No description available.

Στην παρούσα διατριβή προσεγγίσθηκε η βιολογική συνιστώσα του φαινομένου της άσηπτης χαλάρωσης των υλικών των ορθοπαιδικών προθέσεων. Κατ’ αρχήν μελετήθηκαν διεξοδικά περιπροθετικοί ιστοί (IFT και PCT) υγρό (PSSF) από πέντε ασθενείς οι οποίοι υποβλήθηκαν σε επέμβαση αναθεώρησης λόγω άσηπτης χαλάρωσης των προθέσεων. Το ενδεχόμενο σηπτικής χαλάρωσης αποκλείσθηκε με μικροβιολογικό και ιστοπαθολογικό έλεγχο. Οι ιστοί αυτοί εκχυλίσθηκαν παρουσία αναστολέων των πρωτεασών ώστε να αποκλεισθεί το ενδεχόμενο in vitro ενεργοποίησης των περιεχομένων στα εκχυλίσματα ενζύμων. Σε όλα τα δείγματα και σε συμφωνία με άλλους ερευνητές, ανιχνεύθηκε ζελατινολυτική και κολλαγονολυτική δραστικότητα. Ο προσδιορισμός της πρώτης έγινε με χρήση ζυμογραφήματος ζελατίνης, αξιολόγηση και επεξεργασία των ζωνών λύσεως, ενώ για την δεύτερη χρησιμοποιήθηκε το συνθετικό πεπτίδιο DNP-S και χρωματογραφία υψηλής επίδοσης ανάστροφης φάσης RP-HPLC. Οι δραστικότητες που ανιχνεύθηκαν οφείλονταν σε εκφραζόμενες στους ιστούς ΜΜPs. Η ζελατινολυτική δραστικότητα οφειλόταν κατά το πλείστον σε ζελατινάσες (MMP-2 και MMP-9), οι οποίες όμως στο μεγαλύτερο ποσοστό τους ανιχνεύθηκαν σε σύμπλοκη με TIMPs μορφές. Η ειδική ζελατινολυτική δραστικότητα μεταξύ δειγμάτων ίδιας κατηγορίας ιστών (IFT ή PCT) δεν παρουσίαζε μεταβολή ανεξάρτητα από το είδος της αρθροπλαστικής ή την παρουσία οστεόλυσης. Ελαττωμένη δραστικότητα εμφάνισαν τα δείγματα των PSSF. Η κολλαγονολυτική δραστικότητα, η οποία ήταν αυξημένη στα δείγματα όπου συνυπήρχε περιπροθετική οστεόλυση, οφειλόταν κυρίως σε κολλαγονάσες του ενδιάμεσου στρώματος. Πιο σημαντική συμβολή φάνηκε ότι είχε η ΜΜΡ-13, η οποία ανιχνεύθηκε στα περισσότερα δείγματα σε ενεργό μορφή, σε σχέση με την ΜΜΡ-1. Η ΜΤ-1-ΜΜΡ μάλλον δεν ανιχνεύθηκε λόγω του τρόπου αρχικής επεξεργασίας των εκχυλισμάτων. Σε πειράματα που ακολούθησαν και δεν περιλαμβάνονται στην παρούσα μελέτη, ανιχνεύθηκε κυρίως σε σύμπλοκη με ΤΙΜΡ-2 μορφή. Συνοψίζοντας τα παραπάνω προέκυψε το συμπέρασμα ότι στους περιπροθετικούς ιστούς εκφράζονται μέλη της οικογένειας των ΜΜPs, που εμπλέκονται, σε διαφορετικό βαθμό το κάθε ένα, στην διαδικασία της οστικής απορρόφησης και της άσηπτης χαλάρωσης. Η ανίχνευση δε δραστικοτήτων στους ιστούς των PCT, αντίστοιχων μάλιστα με αυτών των IFT, στηρίζει την υπόθεση της έναρξης της κυτταρικής αντίδρασης του οργανισμού, στα μικροσωματίδια των υλικών, στον ιστό αυτόν. Η διευκρίνιση του ακριβούς ποσοστού συμμετοχής της κάθε μίας ΜΜΡ αναμένεται να δώσει σημαντική ώθηση στην προσπάθεια επιβράδυνσης των διαδικασιών της χαλάρωσης, μέσω της χρήσης ειδικών και πιθανώς εκλεκτικών φαρμακευτικών αναστολέων των ενζύμων αυτών. Στα πλαίσια της παραπάνω πιθανής θεραπευτικής προσέγγισης μελετήθηκε η επίδραση μερικών γνωστών μη-στεροειδών αντιφλεγμονωδών φαρμάκων (ΜΣΑΦ) στην, επαγόμενη από δέκα IFT, in vitro παραγωγή ΜΜPs και ΤΙΜΡs. Λόγω δε της πολυπλοκότητας των παθογενετικών μηχανισμών της οστικής απορρόφησης, μελετήθηκε η επίδραση των φαρμάκων αυτών και σε άλλους εμπλεκόμενους, στην οστεόλυση και την χαλάρωση, παράγοντες (IL-1β, IL-6, TNF-α και PGE2). Τα ΜΣΑΦ που δοκιμάσθηκαν ήταν η ασεκλοφαινάκη, η πιροξικάμη, η τενοξικάμη και η ινδομεθακίνη, ενώ για τον προσδιορισμό της επίδρασής τους χρησιμοποιήθηκαν ζυμογράφημα ζελατίνης και τεχνικές ELISA. Τα αποτελέσματα έδειξαν στατιστικά μη-σημαντική ανασταλτική επίδραση στα επίπεδα των MMPs και των αναστολέων τους, σημαντικότατη αναστολή της PGE2, αναστολή της IL-6 και του TNF-α ιδιαίτερα