Long-term follow-up of patients with idiopathic infantile hypercalcaemia

Idiopathic infantile hypercalcaemia (IIH) is a rare disorder of unknown etiology that presents with hypercalcaemia in a child's first year of life. There is only a limited number of published reports of the natural history of this condition, and the long-term prognosis is largely unknown. The presentation, treatment and long-term follow-up of 11 children with IIH treated at our institution since 1993 are described. Hypercalcaemia resolved in the majority of children by the time they were 3 years of age, but nephrocalcinosis and persistent hypercalciuria were common, and, in some cases, urinary calcium excretion increased after initially becoming normal. This study suggests that clinical and biochemical abnormalities may persist for longer than previously reported and implies the need for ongoing surveillance of patients with IIH.     

Zirconia陶瓷头-聚乙烯全髋关节的长期随访

目的: 通过对 28例 (30髋) zirconia-聚乙烯全髋关节的长期随访, 了解Zirconia陶瓷头的实际临床使用效果。方法: 用Harris评分分别评价术前和最后一次随访时髋关节功能。比较术后 1年及最后随访时的X线片, 记录假体松动、假体周围骨溶解、透亮线、及股骨矩吸收情况。根据Liv ermore的方法测量聚乙烯杯的磨损率。比较有骨溶解发生的髋关节与无骨溶解发生的髋关节的聚乙烯磨损率有无差别。结果: 共有 24例 (26髋) 获长期随访, 平均随访 9年 ( 6 ~13年 )。术前平均Harris评分 46分 ( 20 ~78分 ),最后随访时平均Harris评分 86分 (48~98分)。13髋 (50% ) 有假体周围的骨溶解发生。有 10髋 (38% ) 因髋臼假体的松动或髋臼周围骨溶解而接受翻修手术。平均聚乙烯髋臼磨损率为 0. 118mm/年。结论: 在本组研究病例中, 其髋臼磨损率并不比文献报道的传统的金属头低。而临床平均 9年翻修率更达 38%。其临床实际效果有待更深入的研究。     

Treatment of severe sequelae of infantile hip sepsis with trochanteric arthroplasty

We retrospectively reviewed 30 hips in 30 patients with complete destruction of the femoral head and neck from infantile septic arthritis to investigate the result and the ideal age for performance of trochanteric arthroplasty. All patients were treated with a 1-stage trochanteric arthroplasty at age from 11 to 98 months. We measured the range of motion of the hip, and we used the modified Harris hip score to evaluate pain and hip function and the multiplier growth-remaining method to assess predicted limb-length discrepancy. At a mean 7-year follow-up, we found that the modified Harris hip scores were negatively correlative--and the predicted limb-length discrepancy positively correlative--with the age at surgery in months. Range of motion in flexion and abduction of the hips of patients operated on at age older than 4 years were worse than that of the hips of patients operated on at age younger than 4 years. Therefore, we recommend that trochanteric arthroplasty should be performed as early as age 1 year for children with Hunka type V deformities after infantile septic arthritis of hip. Children older than 4 years might be contraindicated for trochanteric arthroplasty.     

Long-term follow-up of metal-on-metal total hip replacement.

Metal-on-metal articulations were reintroduced to reduce polyethylene particle-induced osteolysis. Elevated serum metal levels have been detected at short- and intermediate-term follow-up. There is little knowledge about long-term effects of increased ionic metal generation. Our study was undertaken to provide information about long-term survival, clinical outcome, radiographic appearance, and serum metal concentrations after a minimum 10 years follow-up with a metal-on-metal hip prosthesis: 105 cementless primary total hip prostheses with metal-on-metal articulating surfaces were implanted in 98 patients with a mean age of 56 years. Clinical data, radiographs, and blood samples were obtained at a follow-up visit 10 years after implantation. Serum cobalt and chromium levels were determined with use of atomic absorption spectrometry. General laboratory analyses included a full blood count and kidney function parameters. The Harris score was 92 points and the UCLA score 6 points after 10 years. Small osteolytic lesions and radiolucent lines were found in Gruen's zones 1, 7, 8, and 14. The probability of survival was 98.6%. The median serum cobalt concentration of the 22 patients with their hip replacement as the only source of cobalt was 0.75 microg/L (range, 0.3-50.1 microg/L). No patient was diagnosed with renal insufficiency during the study period. Five patients were diagnosed with a malignancy between surgery and the follow-up. We do not have evidence of an increased rate of primary malignancies nor could we detect renal failure in our study group. Serum metal levels did not differ from short- and intermediate term follow-up values.     

