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1.  Results of 3,668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years 
Acta Orthopaedica  2011;82(5):521-529.
Background and purpose
In a previous study based on the Finnish Arthroplasty Register, the survival of cementless stems was better than that of cemented stems in younger patients. However, the survival of cementless cups was poor due to osteolysis. In the present study, we analyzed population-based survival rates of the cemented and cementless total hip replacements in patients under the age of 55 years with primary osteoarthritis in Finland.
Patients and methods
3,668 implants fulfilled our inclusion criteria. The previous data included years 1980–2001, whereas the current study includes years 1987–2006. The implants were classified in 3 groups: (1) implants with a cementless, straight, proximally circumferentially porous-coated stem and a porous-coated press-fit cup (cementless group 1); (2) implants with a cementless, anatomic, proximally circumferentially porous-coated stem, with or without hydroxyapatite, and a porous-coated press-fit cup with or without hydroxyapatite (cementless group 2); and (3) a cemented stem combined with a cemented all-polyethylene cup (the cemented group). Analyses were performed separately for 2 time periods: those operated 1987–1996 and those operated 1997–2006.
Results
The 15-year survival for any reason of cementless total hip replacement (THR) group 1 operated on 1987–1996 (62%; 95% CI: 57–67) and cementless group 2 (58%; CI: 52–66) operated on during the same time period was worse than that of cemented THRs (71%; CI: 62–80), although the difference was not statistically significant. The revision risk for aseptic loosening of cementless stem group 1 operated on 1987–1996 (0.49; CI: 0.32–0.74) was lower than that for aseptic loosening of cemented stems (p = 0.001).
Interpretation
Excessive wear of the polyethylene liner resulted in numerous revisions of modular cementless cups. The outcomes of total hip arthroplasty appear to have been relatively unsatisfactory for younger patients in Finland.
doi:10.3109/17453674.2011.618908
PMCID: PMC3242947  PMID: 21992084
2.  Cementless total hip arthroplasty for primary osteoarthritis in patients aged 55 years and older 
Acta Orthopaedica  2010;81(1):42-52.
Background
Cemented total hip arthroplasty has been the treatment of choice for elderly patients with osteoarthritis. We analyzed survival rates of the most common cementless designs used in this age group in Finland.
Patients and methods
Inclusion criteria permitted 10,310 replacements (8 designs) performed in patients aged 55 years or older to be selected for evaluation. The risk of revision of each of the 8 implants was compared with that of a group comprising 3 cemented designs as the reference (9,549 replacements). Survival analyses were performed overall and separately for 3 age cohorts: 55–64 years (6,781 replacements), 65–74 years (8,821 replacements), and 75 years or older (4,257 replacements).
Results
In all patients aged 55 years or more, the Bi-Metric stem had a higher survival rate for aseptic loosening at 15 years than the cemented reference group: 96% (95% CI: 94–98) vs. 91% (CI: 90–92). However, the 15-year survival rates of the Bi-Metric/Press-Fit Universal (71% (CI: 67–75)) and the Anatomic Mesh/Harris-Galante II (72% (CI: 67–78)) total hip replacements were lower than that of the reference group (86% (CI: 84–87)). Information was scarce for patients aged 75 years or more.
Interpretation
Cementless proximal porous-coated stems are a good option for elderly patients. Even though biological fixation is a reliable fixation method in THA, polyethylene wear and osteolysis remain a serious problem for cementless cup designs with unplugged screw holes and low-quality liners.
doi:10.3109/17453671003635900
PMCID: PMC2856203  PMID: 20180718
3.  Cancer risk is not increased after conventional hip arthroplasty 
Acta Orthopaedica  2010;81(1):77-81.
Background and purpose
Wear debris from conventional total hip arthroplasty (THA) induces chromosomal aberrations and DNA damage, which may promote cancerogenesis. A long latent period is required for solid tumors. We therefore re-analyzed a large THA cohort for cancer.
Patients and methods
We updated a cohort of 24,636 patients with primary osteoarthritis and metal-on-polyethylene THA who had been entered in the Finnish Arthroplasty Register between 1980 and 1995, and linked it to the Finnish Cancer Registry for cancer risk assessment up to 2005. The mean follow-up time was 13 years. The numbers of cancer cases observed were compared with expected rates based on incidence in the general population.
