the joint, with the aim of moving towards an increasingly realistic total hip arthroplasty in silico wear assessment accounting for differences in radial clearances.

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Bagherifard, Abolfazl, Kaveh Gharanizadeh, Mostafa Salehpour, Hamed Jafarpour, and Mani Mahmoudi. "Comparing Prophylactic Effect of Rivaroxaban and Enoxaparin on Thromboembolism After Total Hip or Knee Arthroplasty." Journal of Research in Orthopedic Science 7, no. 1 (February 1, 2020): 13–22. http://dx.doi.org/10.32598/jrosj.7.1.13.

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Background: Vascular thromboembolism is one of the major concerns of orthopedic surgeons after hip or knee replacement surgery. Although many thromboprophylactic drugs have been introduced, there is still no consensus over their efficacy and safety. Therefore, this study aimed to compare the efficacy and safety of oral rivaroxaban and aspirin administration and enoxaparin injections in patients undergoing knee or hip replacement. Objectives: Determination and comparison of the side effect and efficacy of Rivaroxaban and Enoxaparin after total hip or knee arthroplasty. Methods: A total of 231 patients undergoing knee or hip replacement surgery were included in the study. Of them, 31 patients were excluded due to missing the follow-up. Of the remaining 200 patients, 42 low-risk and 158 moderate- to high-risk patients were identified, according to Caprini risk assessment model. Then, they were divided into three groups: aspirin (42 patients), enoxaparin (78 patients), and rivaroxaban (80 patients). Severe hemorrhage (hemoglobin reduction of more than 2 g/dL or requiring blood transfusion) was assessed after the first dose of medication until discharge through daily hemoglobin testing. Frequency of other side effects such as wound complications (ecchymosis, hematoma, and wound infection) and gastrointestinal or skin problems was recorded and compared by daily examination during the hospital stay and then in the future visits to the clinic up to 6 months in each group. Follow up visits were performed at weeks 6, 12, and 24. Results: No cases of deep vein thrombosis or pulmonary thromboembolism were observed in any of the study groups. There was no significant difference between the two groups in the number of major bleeding cases (P=0.39). Ecchymosis around the wound was significantly higher in the rivaroxaban group than in the enoxaparin group (33.8% vs. 23%). However, this difference was not statistically significant (P=0.06). Conclusion: The efficacy and safety of rivaroxaban and enoxaparin drugs are comparable. Although ecchymosis was seen after using rivaroxaban rather than enoxaparin, rivaroxaban is orally administered and costs less for the patient and the health system. So, its use as a thromboprophylactic drug of choice following hip and knee arthroplasty surgery is still recommended.

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Schulz, K. S., P. H. Kass, S. M. Stover, and D. R. Mason. "Effect of stem flattening on rotational stability of a canine femoral total hip component in polymethylmethacrylate cement." Veterinary and Comparative Orthopaedics and Traumatology 16, no. 04 (October 2003): 238–42. http://dx.doi.org/10.1055/s-0038-1632786.

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SummaryThis study was designed to determine the effect of flattening the lateral aspect of a commercially available femoral prosthesis on its rotational stability in polymethylmethacrylate cement. Five standard design and five laterally flattened size 7 canine femoral components were evaluated. The stems were embedded in commercially available medical grade polymethylmethacrylate and rotated 15° while torque and angular displacement data were collected. The stiffness, yield and failure variables were compared between commercial and flattened stems. None of the mechanical testing variables were statistically different between commercial and flattened stems although all of the mean values for flattened stems were higher (1-30%) than mean values for commercial stems. Rotational stability of a canine total hip replacement femoral component was not significantly enhanced by the flattened component design modification evaluated by the testing protocol in this study.

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Hoek, J. A., M. T. Nurmohamed, K. J. Hamelynck, R. K. Marti, H. C. Knipscheer, H. ten Cate, H. R. Büller, H. N. Magnani, and J. W. ten Cate. "Prevention of Deep Vein Thrombosis following Total Hip Replacement by Low Molecular Weight Heparinoid." Thrombosis and Haemostasis 67, no. 01 (1992): 028–32. http://dx.doi.org/10.1055/s-0038-1648374.

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SummaryWe assessed the safety and efficacy of the novel low molecular weight heparinoid Lomoparan (Org 10172) for the prevention of deep-vein thrombosis in patients undergoing elective total hip replacement in a randomized, placebo-controlled, double-blind trial in 197 consecutive patients. The heparinoid (750 anti-factor Xa-units, s. c., b.i.d.) was administered to 97 patients and 99 patients received placebo. Study medication was started preoperatively and continued for 10 days. Efficacy was assessed by bilateral phlebography at day 10, postoperatively.The incidence of deep-vein thrombosis was 56.6% and 15.5% respectively in the placebo and heparinoid treated patients (incidence reduction: 74%; P <0.001). This reduction was observed both for proximal-vein thrombosis (25% to 8%; P <0.005) and isolated calf-vein thrombosis (31% to 7%; P <0001.No major hemorrhage was observed. The number of red-cell units transfused and drain-fluid loss were comparable for the two study groups. Six patients in the heparinoid group and none in the control group developed minor wound hematomas (P <0.05).During an 8-week post-discharge follow-up period three patients with a normal venogram at day 10 developed clinically apparent venous thromboembolism, which was confirmed by objective testing. All three patients belonged to the heparinoid-treated group.We conclude that 750 anti-factor Xa units Org 10172 s.c. twice daily starting preoperatively is safe and effectively reduces early deep-vein thrombosis following elective total hip replacement. Further studies on the incidence of post-discharge thromboembolism are required.

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Mahomed, N., Rajiv Gandhi, Lawrence Daltroy, and J. N. Katz. "The Self-Administered Patient Satisfaction Scale for Primary Hip and Knee Arthroplasty." Arthritis 2011 (January 10, 2011): 1–6. http://dx.doi.org/10.1155/2011/591253.