από ασεκλοφαινάκη και τενοξικάμη και αύξηση των επιπέδων IL-1β (ιδιαίτερα από την ασεκλοφαινάκη). Για να υποστηριχθεί βέβαια η θέση της χορήγησης των ΜΣΑΦ αυτών με σκοπό τουλάχιστον την επιβράδυνση των διαδικασιών της χαλάρωσης απαιτούνται μετρήσεις σε μεγαλύτερο αριθμό δειγμάτων ή in vivo μετρήσεις. / In this study the biological mechanisms, which contribute to aseptic loosening process, were evaluated. Periprosthetic tissues (IFT and PCT) and liquids (PSSF) from five patients, who subjected to hip revision due to aseptic loosening, were collected. The possibility of septic loosening was, by histopathological and culture examinations, excluded. Extraction of tissues and dialysis were, in the presence of proteinases inhibitors, performed in order to exclude the in vitro activation of the sample-enzymes. Collagenolytic and gelatinolytic activity were, in all samples, detected. In order to examine the gelatinolytic activity, all samples were subjected in gelatin zymography and the lysis bands were evaluated. The collagenolytic activity was examined by using the DNP-S peptide and reverse phase high performance liquid chromatography (RP-HPLC). The activities, mentioned above, were the outcome of, expressed in periprosthetic tissues, MMPs. The gelatinolytic activity was the result of gelatinases (MMP-2 and MMP-9), which were mainly in complex with TIMPs forms detected. The specific gelatinolytic activities of the samples were almost equal, independently the type of arthroplasty and the presence or absence of osteolysis. In PSSF samples low activity was detected. Collagenolytic activity, which was higher in samples collected from osteolytic lesions, was the result of presence and action of interstitial callagenases. MMP-13 seems to have the major contribution, compared to MMP-1 in collagenolytic activity. MT1-MMP was not detected, possibly due to the extraction methods. In more recent and unpublished results, MT1-MMP was detected in complex to TIMP-2. In brief, different members of the MMP family are expressed in periprosthetic tissues and fluids. These MMPs contribute in different way in loosening and osteolysis processes. The fact that in PCTs high activities were measured can support the hypothesis that all the biological events that lead to loosening start to take place in the PCT tissue. The contribution of each MMP in these processes has to be elucidated in order to try to decelerate them by using selective MMPs-inhibitors. In order to evaluate the possible usage of several well-known non-steroidal anti-inflammatory drugs for retarding the loosening process, the in vitro effect of these drugs in the IFT- induced production of MMPs and TIMPs was studied. Because of the complexity of the involved in pathogenesis factors, the effect of the drugs in other soluble cytokines (such as IL-6, IL-1β, TNF-a) and PGE2 was also measured. For all these experiments cultures of IFT of ten patients were used. Aceclofenac, Piroxicam, Tenoxicam and Indomethacin were used. The drugs didn’t have a statistically significant effect in the MMPs or TIMPs production. In all cases the inhibitory effect on PGE2 was potent. Aceclofnac and tenoxicam reduced strongly the IL-6 and TNF-α levels. Finally the drugs seemed to induce the ΙL-1β levels (especially aceclofenac). More experimental studies are necessary for supporting the usage of the tested drugs, for retarding the aseptic loosening phenomenon. In vivo studies will also be useful.

