Abstract：
BACKGROUND:Numerous cementless femoral stem design variations are in clinical use. Because initial implant instability and micromotion are associated with aseptic loosening of the femoral component, migration analysis provides an early assessment of implant survivorship. QUESTIONS/PURPOSES:We determined the (1) migration pattern of the Accolade cementless femoral stem; (2) clinical factors predisposing to stem migration; (3) self-reported patient outcomes; and (4) our current rate of aseptic stem loosening. METHODS:We retrospectively analyzed 81 femoral stems for aseptic migration using Ein-Bild-Roentgen-Analyse-femoral component analysis. Postoperatively, patients completed the WOMAC and SF-12 questionnaires. We assessed radiographic factors potentially associated with subsidence: indices of bone shape and quality, canal fill of the implant, and radiographic signs of loosening. Minimum followup was 24 months (mean, 29 months; range, 24-48 months). RESULTS:The average subsidence at 24 months was 1.3 mm (range, 0-1.5 mm). In the first 2 years, 36% of stems subsided more than 1.5 mm. Large stem size was associated with subsidence. Radiolucent lines (> 1.5 mm in three zones) were present in 10% of stems and associated with lower questionnaire scores. The 5-year survivorship for aseptic loosening of the 367 stems was 97% with revision as end point and 95% for radiographic failure. CONCLUSIONS:The high incidence of migration and stems with radiographic failure raises concerns about patient clinical function and long-term survivorship of this stem design. This migration pattern may be due to poor initial stability with a subsequent lack of osseointegration. Our results differ from radiographic findings and clinical durability of other similar cementless stem designs. LEVEL OF EVIDENCE:Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
White CA,Carsen S,Rasuli K,Feibel RJ,Kim PR,Beaulé PEdoi
10.1007/s11999-011-2160-zsubject
Has Abstractpub_date
2012-02-01 00:00:00pages
410-7issue
2eissn
0009-921Xissn
1528-1132journal_volume
470pub_type
杂志文章abstract：:During a ten-year period (1978-1988), 143 of 1386 patients with proximal humeral fractures were treated with internal osteosynthesis. Ninety-seven proximal humeral osteosynthesis cases had adequate documentation, and 77 (80%) were available for clinical review. The 97 fractures were graded by the AO/ASIF classificatio...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：1993-07-01 00:00:00
abstract：:Chondrocytes are the single cellular component of hyaline cartilage. Under physiologic conditions, they show steady-state equilibrium between anabolic and catabolic activities that maintains the structural and functional integrity of the cartilage extracellular matrix. Implicit in the loss of cartilage matrix that is ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/01.blo.0000144854.66565.8f
更新日期：2004-10-01 00:00:00
abstract：:Periosteal osteosarcoma is a surface lesion without evidence of medullary involvement. This report extends the Mayo Clinic series of periosteal osteosarcoma cases from 11 to 22 cases. In a review of demographic information from our 22 cases and from 30 additional cases, referred only for pathologic diagnosis, the aver...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-06-01 00:00:00
abstract：:Reconstruction of the proximal humerus after resection for tumor and modification of the clavicular transposition procedure is described in which the blood supply of the clavicle is preserved and the clavicle is used to bridge the defect. An 11-year-old boy presented with shoulder pain, and the diagnosis was osteosarc...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200104000-00026
更新日期：2001-04-01 00:00:00
abstract：BACKGROUND:To prevent symptomatic heterotopic ossification (HO) and guide primary prophylaxis in patients with combat wounds, physicians require risk stratification methods that can be used early in the postinjury period. There are no validated models to help guide clinicians in the treatment for this common and potent...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-015-4302-1
更新日期：2015-09-01 00:00:00
abstract：BACKGROUND:Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wo...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-013-3123-3
更新日期：2014-03-01 00:00:00
abstract：:Reaming increases intramedullary pressure and can cause fat intravasation. This study investigated the influence of reaming parameters on pressure changes using the AO, Gray, and Howmedica reamers. Silicone cylindrical shells with 10-, 11-, 16-, 19-, and 20-mm inner diameters were filled with a 1:2 ratio of paraffin a...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200004000-00036
更新日期：2000-04-01 00:00:00
abstract：BACKGROUND:Cementless fixation remains controversial in TKA due to the challenge of achieving consistent skeletal attachment. Factors predicting durable fixation are not clearly understood, but we presumed bone ingrowth could be enhanced by the quantity of host bone and application of autograft bone chips. QUESTIONS/P...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-011-2214-2
更新日期：2012-07-01 00:00:00
abstract：:A study of 281 patients evaluated for a meniscus pathologic condition was performed to assess the accuracy of the clinical diagnosis and arthrogram and delineate the role of arthroscopy. Following the clinical examination, the surgeon stated his level of confidence in his diagnosis, as did the radiologist in his inter...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-03-01 00:00:00
abstract：:Experimental studies of osteomyelitis have been hampered by methodologic problems. For inducing experimental anaerobic osteomyelitis, the medullary cavity of the proximal tibial metaphysis of five New Zealand white rabbits was excavated and filled with a polyvinyl alcohol sponge. On the right side, 1 ml of a suspensio...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1991-04-01 00:00:00
abstract：:A way to prevent polyethylene wear in total hip replacements is to use metal-on-metal bearings. The cup design of these bearings may be a metal inlay in a polyethylene cup. However, these metal inlays are relatively thin and may deform on loading. The purpose of the current study was to determine whether these potenti...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200211000-00052
更新日期：2002-11-01 00:00:00
abstract：BACKGROUND:Studies suggest, even when controlling for disease severity, socioeconomic status, education, and access to care, racial and ethnic minorities receive lower-quality health care and have worse perceived pain and function before and after total joint arthroplasty. QUESTION/PURPOSES:We evaluated the influence ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-011-1841-y
更新日期：2011-07-01 00:00:00
abstract：:Computed tomography (CT) scanning is a useful tool in many areas of orthopedics. This prospective study reviews the authors' experience with CT scans in 73 patients studied prior to total hip arthroplasty. The CT scan is valuable in the primary total hip arthroplasty if the radiograph suggests medial, posterior, or su...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-09-01 00:00:00
abstract：UNLABELLED:Impaction grafting is controversial in the presence of segmental and cavitary acetabular defects and requires the use of supplemental devices to close segmental defects. This approach, however, would allow treating combined deficiencies that could not be managed with impacted cancellous bone alone. We raised...