Long-term follow-up of congenital subluxation of the hip.

SUMMARY: This is a retrospective study of long-term radiographic results for congenital subluxation of the hip (CSH) after closed reduction at the authors' hospital from 1963 to 1980. The age at final follow-up ranged from 14.0 to 33.9 years (average 19.1). The diagnosis of CSH was determined radiographically using Ishida criteria. The center-edge angle (CE angle) and the Sharp angle were measured serially, and the final results were evaluated using Severin classification, and evaluation of avascular necrosis used the classification of Kalamchi and MacEwen. Sixty-nine (26.3%) of 262 hips with CSH were rated as Severin group III or IV. Avascular necrosis was found in 12 hips (4.6%). The CE angle of unaffected hips had strong correlation with that of affected hips. These late results were not satisfactory and indicate that patients with CSH should be followed up at least until skeletal maturity, as is done with complete hip dislocation.     

Long-term follow-up of Charnley arthroplasty of the hip.

A review of 11.5 year (average interval) follow-up examination of 409 low friction arthroplasties performed included only 3 late failures. The excellent results of the successes have been fully maintained for as long as 14 years. This was true with regard to pain, function of walking and mobility. Resorption of the calcar femorale was rare and no correlation was found with the wear of the socket. The average wear of 1.5 mm was less than predicted by Professor Sir John Charnley. Although 10 patients (7.8%) had excessive wear no patient is at present near the stage of requiring replacement of the socket for this reason. No adverse reaction was found to the implant or the cement.     

Long-term follow-up of the Indiana conservative resurfacing hip arthroplasty

Sixty-four Indiana conservative (Depuy, Warsaw, IN) hip arthroplasties performed in 61 patients were reviewed for loosening, mechanisms of loosening, and revision rate. Mean follow-up time was 6.8 years. There were revisions in 26 hips (40.6%) with 4 hips awaiting revision, yielding a total of 30 hips (47%) defined as failures. Acetabular failure occurred in 20 hips, femoral failure in 18, and combined failure in 13. Failure of this prosthesis persists over time. There seems to be little or no place for this design in contemporary hip joint arthroplasty.     

Long-term follow-up of cemented total hip arthroplasty in rheumatoid arthritis

Seventy-five primary cemented total hip arthroplasties (THAs) were performed in 53 patients with rheumatoid arthritis and juvenile rheumatoid arthritis. All patients were followed for an average of 7.4 years, unless their prosthetic hips failed before that time. Clinical evaluation was based on a 10-point maximum rating scale, and ratings for pain, walking, function, and activity improved from preoperative values to the most recent follow-up examination. Revision THA was performed for aseptic acetabular loosening in four hips, and femoral loosening in one hip. Sepsis occurred in another four hips. Complications of wound healing occurred in 14 hips. Roentgenographic evidence of loosening was seen in six acetabular components, in three femoral components, and in the femoral and acetabular component of one hip; none of these hips have as yet required revision THA. The Kaplan-Meier survivorship analysis revealed a 93% survival probability at seven years, which fell to 77% at 12 years in these patients. A trend was that younger, larger patients had increased failure and component loosening rates. Cemented primary THA has been a satisfactory operation in the rheumatoid patient. The relatively high rate of wound healing problems and sepsis may be due to the systemic immune nature of rheumatoid arthritis; however, 25% of these prosthetic hips either failed or are at risk for future failure. Thus, improved techniques are still necessary to increase the long-term success of THA in the rheumatoid patient.     

Long-term follow-up of 166 surgically treated patients with congenital hip dislocation

166 patients with congenital dislocation of the hip, ranging from 10 months to 5 years old, were operated between 1958 and 1971. 140 patients were women (84%) and 26 patients were men (16%). 96 patients had unilateral and 70 patients had bilateral dislocation; that makes a total of 236 dislocated hips. 61 patients with bilateral hip dislocation were operated simultaneously on both hips. All the patients were treated with adductor tenotomy and open reduction through Smith Petersen incision with section or elongation of the psoas tendon. The postoperative immobilization consisted in a period of one month pelvic toecast followed by 2 plaster casts with abduction rod during 3 to 5 months. The postoperatory follow-up ranged from 9 years to 26 years, 2 months; average 14 years, 5 months. The clinical evaluation comprises pain, hip mobility, gait and muscle power. Results: excellent 138 (59%); good 66 (28%); fair 29 (12%); and poor 3 (1%). The radiological evaluation considered: Mose; acetabular femoral head index; Wiberg's CD-angle; cervico-diaphysiary angle and radial quotient. Results: normal 5 (2%); excellent 44 (19%); good 78 (33%); subtotal 54%; fair 90 (38%), and poor 19 (8%). Complications (hips); infections 12 (5%); 3 of them deep ones (1%); residual subluxation 19 (8%); reluxation 1 (0.5%). Isquemic necrosis Grade II of T?nnis 31 (13%); Grade III 2 (1%) and Grade IV 1 (0.5%).     