No description available.

Hip replacement surgery has experienced a dramatic evolution in recent years supported by the latest developments in many areas of technology and surgical procedures. Unfortunately complications that follow hip replacement surgery remains the most challenging dilemma faced both by the patients and medical experts. The thesis presents a novel approach to segment the prosthesis of a THR surgical process by using an Active Contour Model (ACM) that is initiated via an automatically detected seed point within the enarthrosis region of the prosthesis. The circular area is detected via the use of a Fast, Randomized Circle Detection Algorithm. Experimental results are provided to compare the performance of the proposed ACM based approach to popular thresholding based approaches. Further an approach to automatically detect the Obturator Foramen using an ACM approach is also presented. Based on analysis of how medical experts carry out the detection of loosening and subsidence of a prosthesis and the presence of infections around the prosthesis area, this thesis presents novel computational analysis concepts to identify the key feature points of the prosthesis that are required to detect all of the above three types of complications. Initially key points along the prosthesis boundary are determined by measuring the curvature on the surface of the prosthesis. By traversing the edge pixels, starting from one end of the boundary of a detected prosthesis, the curvature values are determined and effectively used to determine key points of the prosthesis surface and their relative positioning. After the key-points are detected, pixel value gradients across the boundary of the prosthesis are determined along the boundary of the prosthesis to determine the presence of subsidence, loosening and infections. Experimental results and analysis are presented to show that the presence of subsidence is determined by the identification of dark pixels around the convex bend closest to the stem area of the prosthesis and away from it. The presence of loosening is determined by the additional presence of dark regions just outside the two straight line edges of the stem area of the prosthesis. The presence of infections is represented by the determination of dark areas around the tip of the stem of the prosthesis. All three complications are thus determined by a single process where the detailed analysis defer. The experimental results presented show the effectiveness of all proposed approaches which are also compared and validated against the ground truth recorded manually with expert user input.

No description available.

Aseptic loosening of the tibial component is an important cause of failure after total knee arthroplasty. Bone destruction often claimed to be caused by the cement makes the revision difficult. In order to treat younger patients, uncemented fixation has been introduced, but the etiology to loosening is multifactorial and only partly known. Early detection of implant migration facilitates research in this field but is difficult using conventional techniques. In this study modified versions of roentgen stereophotogrammetric analysis (RSA) were developed to obtain accurate and standardized evaluations facilitating comparison between prosthetic designs. The method was used to record the efficacy of cemented and uncemented fixation of different designs of the tibial component, to determine the accuracy of scintimetry in the detection of early aseptic loosening, and to analyse the in vivo kinematics of knee arthroplasties with different design and stability between the joint surfaces. Forty-three arthroplasties with comparatively high inherent stability of the joint surfaces were randomized to cemented or uncemented fixation of the tibial component. In all groups micromovements were rather large, but with no differences between the cemented and uncemented components. The preoperative diagnosis (arthrosis OA, n=25; rheumatoid arthritis RA, n=18) did not influence the magnitude of micromotion. 