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Introduction. The objective of this study was to develop a short self-report questionnaire for evaluating patient satisfaction with the outcome of hip and knee replacement surgery. Methods. This scale consists of four items focusing on satisfaction with the extent of pain relief, improvement in ability to perform home or yard work, ability to perform recreational activities, and overall satisfaction with joint replacement. This instrument does not measure satisfaction with process of care. The responses are scored on a Likert scale, with the total score ranging from 25 to 100 per question. The instrument was tested on 1700 patients undergoing primary total hip and total knee replacement surgery, evaluated preoperatively, at 12 weeks, and one year postoperatively. Psychometric testing included internal consistency, measured with Cronbach's alpha, and convergent validity, measured by correlation with changes in measures of health status between the preoperative, 12-week, and one-year evaluations. Results. The internal consistency (reliability) of the scale, measured by the Cronbach's alpha, ranged from 0.86 to 0.92. The scale demonstrated substantial ceiling effects at 1 year. The scale scores correlated modestly with the absolute SF-36 PCS and WOMAC scores (ρ=0.56–0.63 and also with the WOMAC change scores (ρ=0.38–0.46) at both 12-week and 1-year followups. Conclusions. This instrument is valid and reliable for measuring patient satisfaction following primary hip and knee arthroplasty and could be further evaluated for use with other musculoskeletal interventions.

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Liaw, Chen-Kun, Rong-Sen Yang, Sheng-Mou Hou, Tai-Yin Wu, and Chiou-Shann Fuh. "A Simple Mathematical Standardized Measurement of Acetabulum Anteversion after Total Hip Arthroplasty." Computational and Mathematical Methods in Medicine 9, no. 2 (2008): 105–19. http://dx.doi.org/10.1080/17486700701865265.

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We invented a standardization method to measure the cup's anteversion after total hip arthroplasty without the influence of patient's position. We measured 68 radiographs of 10 patients after total hip replacement (THR) and calculated the error of each measurement, defined as the difference with the average of the same measuring method on the same patient. We also calculated the repeatability standard deviation (RSD) of each method according to the American Society for Testing and Materials, ASTM E691.Mean absolute inter-examination angle error, defined as the average of the absolute deviations, was 0.75° for standardized anteversion (range 0.03–2.51°), as compared with those without standardization, 2.30° (range 0.04–13.04°). The inter-examination measurement reliability (precision), defined as one RSD, was 0.99° for standardized anteversion, as compared with those without standarization, 3.50°. There is no difference between patients four and five without (p = 0.097). There is a significant difference with standardization (p < 0.0001).Our study demonstrated that this mathematical method is a precise tool to measure the anteversion of the acetabular cup. We hope that it can be used widely in the future.

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Hadley, Scott, Igor Immerman, Lorraine Hutzler, James Slover, and Joseph Bosco. "Staphylococcus aureus Decolonization Protocol Decreases Surgical Site Infections for Total Joint Replacement." Arthritis 2010 (December 20, 2010): 1–4. http://dx.doi.org/10.1155/2010/924518.

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We investigated the effects of implementation of an institution-wide screening and decolonization protocol on the rates of deep surgical site infections (SSIs) in patients undergoing primary knee and hip arthroplasties. 2058 patients were enrolled in this study: 1644 patients in the treatment group and 414 in the control group. The treatment group attended preoperative admission testing (PAT) clinic where they were screened for MSSA and MRSA colonization. All patients were provided a 5-day course of nasal mupirocin and a single preoperative chlorhexidine shower. Additionally, patients colonized with MRSA received Vancomycin perioperative prophylaxis. The control group did not attend PAT nor receive mupirocin treatment and received either Ancef or Clindamycin for perioperative antibiotic prophylaxis. There were a total of 6 deep infections in the control group (1.45%) and 21 in the treatment group (1.28%); this represented a decrease of 13% () in the treatment versus control group. This decrease represented a positive trend in favor of staphylococcus screening, decolonization with mupirocin, and perioperative Vancomycin for known MRSA carriers.

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Evered, Lisbeth A., Brendan S. Silbert, David A. Scott, Paul Maruff, David Ames, and Peter F. Choong. "Preexisting Cognitive Impairment and Mild Cognitive Impairment in Subjects Presenting for Total Hip Joint Replacement." Anesthesiology 114, no. 6 (June 1, 2011): 1297–304. http://dx.doi.org/10.1097/aln.0b013e31821b1aab.

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Background The prevalence of preexisting cognitive impairment (PreCI) is documented before cardiac surgery, but there is less information before noncardiac surgery. In addition, the prevalence of mild cognitive impairment, defined by different cognitive criteria and subjective complaints, and which may progress to Alzheimer disease, is unknown in these subjects. Because anesthesia and surgery have been implicated in Alzheimer disease pathology, we prospectively measured PreCI and mild cognitive impairment in subjects scheduled for total hip joint replacement surgery in an observational study. Methods One hundred fifty-two subjects 60 y of age and older who were scheduled for total hip joint replacement surgery underwent assessment, including neuropsychologic testing, 1 week before surgery. Test results were compared with published norms. PreCI was defined as impairment in two or more of seven cognitive tests, for which impairment in an individual test was defined as ≥ 2 SD below norms for that test. Amnestic mild cognitive impairment (aMCI) was defined as impairment ≥1.5 SD below norms for results of the immediate and/or delayed Auditory Verbal Learning Test plus a subjective complaint. Results Subjects performed worse compared with normative data on five of seven neuropsychologic tests. Thirty (20% [95% CI, 13-26%]) subjects were classified as having PreCI. Thirty-four (22% [95% CI, 16-29%]) were classified as having aMCI. Ten (7%) subjects were classified as having both PreCI and aMCI, representing 33% of the 30 subjects with PreCI. Conclusions The prevalence of aMCI in subjects scheduled for total hip joint replacement surgery is similar to that in the general community. PreCI and aMCI tend to identify different subjects. Because aMCI is known to progress to Alzheimer disease, future studies that track cognition before and after anesthesia and surgery should document the presence or absence of aMCI so that the rate of conversion to Alzheimer disease after anesthesia and surgery can be compared with the rate in the nonsurgical population.

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von Skrbensky, Gobert, Karoline Mühlbacher, Emir Benca, Alexander Kolb, Reinhard Windhager, Georg Reischl, and Georg Reinisch. "Evaluation of Aerosol Electrospray Analysis of Metal-on-Metal Wear Particles from Simulated Total Joint Replacement." Sensors 19, no. 17 (August 30, 2019): 3751. http://dx.doi.org/10.3390/s19173751.