Results
The standardized incidence ratio (SIR) for the whole follow-up period was 0.95 (95% confidence interval (CI): 0.92–0.97). After 10 years of follow-up, the SIR was equal to that in the normal population (SIR = 0.98, 95% CI: 0.94–1.03). Incidence of lung cancer was low throughout the follow-up time and that of prostate cancer was slightly elevated. The incidence rates for all other forms of cancer did not deviate significantly from those in the normal population.
Interpretation
We found no increased cancer risk in patients with conventional THA after an average of 13 years and up to 25 years of follow-up.
doi:10.3109/17453671003667150
PMCID: PMC2856208  PMID: 20178446
4.  Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register 
Acta Orthopaedica  2010;81(1):114-118.
Background and purpose
Although total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide arthroplasty registry in Finland.
Methods
573 primary TARs were performed during the period 1982–2006 because of rheumatic, arthritic, or posttraumatic ankle degeneration. We selected contemporary TAR designs that were each used in more than 40 operations, including the S.T.A.R. (n = 217) and AES (n = 298), to assess their respective survival rates. The mean age of the patients was 55 (17–86) years and 63% of operations were performed in women. Kaplan-Meier analysis and the Cox regression model were used for survival analysis. The effects of age, sex, diagnosis, and hospital volume were also studied.
Results
The annual incidence of TAR was 1.5 per 105 inhabitants. The 5-year overall survivorship for the whole TAR cohort was 83% (95% CI: 81–86), which agrees with earlier reports. The most frequent reasons for revision were aseptic loosening of one or both of the prosthesis components (39%) and instability (39%). We found no difference in survival rate between the S.T.A.R. and AES designs. Furthermore, age, sex, diagnosis, and hospital volume (< 10 and > 100 replacements in each of 17 hospitals) did not affect the TAR survival.
Interpretation
Based on our findings, we cannot conclude that any prosthesis was superior to any other. A high number of technical errors in primary TARs suggests that this low-volume field of implant arthroplasty should be centralized to fewer units.
doi:10.3109/17453671003685459
PMCID: PMC2856214  PMID: 20180720
5.  Total elbow arthroplasty in rheumatoid arthritis 
Acta Orthopaedica  2009;80(4):472-477.
Background and purpose Although total elbow arthroplasty (TEA) is a recognized procedure for the treatment of the painful arthritic elbow, the choice of implant is still obscure. We evaluated the survival of different TEA designs and factors associated with survival using data from a nationwide arthroplasty register.
Methods 1,457 primary TEAs for rheumatoid elbow destruction were performed during 1982 to 2006 in one hospital specialized in the treatment of rheumatoid arthritis (n = 776) and in 19 other hospitals (n = 681). The mean age of the patients was 59 years and 87% of the TEAs were performed in women. We selected different contemporary TEA designs, each used in more than 40 operations including the Souter-Strathclyde (n = 912), i.B.P./Kudo (n = 218), Coonrad-Morrey (n = 164), and NESimplavit/Norway (n = 63) to assess their individual survival rates. Kaplan-Meier analysis and the Cox regression model were used for survival analysis.
Results The most frequent reason for revision was aseptic loosening (47%). We found no differences in survival rates between different TEA designs. We did, however, find a 1.5-fold (95% CI: 1.1–2.1) elevated risk of revision in unspecialized hospitals as compared to the one hospital specialized in treatment of rheumatoid arthritis. In the Souter-Strathclyde subgroup, there was a reduced risk of revision (RR 0.6, p = 0.001) in TEAs implanted over 1994–2006 as compared to those implanted earlier (1982–1993). The 10-year survivorship for the whole TEA cohort was 83% (95% CI: 81–86), which agrees with earlier reports.
Interpretation The influence of implant choice on the survival of TEA is minor compared to hip and knee arthroplasties. Inferior survival rates of the TEAs performed in the unspecialized hospitals demonstrates the importance of proper indications, surgical technique, and postoperative follow-up, and endorses the need for centralization of these operations at specialized units.
doi:10.3109/17453670903110642
PMCID: PMC2823192  PMID: 19562563

Results 1-5 (5)