20 arthroplasties with the same design as above but equipped with an intramedullary stem, were randomized to cemented or uncemented fixation in patients with RA. Cement improved the fixation. Uncemented stemmed components displayed micromovements seemingly larger than unstemmed ones. 34 arthroplasties with an unconstrained design of the joint area and fixed to the tibia with four pegs were randomized to cemented or uncemented fixation in patients with OA. When used uncemented 4 screws were added. Compared with previously investigated designs small micromotions were recorded, and especially in the cemented cases. Uncemented components with thin polyethylene inserts displayed larger initial micromotions. The preoperative deformity influenced the direction of the micromotion. 33 knees were followed prospectively with RSA and scintimetry to evaluate any correlation between these methods. Low activity under the tibial component at 2 years implied prosthetic stability, whereas high activity indicated instability or high bone remodelling caused by the preoperative malalignment. The in vivo kinematics in three different designs of knee arthroplasties were analyzed during active flexion and extension without weight-bearing. Each type of prosthesis displayed design-specific abnormalities when compared with a normal material. Pronounced posterior tibial translations were recorded during flexion regardless whether the posterior cruciate ligament had been sacrificed or not. Data from the kinematic and the fixation studies suggest that movements restricted by the design of the joint area are transmitted to the bony interface with design-specific micromotions as the result. Analysis of knee joint kinematics during extension and weight-bearing revealed small alterations compared with non-weight-bearing. Evaluation of the three-dimensional movements in terms of helical axis rotations and translations confirmed the constrained or unconstrained in vivo behaviour of the designs under study. This analysis also facilitated the interpretation of the kinematic behaviour of the prosthetic knees and may be of value in the evaluation of new designs. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1992, härtill 7 uppsatser.</p> / digitalisering@umu

Com disseminação dos implantes osseointegrados na pratica clinica a ocorrência de complicações mecânicas tornam-se comuns, causando problemas para pacientes e profissionais. O objetivo deste estudo foi comparar o grau de rotação de parafusos de titânio (grau 5), durante testes de torque, re-torque e os valores de destorque (Ncm), sobre infra-estruturas fundidas em monobloco, soldadas com solda TIG e solda Convencional, a partir de abutments tipo UCLA com cinta usinada em Co-Cr. Um dispositivo leitor da quantidade de graus foi especialmente desenvolvido para este estudo, juntamente com um software. Seis implantes Titaniun Fix de 3,75 mm de diâmetro e 13 mm de comprimento e hexágono externo foram montados na base de um dispositivo e diretamente sobre eles foram obtidos os padrões para fundição dos corpos de prova. Para os grupos que foram submetidos a soldagem os corpos foram montados à análogos de implantes Titaniun Fix, e vazados blocos de gesso especial tipo IV (Durone) para serem seccionados e fundidos. Cada corpo de prova foi formado por dois abutments tipo UCLA com cinta em Co-Cr, interligados por uma barra acrílica. Foram obtidos 10 corpos de prova para cada grupo e 60 parafusos de titânio (Grau 5- Titaniun Fix) foram usados para os testes. Obteve-se então a medição do ângulo criado durante o aperto e re-aperto dos parafusos, sendo o re-aperto realizado após 10 minutos do aperto inicial, ambos sob torque de 30Ncm. Após o procedimento de re-aperto, o valor de destoque era imediatamente aferido e anotado em Ncm, possibilitando avaliar a quantidade de torque retido pelo parafuso após o procedimento, sendo esta seqüência realizada 3 vezes para cada corpo de prova. Sendo a análise estatística realizada para essa comparação (ANOVA) Análise de Variância a um critério de classificação, o teste Tukey, para verificar se havia diferença estatística entre os grupos. Os resultados revelaram que durante os procedimentos de torque (aperto), os parafusos empregados em infra-estruturas fundidas em monobloco apresentaram um maior grau de rotação (56,12°), quando comparados