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Wear is a common cause for aseptic loosening in artificial joints. The purpose of this study was to develop an automated diagnostical method for identification of the number and size distribution of wear debris. For this purpose, metal debris samples were extracted from a hip simulator and then analyzed by the electrospray method combined with a differential mobility analyzer, allowing particle detection ranging from several nanometers up to 1 µm. Wear particles were identified with a characteristic peak at 15 nm. The electrospray setup was successfully used and validated for the first time to characterize wear debris from simulated total joint replacement. The advantages of this diagnostic method are its time- and financial efficiency and its suitability for testing of different materials.

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Kraus, Moritz, Carl Neuerburg, Nicole Thomasser, Ulla Cordula Stumpf, Matthias Blaschke, Werner Plötz, Maximilian Michael Saller, Wolfgang Böcker, and Alexander Martin Keppler. "Reduced Awareness for Osteoporosis in Hip Fracture Patients Compared to Elderly Patients Undergoing Elective Hip Replacement." Medicina 58, no. 11 (October 31, 2022): 1564. http://dx.doi.org/10.3390/medicina58111564.

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Background: Osteoporotic fractures are associated with a loss of quality of life, but only few patients receive an appropriate therapy. Therefore, the present study aims to investigate the awareness of musculoskeletal patients to participate in osteoporosis assessment and to evaluate whether there are significant differences between acute care patients treated for major fractures of the hip compared to elective patients treated for hip joint replacement.; Methods: From May 2015 to December 2016 patients who were undergoing surgical treatment for proximal femur fracture or total hip replacement due to osteoarthritis and were at risk for an underlying osteoporosis (female > 60 and male > 70 years) were included in the study and asked to complete a questionnaire assessing the awareness for an underlying osteoporosis. ASA Score, FRAX Score, and demographic information have also been examined. Results: In total 268 patients (female = 194 (72.0%)/male = 74 (28%)), mean age 77.7 years (±7.7) undergoing hip surgery were included. Of these, 118 were treated for fracture-related etiology and 150 underwent total hip arthroplasty in an elective care setting. Patients were interviewed about their need for osteoporosis examination during hospitalization. Overall, 76 of 150 patients receiving elective care (50.7%) considered that an examination was necessary, whereas in proximal femur fracture patients the awareness was lower, and the disease osteoporosis was assessed as threatening by significantly fewer newly fractured patients. By comparison, patients undergoing trauma surgery had a considerably greater risk of developing another osteoporotic fracture than patients undergoing elective surgery determined by the FRAX® Score (p ≤ 0.001).; Conclusions: The patients’ motivation to endure additional osteoporosis diagnostic testing is notoriously low and needs to be increased. Patients who underwent acute care surgery for a fragility proximal femur fracture, although acutely affected by the potential consequences of underlying osteoporosis, showed lower awareness than the elective comparison population that was also on average 6.1 years younger. Although elective patients were younger and at a lower risk, they seemed to be much more willing to undergo further osteoporosis assessment. In order to better identify and care for patients at risk, interventions such as effective screening, early initiation of osteoporosis therapy in the inpatient setting and a fracture liaison service are important measures.

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Wroblewski, B. M., P. D. Siney, and P. A. Fleming. "Increasing patients' body mass. Are the criteria for testing stemmed femoral components in total hip arthroplasty still valid?" Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 221, no. 8 (August 1, 2007): 959–61. http://dx.doi.org/10.1243/09544119jeim305.

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The increasing incidence of obesity in the population is a topic of current interest. This trend is reflected in patients undergoing primary Charnley hip replacement. Over a 21 year period from January 1986 to October 2006, during which 6910 primary operations were performed, the body mass of patients increased at a mean rate of 0.48 kg/year. The findings suggest that the test criteria for the endurance of stemmed femoral components be modified. The maximum load should be increased from 2.3 kN to 2.5 kN to reflect patients' increasing weight. The duration of the test should be increased from 5 × 106 cycles during which the ‘femoral component shall not fracture’ to 10 × 106 cycles in order to reflect not only the patients' activity level but also the 4-11 year period at risk for stem fracture, and so ‘reflect developing clinical experience’.

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Wang, A., A. Essner, and R. Klein. "Effect of contact stress on friction and wear of ultra-high molecular weight polyethylene in total hip replacement." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 215, no. 2 (February 1, 2001): 133–39. http://dx.doi.org/10.1243/0954411011533698.

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This paper studies the effect of contact stress on friction and wear of ultra-high molecular weight polyethylene (UHMWPE) acetabular cups by means of friction and wear joint simulator testing under serum lubrication. For a given applied load, increasing the contact stress by increasing the ball/socket radial clearance decreased both the coefficient of friction and the wear rate. Friction and wear were highly correlated. The dependence of friction on contact stress for the UHMWPE socket under serum lubrication was similar to that of semi-crystalline polymers under dry sliding. This finding indicates the occurrence of partial dry contact at asperity levels for the metal-polyethylene ball-in-socket joint under serum lubrication.

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Humphreys, P. K., J. F. Orr, and A. S. Bahrani. "Testing of Total Hip Replacements: Endurance Tests and Stress Measurements: Part 1: Endurance Tests." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 204, no. 1 (March 1990): 29–34. http://dx.doi.org/10.1243/pime_proc_1990_204_225_02.

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Humphreys, P. K., J. F. Orr, and A. S. Bahrani. "Testing of Total Hip Replacements: Endurance Tests and Stress Measurements: Part 2: Stress Measurements." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 204, no. 1 (March 1990): 35–41. http://dx.doi.org/10.1243/pime_proc_1990_204_226_02.

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Sychev, DA, RM Minnigulov, KA Ryzhikova, IYu Yudina, AV Lychagin, and TE Morozova. "Evaluation of the rivaroxaban-influenced effect of ABCB1 and CYP3A5 gene polymorphisms on prothrombin time in patients after total hip or knee replacement surgery." Bulletin of Russian State Medical University, no. 5 (December 15, 2018): 105–9. http://dx.doi.org/10.24075/brsmu.2018.068.