Long-term observation and management of resolving infantile idiopathic scoliosis a 25-year follow-up

Of 42 patients with resolving infantile idiopathic scoliosis, 34 were followed up for more than 25 years. Twenty had been primarily treated in a plaster bed and 14 by physiotherapy. The mean angle of the curve at presentation was 17 degrees and at follow-up it was 5 degrees. No patient had significant progression of the scoliosis during the growth spurt. When adults few had back pain or an increased disability score and there was no interference with work or social activities. The rib-vertebra angle difference proved to be an essential radiological sign when distinguishing resolving from progressive infantile idiopathic scoliosis. There was no advantage of plaster over physiotherapy with regard to either the time to resolution or the functional outcome. Treatment of resolving infantile idiopathic scoliosis in a plaster bed is therefore now outdated.     

Long-term results of revision total hip replacement. A follow-up report

The results of 110 revision total hip replacements performed for aseptic failure, with an average follow-up of 3.4 years, were reported in 1982. We were able to continue to follow ninety-nine of these patients for an average of 8.1 years (range, five to 12.5 years). With this longer follow-up, we found that twenty-nine (29 per cent) of these revised arthroplasties have since failed. Most of the failures after 1982 occurred in the hips that were known to have a progressive radiolucency at the time of the first evaluation. We concluded that there is an increased failure rate with longer follow-up of revision total hip replacement, and that progressive radiolucency at an interface indicates a poor prognosis for the arthroplasty.     

Long-term follow-up study of bioactive bone cement in canine total hip arthroplasty

We report a long-term study of bioactive bone cement (BABC) in a canine total hip arthroplasty (THA) at follow-up of 8 years. Previous studies have shown excellent biomechanical and histological results at follow-up of 6, 12, and 24 months. In the present study, THA was performed in a beagle dog using BABC consisting of an apatite- and wollastonite-containing glass ceramic (AW-GC) powder and SiO2 powder as the filler and a bisphenol-a-glycidyl methacrylate (Bis-GMA) based resin as the organic matrix. Histological examination showed direct bonding between BABC and bone without any intervening soft tissue layer at the BABC-bone interface. A reactive layer, through which BABC bonded to the bone, was observed thicker at 8 years than it was at 24 weeks. No adverse effects of BABC were observed. BABC maintained the high bioactivity and direct bonding to bone in a canine THA at follow-up of 8 years.     

Long-term follow-up of primary total hip arthroplasty with the Alloclassic Variall system

Purpose

The aim of the present study was to evaluate the clinical and radiographic results of primary total hip arthroplasty (THA) performed with the Alloclassic Variall system (a modified version of the Alloclassic Zweymüller system) and to compare them with those in the literature for the original system.

Methods

Between January 2001 and December 2002, 273 consecutive primary THAs were performed in 259 patients at a single centre with the study system, using ceramic-on-ceramic (81.7 %) or ceramic-on-highly-crosslinked-polyethylene (18.3 %) articulations.

Results

At the time of this study, 28 patients (29 hips; 10.6 %) had died and 40 (43 hips; 15.8 %) were lost to follow-up. Seventeen patients (19 hips; 7.0 %) could be reached only by telephone. There were four revisions in four patients (1.5 %), all involving only the femoral component. Ten-year Kaplan-Meier survival with revision of any component for any reason as the endpoint was 98.4 % (95 % confidence interval: 96.9–100 %; 30 hips remained ‘at risk’). A total of 170 unrevised patients (178 hips; 65.2 %) were assessed clinically and radiographically at a median follow-up of 9.3 years (interquartile range [IQR] 8.8–9.8 years). The median Harris hip score (HHS) was 99.9 points (IQR 97.7–100). The score did not differ significantly between the two articulations. There was no sign of radiographic loosening.