aos parafusos empregados em infra-estruturas segmentadas e fundidas separadamente soldadas com solda TIG valor médio de (43,2°) e solda Convencional com valor médio (35,7°), sendo a diferença entre os grupos estatisticamente significante em todos os grupos para o momento torque; p<0,05. Durante o momento re-torque, o ângulo formado na cabeça dos parafusos também foi sempre maior para o grupo monobloco (15,55°) , comparado aos grupos solda TIG (10,15º) e solda Convencional (9,85°) , sendo que diferença estatisticamente significante foi encontrada entre os grupos monobloco em relação aos grupos soldados, e não havendo diferença estatística entre os grupos soldados, p<0,05. Os valores médios de destorque (quantidade de torque retido durante o aperto dos parafusos) foram maiores para o grupo solda TIG (26,77Ncm) em relação aos grupos monobloco (26,55Ncm) e grupo solda Convencional (25,10Ncm) respectivamente, porém sem diferença estatisticamente significante entre os grupos. Tanto para o momento de torque quanto para o momento de re-torque, infra-estruturas do grupo Monobloco permitiram maior rotação dos parafusos dos abutments, quando comparados com os grupos Soldados. Na análise dos valores de destorque, estatisticamente os grupos foram considerados semelhantes. / With the spread of osseointegrated implants in clinical practice the incidence of mechanical complications have become common, causing problems for patients and professionals. The aim of this study was to compare the degree of rotation of titanium screws, during testing of torque, re-torque and destorque values (Ncm) in one-piece casting infrastructures, welded with TIG and Conventional welding, from UCLA strap machined Cr-Co abutments. A reader device for the number of degrees has been specially developed for this study, together with a software. Titaniun Fix implants (n=6) of 3.75mm in diameter and 13mm in length and external hexagon were mounted at the base of a device and they were obtained directly from the casting patterns of the specimens. Groups that were subjected to welding were mounted to the implant analogues, submitted to special plaster type IV (Durone) blocks. Each sample was formed by two UCLA type abutments with strap on Co-Cr, connected by an acrylic bar. It were obtained 10 specimens for each group and 60 titanium screws (Grade 5 - Titaniun Fix) were used for testing. The measurement of the angle created during tightening and re-tightening the screws, and re-grip performed 10 minutes after the initial torque, both under torque 30Ncm were obtained. After re-tightening procedure, the value of destoque was immediately measured and recorded in Ncm, to evaluate the amount of torque by the screw retained after the procedure, being this sequence performed three times for each specimen. The statistical analysis used were, analysis of variance (1 way - ANOVA) and the Tukey test to see whether there were differences between the groups. The results revealed that during the procedures of torque (tightening), the screws used in the one-piece infrastructure castings showed a higher degree of rotation (56,12°) compared to the screws used on targeted infrastructure and rendered separately welded with TIG (43,2°) and Conventional welding with a mean value (35,7°), bei ng the difference between the groups statistically significant in all groups for the torque moment (p<0.05). During the re-torque, the angle formed at the head of the screws was also always greater for the one-piece casting group (15,55°) compared to TI G welding groups (10,15°) and Conventional welding (9,85°), and significant diffe rences were found between the groups (p<0.05). The average values of destorque (retained amount of torque when tightening the screws) were higher for the TIG welding group (26,77Ncm) compared to one-piece casting groups (26,55Ncm) and Conventional welding group (25,10Ncm), respectively, however no statistically significant difference between groups were found. For both the torque and re-torque moments, one-piece infrastructure group allowed more rotation of the abutment screws when compared with the welded groups. In the analysis of destorque values, the groups were statistically similar.