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Rivaroxaban is a safer and more effective alternative to warfarin. However, there are reports of some cases of major hemorrhagic complications associated with rivaroxaban that significantly impair the patients' quality of life and can lead to a fatality. Personalized therapy, including pharmacogenetic testing, may help prevent such adverse events. This study aimed to investigate how ABCB1 3435C>T (rs1045642) and CYP3A5 6986A>G (rs776746) gene polymorphisms, when carried by a patient taking rivaroxaban to prevent thrombosis after total hip or knee replacement surgery, affect prothrombin time (PT). Sixty-five patients participated in the study. Their genotypes were identified by PCR in real time. To learn PT peculiar to each patient, we collected venous blood on the 5th day of their anticoagulation therapy, 1 hour before they took rivaroxaban and 3 hours after. Having calculated %ΔPT, we divided the patients into 2 groups: 1) %ΔPT ≤ 0 (n = 7; 10.8%); 2) %ΔPT > 0 (n = 58; 89.2%). Regarding the distribution of rs1045642 polymorphism, we determined the difference between the groups to be statistically significant (χ2 = 6.64; p = 0.027). As for rs776746 polymorphism, the difference was insignificant (χ2 = 0.101; p = 1.0). We discovered that rs1045642 polymorphism has a significant effect on PT variance in patients taking rivaroxaban to prevent thrombosis after total hip or knee replacement surgery.

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Vioreanu, M. H., M. C. Parry, F. S. Haddad, and C. P. Duncan. "Field testing the Unified Classification System for peri-prosthetic fractures of the pelvis and femur around a total hip replacement." Bone & Joint Journal 96-B, no. 11 (November 2014): 1472–77. http://dx.doi.org/10.1302/0301-620x.96b11.34214.

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Golec, Joanna, Kamil Nafalski, Damian Turzański, Agata Masłoń, Elżbieta Szczygieł, Dorota Czechowska, Joanna Balicka-Bom, Artur Kuzaj, and Edward Golec. "Changes in the contraction ratio of transversus abdominis and quality of life in patients after total hip replacement and three-compartment knee arthroplasty with implant posterior stabilization." Rehabilitacja Medyczna 22, no. 2 (August 3, 2018): 4–10. http://dx.doi.org/10.5604/01.3001.0012.2291.

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Core stability is a reference term for the performance of the deep trunk muscles, which provide functional stability of the lumbopelvic area and control the human body in static and dynamic positions. The study group consisted of 30 patients between the age of 42 and 76 years (mean=61.4) after total hip arthroplasty (total hip replacement, Group I) and total knee arthroplasty (three-compartment arthroplasty with posterior stabilization of the implant - Group II). In 18 (60%) patients, hip endoprosthesis was performed, whereas in 12 (40%), three-compartment knee endoprosthesis with posterior stabilization has been implanted. In the study group, Rehabilitative Ultrasound Imaging (RUSI) of the transversus abdominis muscle thickness was conducted at rest and in contraction, the transversus abdominis activation ratio was specified, the SF-36 Life Quality Questionnaire was applied and a three-week treatment cycle was performed. The tests were carried out twice, i.e. before and after treatment. In the group of patients after total hip replacement, the transversus abdominis (TrA) contraction ratio before the beginning of the exercise programme was 0.79±0.06, and after its completion 0.9 ±0.02. The observed difference was statistically significant at p<0.001. In the group of patients after three-compartment knee arthroplasty, the TrA contraction ratio before the beginning of the exercise programme was 0.78±0.09, and after its completion0 0.91±0.02. The difference of these values was statistically significant at the level of p<0.05. The results of the SF-36 questionnaire in both groups indicate improvement in physical functioning. The observed difference was statistically significant at p<0.001. The performed three-week physiotherapy treatment in conjunction with deep muscle training increases the thickness of the TrA muscle during rest and contraction testing, and increases the transversus abdominis contraction ratio in Rehabilitative Ultrasound Imaging in the study groups. Furthermore, improvement in the level of physical functioning was observed within the studied groups.

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O'Dwyer Lancaster-Jones, Oscar, and Rebecca Reddiough. "The occurrence of squeaking under wear testing standards for ceramic on ceramic total hip replacements." Journal of the Mechanical Behavior of Biomedical Materials 138 (February 2023): 105616. http://dx.doi.org/10.1016/j.jmbbm.2022.105616.

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van der Weegen, Walter, Anke Kornuijt, Dirk Das, Rein Vos, and Thea Sijbesma. "It is safe to use minimal restrictions following posterior approach total hip arthroplasty: results from a large cohort study." HIP International 29, no. 6 (January 10, 2019): 572–77. http://dx.doi.org/10.1177/1120700018823504.

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Background: To prevent early postoperative dislocation following a total hip arthroplasty (THA) procedure, patients must adhere to restrictions. Restrictive protocols are common if THA surgery is performed using the posterior approach, but scientific evidence form larger studies that supports these restrictions are scarce. In this large cohort study we compare the <90-days dislocation rate between patients receiving posterior approach THA managed with minimal versus extensive restrictions. Methods: Prospective cohort ( n = 1049) of consecutive elective primary hip replacement surgery procedures (September 2014–July 2017) managed with minimal postoperative restrictions. Hospital charts were prospectively reviewed for patient demographics, risk factors and any hip dislocation. Control ( n = 1102) consecutive primary elective THAs (January 2011–August 2014) managed with a traditional restrictive protocol. A posterior surgical approach was used in all procedures. Results: Minimal restrictions group: 17 dislocations <90 days (1.6%); Restricted group: 28 (2.5%), chi-square p = 0.1. Testing the hypothesis of inferiority by a minimum of 1% increase in ⩽90 days dislocation risk: p = 0.14 (test for difference) and p < 0.001 (non-inferiority test), allowing us to discard the null hypothesis (absolute increase in risk of ⩾1% with minimal restrictions). The proportion of surgeries performed with a femoral head size ⩾32 mm was higher in the minimal restrictions group. Conclusions: Patients can be managed safely with minimal restrictions following posterior approach THA if combined with frequent use of larger femoral heads.

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Ruggiero, Alessandro, Alessandro Sicilia, and Saverio Affatato. "In silico total hip replacement wear testing in the framework of ISO 14242-3 accounting for mixed elasto-hydrodynamic lubrication effects." Wear 460-461 (November 2020): 203420. http://dx.doi.org/10.1016/j.wear.2020.203420.