Conclusions

The ten-year implant survival and the HHS score outcomes for THAs performed with the novel system were in line with those documented in the literature for its predecessor.

     

Long-term results of total hip arthroplasty in congenital dislocation and dysplasia of the hip. A follow-up note

Twenty-three of twenty-nine hips that were previously reported on were studied at an average of fourteen years (range, eight to 16.5 years) after total hip arthroplasty with cement. The original arthroplasties had been performed between November 1971 and January 1976. In all hips, there was dislocation or severe dysplasia. In six hips, superolateral bone grafts were used to increase acetabular coverage. At the latest follow-up examination, seven hips were rated excellent; nine, good; and one, fair. There were six failures (26 per cent) that were revised: four hips (17 per cent) had a fractured Trapezoidal-28 stem, one had loose femoral and acetabular components, and one had loosening of only the acetabular component. Radiographic analysis of the remaining hips revealed that one had progressive acetabular radiolucencies. This patient had an excellent clinical result. Two-thirds of the failures were due to a fractured stem.     

Chiari截骨术治疗成人髋发育不良的远期随访

目的:对成人髋发育不良行Chiari截骨术进行远期随访,评估该治疗方法的有效性.方法:对接受Chiari截骨术治疗的病人,分别测定其术前和术后JOA评分、中心边缘角和Sharp角、术后截骨远端内移率和截骨平面的高度,并对影响结果的因素进行相关性分析.结果:平均随访时间为12.8年,病人38例,共45侧髋,其中男3例,女35例,手术时平均年龄为38.5岁.45侧髋中,有17例髋关节骨性关节炎得到明显改善,占37.7%;有13侧髋关节骨性关节炎无明显变化,占28.9%;有15侧髋关节骨性关节炎病变继续恶化,占33.3%.术前JOA平均为59.9分,术后83.8分.术后疗效为优占37.0%,良占34.2%,一般占15.5%,差占13.3%.术前平均中心边缘角-11.5°,术后为24.6°.术前平均Sharp角为54.4°,术后平均为43.3°.平均截骨角度为7.51°,股骨头顶点至截骨平面的距离平均为8.17mm.截骨远端内移率平均值为33.6%.结论:经过10年以上的随访表明,Chiari截骨术能使成人髋发育不良的疼痛症状得到缓解,一部分病人骨性关节炎的过程得到有效的遏制.     

Long-term follow-up and metal ion trend of patients with metal-on-metal total hip arthroplasty

Purpose

Long-term studies are required to support the use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) given the concern about systemic metal ion release and reports of adverse local soft tissue reactions. The purpose of this study was to report the seven to 13-year clinical, radiographic, and metal ion results in patients following MoM THA.

Methods

We studied 163 prostheses after second-generation MoM THA between July 1997 and November 2003. Cobalt and chromium metal ions were collected using whole and analysed by inductively-coupled plasma-mass spectrometry.

Results

The mean follow-up was 8.87 years (range, 7–13 years). Four hips (2.5 %) were revised. The Kaplan-Meier survivorship was 91.3 % for revision for all causes, and 97.5 % when excluding the hips revised for a manufacturer’s defect. Median whole blood cobalt levels peaked at a value of 2.87 μg/L at four years (p < 0.0001 vs. pre-operative) and subsequently decreased to 2.0 μg/L after nine years (p = 0.002 vs. four years). Median chromium levels maximally increased up to 0.75 μg/L after five years (p < 0.0001 vs. pre-operative) and tended to decrease thereafter to values of 0.56 μg/L after seven years.

Conclusions

This seven to 13-year follow-up study indicates that the clinical and radiological results following MoM THA are satisfactory with low revision rates. Cobalt and chromium ion levels peaked at four and five years, respectively, and gradually decreased thereafter.     

Double-cup replacement in the treatment of tuberculosis of the hip. Long-term follow-up studies

24 tuberculous hip joints were treated by radical debridement and double-cup replacement in one single stage. They healed up primarily and remained well up to the time of follow-up, a period of 5 years and 7 months on average, except one which recurred 1 month after operation and persisted until removal of the implants. Slipping of head cup occurred in 4 cases in 10 to 12 months post-operatively. The slipped cups were removed or received, showing fibrous drinking of the head stump. Factors influencing and the time taking place of slipping of head cup along with it management were discussed and described. It is shown that radical debridement and double-cup replacement could serve to cure the tuberculosis and preserve the function of the hip joint.