journal_title：Clinical orthopaedics and related research
pub_type： 临床试验,杂志文章
doi：10.1007/s11999-008-0442-x
更新日期：2008-10-01 00:00:00
abstract：:Three hundred three patients undergoing total hip replacement were enrolled in a prospective, randomized, double-blind clinical study of heterotopic bone formation. All the procedures were primary arthroplasties done for osteoarthritis using an anterolateral approach. Patients with spondyloarthropathy, previous surger...
journal_title：Clinical orthopaedics and related research
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1995-05-01 00:00:00
abstract：:Both primary repair and late substitution of anterior cruciate ligaments can be accomplished by intra-articular methods. This principle is to provide temporary struts that are initially avascular but can later undergo revascularization and metaplasia to form a new ligament. The graft does afford initial support, howev...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1979-09-01 00:00:00
abstract：:Common misconceptions about distal radius fractures result in undertreatment of many fractures, particularly in an active population. Loss of reduction of the fracture may cause a symptomatic malunion. Fourteen patients with an average age of 39 years (range, 21-65 years) underwent reconstructive procedures for radial...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199606000-00021
更新日期：1996-06-01 00:00:00
abstract：:Forty-nine knees with osteochondritis dissecans were evaluated and in many cases, treated by arthroscopic means. The lesions were classified as to location and degree of separation. Arthroscopic treatment involved drilling, pinning, reduction of fragments, removal and replacement of fragments, and bone grafting. Of th...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-07-01 00:00:00
abstract：:The purpose of the current investigation was to present a standard method by which an orthopaedic practice can analyze its practice expenses. To accomplish this, a five-step process was developed to analyze practice expenses using a modified version of activity-based costing. In this method, general ledger expenses we...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200003000-00033
更新日期：2000-03-01 00:00:00
abstract：:A retrospective clinical review of 100 consecutive patients with extremity sarcomas managed by limb salvage operations was performed to evaluate local tumor control and morbidity. The mean follow-up period was 45.1 months. Overall survival was 86%. There were local recurrences in 3% of patients, and 26 complications i...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-11-01 00:00:00
abstract：:Intracapsular fractures of the hip have been classified by different authors with a basis on various concepts. Pauwels classified these fractures according to the angle of inclination; Linton used trabecular disposition among the fractural fragments, and Garden described four types according to the order of displaceme...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/00003086-200206000-00004
更新日期：2002-06-01 00:00:00
abstract：:Twenty knee dislocations in 19 patients (one bilateral) occurred over a period of 20 years. The age range was 21 to 65 years, with an average age of 40.8 years. There were two popliteal artery and eight peroneal nerve injuries in the group. All patients were managed by early closed reduction at the scene of the accide...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1985-09-01 00:00:00
abstract：BACKGROUND:Osteochondral allografting is an option for successful treatment of large articular cartilage defects. Use of osteochondral allografting is limited by graft availability, often because of loss of chondrocyte viability during storage. QUESTIONS/PURPOSES:The purpose of this study was to compare osteochondral ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-014-3773-9
更新日期：2014-11-01 00:00:00
abstract：BACKGROUND:Various head-preserving procedures have been used for young patients with osteonecrosis of the femoral head (ONFH) to avert the need for THA. However, none of these techniques are accepted universally because of the technical difficulties, complications, or mixed results that often are difficult to reproduce...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-009-1159-1
更新日期：2010-05-01 00:00:00
abstract：BACKGROUND:Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional g...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-011-1996-6
更新日期：2012-01-01 00:00:00
abstract：:Only 1 well-documented case of osteochondroma in the posterior elements of the cervical spine has been previously reported. Although unusual, osteochondroma should be considered in the differential diagnosis of benign appearing tumors in the cervical spine. ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1977-07-01 00:00:00
abstract：BACKGROUND:Wear of polyethylene tibial inserts can decrease the longevity of total knee arthroplasty. Wear is currently assessed using laboratory methods that may not permit backside wear measurements or do not quantify surface deviation. QUESTIONS/PURPOSES:We developed and validated a technique to quantify polyethyle...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-010-1490-6
更新日期：2011-01-01 00:00:00
abstract：:A case of isolated dislocation of the pisiform occurred in an 18-year-old man who was treated by primary resection and followed for two years. As observed in previous reports, primary resection was a successful treatment. ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1989-04-01 00:00:00
abstract：:Although previously unreported in the orthopaedic literature, hepatocellular carcinoma metastasizes to bone in 2 to 20% of cases. The poor prognosis associated with this tumor often results in patient demise before the need for orthopaedic intervention. A liver transplant recipient with no known history of hepatocellu...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1994-06-01 00:00:00
abstract：:Unicompartmental knee arthroplasty was conceived for the treatment of osteoarthritic knees with deterioration of either the medial or lateral compartment of the knee. The Unicondylar prosthesis was used in 19 medial and 5 lateral compartment arthroplasties. A two to 4 year follow-up evaluation of these patients was so...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1976-10-01 00:00:00