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Haas, Sylvia, Alexander GG Turpie, Michael Rud Lassen, Ajay K. Kakkar, Bengt Eriksson, Kai Vogtlaender, Dagmar Kubitza, et al. "Prothrombin Time and Bleeding Events in Patients Undergoing Total Hip or Knee Replacement Surgery Receiving 10 Mg Rivaroxaban." Blood 114, no. 22 (November 20, 2009): 2099. http://dx.doi.org/10.1182/blood.v114.22.2099.2099.

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Abstract Abstract 2099 Poster Board II-76 Rivaroxaban is a new, oral, direct Factor Xa inhibitor with a linear dose-relationship between Factor Xa inhibition and drug concentrations in plasma. It also affects global clotting tests such as prothrombin time (PT), particularly when Neoplastin® is used for testing. Rivaroxaban was investigated in four randomized, double-blind phase III studies (RECORD1, 2, 3, and 4) for the prevention of venous thromboembolism (VTE) after total hip or knee replacement surgery. This post hoc, explorative analysis evaluated the relationship between PT and bleeding events from pooled RECORD1–4 data. Patients were randomized to receive oral rivaroxaban 10 mg once daily (od) starting 6–8 hours after surgery, or subcutaneous enoxaparin 40 mg od starting the evening before surgery (RECORD1–3), or 30 mg twice daily starting 12–24 hours after wound closure (RECORD4). RECORD1, 3, and 4 were head-to-head comparisons of rivaroxaban and enoxaparin; RECORD2 compared extended-duration rivaroxaban with short-duration enoxaparin. Pooled analysis of the results of these studies showed that rivaroxaban significantly reduced the incidence of symptomatic VTE and death compared with enoxaparin regimens. The relationship between PT (measured by Neoplastin reagent) and adjudicated bleeding events was evaluated in 6,040 subjects valid for the safety analysis who underwent surgery and had taken at least one dose of rivaroxaban. The day of the surgery was defined as day 1. PT was measured on day 0 (baseline) and day 6 (trough and peak, and grouped according to quartiles). All adjudicated bleeding events were analyzed with respect to the day 6 measurements. The analysis focused on treatment-emergent adjudicated bleeding events up to 12±2 days after the initiation of active rivaroxaban administration. Bleeding events were grouped as major and clinically relevant non-major bleeding (composite) or any bleeding. A total of 5,912 patients had PT measurements at baseline; 345 experienced any bleeding event, of which 149 events were major or clinically relevant non-major bleeding events. Baseline mean PT ranged from 13.5 (with no bleeding) to 14.0 seconds (with any bleeding). Mean trough values on day 6 ranged from 14.3 (no bleeding) to 15.3 seconds (any bleeding). Mean peak values for PT on day 6 (measured at 2–4 hours after dosing) ranged from 18.9 (no bleeding) to 20.5 seconds (any bleeding). The peak/baseline PT ratios were 1.42 (no bleeding events), 1.46 (with major and clinically relevant non-major bleeding events), and 1.49 (any bleeding events). Of the patients with bleeding events, most events occurred in those with PT values in the extreme (Q4) peak and trough quartiles (Table). This explorative analysis indicated that PT values (seconds) in patients with no bleeding or with different types of bleeding were similar for each time point (baseline, day 6 trough and peak). The reproducible effects of rivaroxaban on PT are consistent with its known pharmacokinetics in plasma. Although extreme PT trough and peak values were associated with an increased risk of bleeding, this analysis suggests that PT over a wide range is not an accurate predictor of bleeding events in individual patients undergoing total hip or knee replacement surgery receiving 10 mg rivaroxaban. Refinement of PT testing methods has focused specifically on vitamin K antagonist (VKA) monitoring; therefore PT testing may be of greater utility for monitoring VKAs than Factor Xa inhibitors. Table. Percentage of patients with bleeding events grouped by prothrombin time peaks and troughs according to quartiles in rivaroxaban-treated patients from the RECORD1–4 studies Prothrombin time range (seconds) Patients with bleeding events (%) 95% confidence interval Any bleeding Prothrombin time day 6 trough Q1 9.1–12.9 3.00 2.11–4.10 Q2 >12.9–13.6 3.43 2.40–4.74 Q3 >13.6–14.7 4.89 3.66–6.38 Q4 >14.7–36.4 8.17 6.60–9.96 Prothrombin time day 6 peak Q1 10.0–16.0 3.70 2.66–4.98 Q2 >16.0–18.4 3.48 2.47–4.74 Q3 >18.4–21.1 4.11 3.01–5.45 Q4 >21.1–70.4 8.09 6.52–9.87 Major and clinically relevant non-major bleeding Prothrombin time day 6 trough Q1 9.1–12.9 1.54 0.92–2.39 Q2 >12.9–13.6 1.86 1.12–2.89 Q3 >13.6–14.7 1.92 1.17–2.94 Q4 >14.7–36.4 3.71 2.66–5.02 Prothrombin time day 6 peak Q1 10.0–16.0 1.62 0.96–2.55 Q2 >16.0–18.4 2.20 1.41–3.25 Q3 >18.4–21.1 1.73 1.04–2.69 Q4 >21.1–70.4 3.44 2.43–4.70 Day 6 trough: value at pre-dose on day 6. Day 6 peak: value at 2–4 hours post-dose on day 6. Q, quartile. Disclosures: Haas: Bayer Healthcare: Honoraria; BMS: Honoraria; Sanofi-Aventis: Honoraria; CSL-Behring: Honoraria; Novartis: Honoraria. Turpie:Astellas: Consultancy; Takeda: Consultancy; GSK: Consultancy; sanofi-aventis: Consultancy; Bayer Schering Pharma AG: Consultancy, Speakers Bureau; Johnson & Johnson Pharmaceutical Research & Development, L.L.C: Consultancy; Portola: Consultancy. Lassen:Bayer Schering Pharma: Consultancy, Honoraria; sanofi-aventis: Consultancy; Astellas Pharma: Consultancy; Bristol-Myers Squibb: Consultancy; Pfizer Inc.: Consultancy. Kakkar:Aryx therapeutics: Consultancy; Eisai: Consultancy, Honoraria, Research Funding, Scientific Advisory Board; Bristol–Myers Squibb: Consultancy, Honoraria, Research Funding, Scientific Advisory Board; Pfizer: Consultancy, Honoraria, Research Funding, Scientific Advisory Board; Boehringer Ingelheim: Consultancy, Honoraria, Research Funding, Scientific Advisory Board; Sanofi-Aventis: Consultancy, Honoraria, Research Funding, Scientific Advisory Board; Bayer HealthCare: Consultancy, Honoraria, Research Funding, Scientific Advisory Board; GSK: Honoraria. Eriksson:Bayer Schering Pharma: Consultancy, Honoraria. Vogtlaender:Bayer Schering Pharma AG: Employment. Kubitza:Bayer Schering Pharma AG: Employment. Mueck:Bayer Schering Pharma AG: Employment. Misselwitz:Bayer Schering Pharma AG: Employment, Patents & Royalties. Berkowitz:Bayer HealthCare Pharmaceuticals : Employment.

