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1.  Outcome of periacetabular osteotomy 
Acta orthopaedica  2005;76(3):303-313.
Background
Due to wide variations in acetabular structure of individuals with hip dysplasia, the measurement of the acetabular orientation may not be sufficient to predict the joint loading and pressure distribution across the joint. Addition of mechanical analysis to preoperative planning, therefore, has the potential to improve the clinical outcome.
We analyzed the effect of periacetabular osteotomy on hip dysplasia using computer-aided simulation of joint contact pressure on regular AP radiographs. The results were compared with the results of surgery based on realignment of acetabular angles to the normal hip.
Patients and methods
We studied 12 consecutive periacetabular osteotomies with no femoral head deformity. The median age of patients, all females, was 35 (20−50) years. The median follow-up was 2 years (1.3−2.2). Patient outcome was measured with the total score of a self-administered questionnaire (q-score) and with the Harris hip score. The pre- and postoperative orientation of the acetabulum was defined using reconstructed 3D CT-slices to measure angles in the three anatomical planes. Peak contact pressure, weight-bearing area, and the centroid of the contact pressure distribution (CP-ratio) were calculated.
Results
While 9 of 12 cases showed decreased peak pressure after surgery, the mean changes in weight-bearing area and peak contact pressure were not statistically significant. However, CP-ratio changed (p < 0.001, paired t-test) with surgery. For the optimal range of CP-ratio (within its mid-range 40−60%), the mechanical outcome improved significantly.
Interpretation
Verifying the correlation between the optimal CP-ratio and the outcome of the surgery requires additional studies on more patients. Moreover, the anatomically measured angles were not correlated with the ranges of CP-ratio, suggesting that they do not always associate with objective mechanical goals of realignment osteotomy. Mechanical analysis, therefore, can be a valuable tool in assessing two-dimensional radiographs in hip dysplasia.
PMCID: PMC2745131  PMID: 16156455
2.  Cement/implant interface gaps explain the poor results of CMW3 for femoral stem fixation: a cadaver study of migration, fatigue and mantle morphology. 
Acta orthopaedica  2005;76(5):679-687.
Background: Norwegian Arthroplasty Register (NAR) reported that CMW3 cement performed poorly for femoral stem fixation.
Methods: Collared, satin-finished stems (Ra = 0.35μm) were implanted into cadaver femora using CMW3 and Simplex as control. Cement mantle function was quantified by stem migration after 300,000 cycles of “stair-climbing”. Cement cracks and interface gaps were quantified in transverse sections.
Results: The variances of the CMW3 migrations were substantially and significantly higher (p < 0.0001): subsidence (CMW3 = -32(SD42)μm, Simplex = -7(SD9)μm, p = 0.16); retroversion (CMW3 = 0.60(SD0.25)°, Simplex = 0.37(SD0.04)°, p = 0.08). Crack length-densities were similar (CMW3 = 50(SD15)μm/mm2, Simplex = 45(SD12)μm/mm2, p = 0.30). CMW3 had significantly more non-apposed stem/cement interface: 52(SD17)% versus 33(SD8)% (p = 0.040).
Migrations were predicted by fraction of non-apposed stem/cement interface (retroversion: R2 = 0.80, p < 0.0001, subsidence: R2 = 0.46, p = 0.016) but not by cement cracks or non-apposed cement/bone interface (R2 < 0.05, p = 0.49—0.77)
Interpretation: This study showed that increased stem/cement non-apposition resulted in increased stem migration. Early migration is known to correlate with revision risk. Therefore, the higher stem-revision risk for CMW3 cement reported by the NAR may have been due to inferior and variable stem/cement apposition.
doi:10.1080/17453670510041763
PMCID: PMC1383657  PMID: 16263615

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