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Kotelnikov, G. P., A. V. Yashkov, and Stanislav Yu Borinskiy. "A NEW MODEL OF MEDICAL REHABILITATION OF PATIENTS FOLLOWING ENDOPROSTHETIC HIP REPLACEMENT IN THE CLINICS OF THE SAMARA STATE MEDICAL UNIVERSITY." Medical and Social Expert Evaluation and Rehabilitation 21, no. 1-2 (June 15, 2018): 34–38. http://dx.doi.org/10.18821/1560-9537-2018-21-1-34-38.

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The study is devoted to the evaluation of the effectiveness of the new organizational model of medical rehabilitation in patients after the endoprosthetic hip replacement in conditions of the Samara State Medical University clinics.There were observed 348 patients underwent total endoprosthesis of the hip joint due to degenerative-dystrophic processes. In the comparison group consisted of 179 patients, the traditional approaches to re-rehabilitation remained. In the main group of 169 patients, a problem-oriented multidisciplinary approach was implemented, using the International Classification of Functioning (ICF) clinical scales to execute timely examination and route patients to medical organizations. Within the framework of the Pilot Project, for the patients of the main group there were worked out the stage-by-stage approach, continuity, consistency of received medical measures in specialized licensed medical rehabilitation clinics of the Ministry of Health of the Samara Region. There was executed the evaluation of immediate, remote results of clinical and functional parameters of patients after hip joint prosthetics within the framework of the Pilot Project. To evaluate the rehabilitation potential and prognosis, a clinical, laboratory, functional and biomechanical assessment of the patients’ condition was carried out based on radiography, rheovasography, electromyography, podography, thermography, psycho-logical testing, and scale analysis. The analysis of the effectiveness of the new organizational model of medical rehabilitation in patients after hip arthroplasty in conditions of Clinics of the Samara State Medical University is presented.

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Geerdink, Carel H., Bernd Grimm, Rama Ramakrishnan, Jorco Rondhuis, Aart J. Verburg, and Alphons J. Tonino. "Crosslinked polyethylene compared to conventional polyethylene in total hip replacement: Pre-clinical evaluation, in-vitro testing and prospective clinical follow-up study." Acta Orthopaedica 77, no. 5 (January 2006): 719–25. http://dx.doi.org/10.1080/17453670610012890.

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Willmann, G., H. Kälberer, and H. G. Pfaff. "Keramische Pfanneneinsätze für Hüftendoprothesen. Teil 2: Bauteilprüfung und -sicherheit - Ceramic Acetabular Cups for Total Hip Replacement. Part 2: Component Testing and Reliability." Biomedizinische Technik/Biomedical Engineering 41, no. 10 (1996): 284–90. http://dx.doi.org/10.1515/bmte.1996.41.10.284.

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Francis, Ara, Robert Flavin, Khalid Merghani Saleh Mohammed, and Yasser Aljabi. "Total Ankle Arthroplasty." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000172.

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Category: Ankle, Ankle Arthritis Introduction/Purpose: Total Ankle Arthroplasty has been introduced relatively late in the modern era in comparison to hip and knee replacement. it suffered from poor outcomes initially leading to abandonment of the procedure in favour of ankle arthrodesis. The reasons for failure have been debated in the literature. The development of second generation implants, consisting of a three component design, has heralded a new era for Total Ankle Arthoplasty. The purpose of this study was to perform a biomechanical analysis of three commercially available Total Ankle Arthroplasty implants and a literature review to shed light on mechanisms of failure. Methods: Three commercially available ankle arthroplasty (STAR, Hintegra, Mobility) implants were tested using a specifically designed ankle simulator which replicated plantarflexion/ dorsiflexion and inversion/eversion movements. Different loads were applied to the implants which were put through 50,000 cycles at a rate of 1.4 Hz and bearings were removed for inspection. The followoing were conducted before, during and after testing - Visual inspection, Weight of implant, Optical Profile Projector and Scanning Electron Microscopy. A literature review was also performed to compare and contrast results seen elsewhere. Results: Biomechanical analysis revealed loss of congruency and wear of the polymer bearing surfaces with varying degrees across the three implants - STAR 7%, Hintegra 10% and Mobility 4%. This is supported by evidence in the literature that STAR and Hintegra implants suffer considerably from flattening of the polymer bearing surfaces and subsequent decrease in height. Conclusion: The above biomechanical analysis and literature review of these implants supports our senior author’s clinical experience that the main reason for failure is medial insufficiency and tibialis posterior dysfuction that cause increased demand on the implants ultimately leading to implant failure.

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Ali, Maria, Veena Kumari, Mehreen Mehmood, Huma Mansoori, Sidra Asad Ali, and Mahadev Harani. "INDISCRIMINATE COAGULATION TESTING FOR BLEEDING RISK ASSESSMENT PRIOR TO ORTHOPEDIC SURGERY. IS IT A RATIONAL APPROACH?" Pakistan Journal of Pathology 33, no. 2 (June 30, 2022): 61–64. http://dx.doi.org/10.55629/pakjpathol.v33i2.689.

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Abstract Objective: Indiscriminative preoperative coagulation testing to identify patients at risk of bleeding is commonly practiced. However, this practice is no longer supported by current recommendations. We conducted this study with an aim to evaluate the advantage of doing screening testing for coagulation and hemostasis in unselected patients prior to elective orthopedic surgeries in our setting. Material and Methods: It was a retrospective, cross sectional study carried out at Medicare Cardiac and General Hospital, Jinnah Medical and Dental College, Karachi. All the patients admitted for elective orthopedic bilateral total knee replacement and Hip replacement surgeries from March 2016 to December 2018 were included in the study. Electronic data of patients’ pre-operative test results for Prothrombin time, activated partial Thromboplastin time was retrieved. Frequency of patients with deranged coagulation screening was calculated. Results: A total of 367 patients underwent pre-surgical coagulation testing. Male to female ratio was 1:3. Median age of patients was 61±5 years. A total of 2.9% (n=11) patients were found to have deranged coagulation profile. Out of which 3 patients did not undergo surgery and were loss to follow up. Out of total 0.54% (n=2) patients had both prolonged PT and APTT, 1.6% (n=6) patients had prolonged APTT and 0.3% (n=1) patient experienced intraoperative bleeding requiring one unit of packed cell transfusion. Only 0.3% (n=1) patient experienced post-operative bleeding and dropped her Hemoglobin and received transfusion. Conclusion: The overall results of the study suggest that indiscriminate coagulation screening does not provide any additional information unless further detailed hemostatic evaluation is carried out. It is suggested that routine screening tests should not be performed unless a medical history is indicative of bleeding tendency. Key Words: Coagulation screening, Bleeding risk, Orthopedic surgery.

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Tanner, K. E., W. Bonfield, D. Nunn, and M. A. R. Freeman. "Rotational Movement of Femoral Components of Total Hip Replacements in Response to an Anteriorly Applied Load." Engineering in Medicine 17, no. 3 (July 1988): 127–29. http://dx.doi.org/10.1243/emed_jour_1988_017_033_02.

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Mechanical testing has been performed on total hip replacements implanted in sections of cadaveric femora. A purpose built transducer has been used to measure the rotation of the implant in the bone under loads applied in the anterior-posterior direction. This has been used to assess the effect of cement and also of retaining more of the femoral neck. The retention of the femoral neck improved stability, as did the bone cement, and in the case of the uncemented prosthesis, longitudinal ridges increased the stability of the prosthesis.

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Eichler, Sarah, Annett Salzwedel, Sophie Rabe, Steffen Mueller, Frank Mayer, Monique Wochatz, Miralem Hadzic, Michael John, Karl Wegscheider, and Heinz Völler. "The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement: Randomized Controlled Trial." JMIR Rehabilitation and Assistive Technologies 6, no. 2 (November 7, 2019): e14236. http://dx.doi.org/10.2196/14236.

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Background Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare. Objective The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare. Methods From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints. Results Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note. Conclusions The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare. Trial Registration German Clinical Trials Register DRKS00010009; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010009

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Carillo, Daniel G., M. C. Curiel, Ho Sung Aum, and Soo Wohn Lee. "Finite Element Analysis on Proof Testing of Ceramic Ball Heads for Total Hip Replacements: Trauma Loading Considerations." Key Engineering Materials 317-318 (August 2006): 773–76. http://dx.doi.org/10.4028/www.scientific.net/kem.317-318.773.

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Trauma related loading of hip prostheses has been reported as a cause of failure of implanted ceramic materials, ball and/or cup. In this study a computer simulated model is made to evaluate contact pressures and stresses in the stem/ball contact pair, as well as stress concentration regions in the ceramic cup. A 3D Non-Linear Finite Element Analysis was performed in a “proof test” scenario. A high peak trauma-like loading of 15 KN was used. 28mm ball heads (in diameter) were modeled and two sizes for taper lock were simulated to report their influence on the contact pressure over the critical areas of the ballhead. It was found that the ball head cone’s depth has a major incidence in the stress and contact pressure surrounding the stem when an impact load is applied. The best stress and pressure configurations were found for the case of the stem lying completely inside the ballhead.

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Aleixo, I., A. C. Vale, M. Lúcio, P. M. Amaral, L. G. Rosa, J. Caetano-Lopes, A. Rodrigues, H. Canhão, J. E. Fonseca, and M. Fatima Vaz. "A Method for the Evaluation of Femoral Head Trabecular Bone Compressive Properties." Materials Science Forum 730-732 (November 2012): 3–8. http://dx.doi.org/10.4028/www.scientific.net/msf.730-732.3.

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We addressed the importance of defining a mechanical testing methodology for the compression of human trabecular bone specimens. In fact, currently there are several protocols to test trabecular bone, but a single, standard and validate method has not been accepted yet. In our work, human femoral epiphyses collected from patients with osteoporosis (fragility fractures) and hip osteoarthritis, submitted to total hip replacement surgery, were used. The aims of our work were to develop a mechanical testing methodology for the compression of trabecular bone specimens taking into account the optimization of bone extrinsic and intrinsic variables, in order to establish a patient bone sample database with clinical, structural and mechanical information. Extrinsic variables, such as the effect of specimen preparation, with particular focus on the dimensions of test specimens, and others associated with the compression test, such as the method employed to determine specimen deformation, and hence strain, were evaluated. Also, a new device used to withhold the specimens was developed and tested by the present authors. Although each specimen showed a unique behaviour, even when comparing compression curves between patients from the same disease group, implicating additional complexity and difficulty in the data analysis, the authors managed to assemble the results in two groups related with a possible difference in the deformation mechanisms occurring after yielding.

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Christiansen, Rune J., Henrik J. Münch, Charlotte M. Bonefeld, Jacob P. Thyssen, Jens J. Sloth, Carsten Geisler, Kjeld Søballe, Morten S. Jellesen, and Stig S. Jakobsen. "Cytokine Profile in Patients with Aseptic Loosening of Total Hip Replacements and Its Relation to Metal Release and Metal Allergy." Journal of Clinical Medicine 8, no. 8 (August 20, 2019): 1259. http://dx.doi.org/10.3390/jcm8081259.

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Metal release from total hip replacements (THRs) is associated with aseptic loosening (AL). It has been proposed that the underlying immunological response is caused by a delayed type IV hypersensitivity-like reaction to metals, i.e., metal allergy. The purpose of this study was to investigate the immunological response in patients with AL in relation to metal release and the prevalence of metal allergy. THR patients undergoing revision surgery due to AL or mechanical implant failures were included in the study along with a control group consisting of primary THR patients. Comprehensive cytokine analyses were performed on serum and periimplant tissue samples along with metal analysis using inductive coupled plasma mass spectrometry (ICP-MS). Patient patch testing was done with a series of metals related to orthopedic implant. A distinct cytokine profile was found in the periimplant tissue of patients with AL. Significantly increased levels of the proinflammatory cytokines IL-1β, IL-2, IL-8, IFN-γ and TNF-α, but also the anti-inflammatory IL-10 were detected. A general increase of metal concentrations in the periimplant tissue was observed in both revision groups, while Cr was significantly increased in patient serum with AL. No difference in the prevalence of metal sensitivity was established by patch testing. Increased levels of IL-1β, IL-8, and TNF-α point to an innate immune response. However, the presence of IL-2 and IFN-γ indicates additional involvement of T cell-mediated response in patients with AL, although this could not be detected by patch testing.

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Figueiredo-Pina, C. G., Y. Yan, A. Neville, and J. Fisher. "Understanding the differences between the wear of metal-on-metal and ceramic-on-metal total hip replacements." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 222, no. 3 (March 1, 2008): 285–96. http://dx.doi.org/10.1243/09544119jeim363.

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Hip simulator studies have been carried out extensively to understand and test artificial hip implants in vitro as an efficient alternative to obtaining long-term results in vivo. Recent studies have shown that a ceramic-on-metal material combination lowers the wear by up to 100 times in comparison with a typical metal-on-metal design. The reason for this reduction remains unclear and for this reason this study has undertaken simple tribometer tests to understand the fundamental material loss mechanisms in two material combinations: metal-on-metal and ceramic-on-ceramic. A simple-configuration reciprocating pin-on-plate wear study was performed under open-circuit potential (OCP) and with applied cathodic protection (CP) in a serum solution using two tribological couples: firstly, cobalt—chromium (Co—Cr) pins against Co—Cr plates; secondly, Co—Cr pins against alumina (Al2O3) plates. The pin and plate surfaces prior to and after testing were examined by profilometry and scanning electron microscopy. The results showed a marked reduction in wear when CP was applied, indicating that total material degradation under the OCP condition was attributed to corrosion processes. The substitution of the Co—Cr pin with an Al2O3 plate also resulted in a dramatic reduction in wear, probably due to the reduction in the corrosion—wear interactions between the tribological pair.

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Eldesouky, Ibrahim, Hassan El-Hofy, and Ola Harrysson. "Research: Design and Analysis of a Low-Stiffness Porous Hip Stem." Biomedical Instrumentation & Technology 51, no. 6 (November 1, 2017): 474–82. http://dx.doi.org/10.2345/0899-8205-51.6.474.

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Abstract Two major problems are associated with total hip replacement: 1) stress shielding and 2) the adverse tissue reaction to certain elements of the implant material. In this regard, a porous implant provides lower stiffness and vacancies for bone ingrowth, making it more suitable for the human bone compared with a solid stem. Moreover, second-generation titanium biomedical alloys, such as TNZT (Ti35Nb7Zr5Ta) and TMZF (Ti12Mo6Zr2Fe), have been introduced to prevent the adverse tissue reactions related to aluminum and vanadium elements of the popular Ti6Al4V alloy. In the current work, an analysis was performed based on uniaxial compression testing of cubic Ti6Al4V structures of different porosities to predict the governing equations that relate the relative density of the structure to the mechanical properties of the structure according to the Gibson-Ashby model. A numerical study was conducted to evaluate the change in stress distribution obtained by incorporating the new titanium alloys in porous hip stem implants. Implants modeled with the mechanical properties of TNZT and TMZF showed a minimum safety factor of 1.69 and 3.02, respectively, with respect to the yield strength. The results demonstrated an increase in the equivalent von Mises stresses and maximum principal elastic strain up to 7% and 15%, respectively, compared with the porous Ti6Al4V implant and up to 108% and 156%, respectively, compared with the solid Ti6Al4V implant.

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Rawlinson, Jeremy J., Karan P. Punga, Kirk L. Gunsallus, Donald L. Bartel, and Timothy M. Wright. "Wear simulation of the ProDisc-L disc replacement using adaptive finite element analysis." Journal of Neurosurgery: Spine 7, no. 2 (August 2007): 165–73. http://dx.doi.org/10.3171/spi-07/08/166.

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Object. An understanding of the wear potential of total disc replacements (TDRs) is critical as these new devices are increasingly introduced into clinical practice. The authors analyzed the wear potential of a ProDisc-L implant using an adaptive finite element (FE) technique in a computational simulation representing a physical wear test. Methods. The framework for calculating abrasive wear, first validated using a model of a total hip replacement (THR), was then used to model the ProDisc-L polyethylene component that is fixed to the inferior endplate and articulates with the rigid superior endplate. Proposed standards for spine wear testing protocols specified the inputs of flexion–extension (6/−3°), lateral bending (± 2°), axial twist (± 1.5°), and axial load (200–1750 N or 600–2000 N) applied to the model through 10 million simulation cycles. The model was calibrated with a wear coefficient determined from an experimental wear test. Implicit FE analyses were then performed for variations in coefficient of friction, polyethylene elastic modulus, radial clearance, and polyethylene component thickness to investigate their effects on wear. Results. Using the initial loading protocol (single-peaked axial load profile of 300–1750 N) from the experimental wear test, the polyethylene wear rate was 9.82 mg per million cycles. When a double-peaked loading profile (600–2000 N) was applied, the wear rate increased to 11.77 mg per million cycles. Parametric design variations produced only small changes in wear rates for this simulation. Conclusions. The chosen design variables had little effect on the resultant wear rates. The comparable wear rate for the THR validation analysis was 16.17 mg per million cycles, indicating that, using this framework, the wear potential of the TDR was equivalent to, if not better, than the THR using joint-specific loading standards.

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Williams, S. R., J. J. Wu, A. Unsworth, and I. Khan. "Wear and surface analysis of 38 mm ceramic-on-metal total hip replacements under standard and severe wear testing conditions." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 225, no. 8 (June 2, 2011): 783–96. http://dx.doi.org/10.1177/0954411911404773.

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

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