Este estudo avaliou próteses implantossuportadas obtidas por 2 técnicas (cilindro cimentado ou soldado a laser) e seus comportamentos no que tange à passividade e afrouxamento de parafusos. Foram confeccionadas PPFs de 3 elementos sobre 2 implantes: G1, técnica do cilindro cimentado; G2, técnica do cilindro soldado a laser (n=10). Avaliados níveis de desajuste vertical e passividade antes e após aplicação de cerâmica prensada e após ciclagem mecânica, e a perda de torque inicial dos parafusos de retenção protética antes e após fadiga. Ciclagem mecânica simulando 1 ano de função mastigatória normal (50N, 300.000 ciclos). Análises de desajuste vertical e passividade realizadas pelo método de Sheffield. Calculada % de perda de torque de inserção. Os dados de desajuste e perda de torque foram comparados estatisticamente pelo Modelo Linear de Efeitos Mistos. De modo geral, G1 apresentou níveis de desajuste vertical estatisticamente inferiores a G2 (p<0,05) nas três condições analisadas pelo teste de Sheffield, tanto antes quanto após ciclagem mecânica, atingindo valores máximos de desajuste correspondentes a: 11,94 ± 3,17&mu;m (G1) e 48,63 ± 39,68 &mu;m (G2), antes da ciclagem, 12,42 ± 6,19&mu;m (G1) e 47,62 ± 35,16&mu;m (G2), após a ciclagem, estando os parafusos parafusados. Adicionalmente, em todas as condições experimentais, a ciclagem mecânica não influenciou no desajuste de ambos os grupos (p<0,05), com exceção do molar em G1 quando analisado apertado (p<0,0001). Quando analisado G2, verificamos aumento estatisticamente significante do desajuste vertical após prensagem cerâmica para todos os elementos (p<0,0001) nos diferentes momentos avaliados, com exceção do molar quando avaliado solto, o qual apresentou desajustes semelhantes antes e após prensagem (p=0,052). Na análise de perda de torque, valores expressos em % de perda são apresentados: Pré-molar - G1- antes ciclagem: 31,04 ± 13,22%; G2- antes ciclagem: 33,97 ± 13,41% (G1 x G2 antes ciclagem: p=0,662); G1- após ciclagem: 42,36 ± 14,99%; G2- após ciclagem: 37,92 ± 9,32% (G1 x G2 após ciclagem: p=0,461). Quando analisado o pré-molar, não foram verificadas diferenças estatísticas antes e após ciclagem mecânica para ambos os grupos (G1: p=0,067; G2: p=0,423); Molar - G1- antes ciclagem: 30,77 ± 12,37%; G2- antes ciclagem: 44,37 ± 11,14% (G1 x G2 antes ciclagem: p=0,032); G1- após ciclagem: 39,28 ± 13,96%; G2- após ciclagem: 54,40 ± 26,39% (G1 x G2 após ciclagem: p=0,189). Quando analisado o molar, diferenças estatísticas também não foram identificadas antes e após ciclagem, para ambos os grupos (G1: p=0,392; G2: p=0,233). Diante dos resultados, é possível concluir que: G1 apresentou índices de desajuste vertical e passividade menores que G2, porém para ambos os grupos os desajustes estão dentro dos padrões aceitáveis pela literatura; ciclagem mecânica não promoveu alterações nos níveis de desajuste vertical e perda de torque (%) para ambos os grupos; ambas as técnicas não foram capazes de promover passividade absoluta, tendo em vista os maiores valores de desadaptação do lado solto quando comparados ao lado parafusado. / This study evaluated implant supported prostheses obtained by two techniques (cemented cylinder or laser welded cylinder) and their behavior regarding passivity and screw loosening. Three-element FPPs were made over 2 implants: G1, cemented cylinder technique, G2, laser welded cylinder technique (n=10). The levels of vertical misfit and passivity were evaluated before and after ceramic pressing, and after mechanical cycling; while loss of initial torque of prosthetic retaining screws, before and after mechanical cycling. The mechanical cycling simulated one year of normal masticatory function (50N, 300,000 cycles). Vertical misfit and passivity were analyzed by Sheffield\'s test. The percentage of torque loss was calculated. The misfit and torque loss data were statistically compared by Mixed Linear Model . Overall, G1 showed vertical misfit statistically lower than G2 (p<0.05) in the three conditions analyzed by Sheffield\'s test, before and after mechanical cycling, reaching maximum values of misfit corresponding to: 11.94 ± 3.17&mu;m (G1) and 48.63 ± 39.68 &mu;m (G2) before cycling; 12.42 ± 6.19&mu;m (G1) and 47.62 ± 35.16&mu;m (G2), after cycling, when screws were tightened. Additionally, in all experimental conditions, the mechanical cycling did not influence the misfit in both groups (p<0.05), except for the molar G1 when analyzed in the tightened condition (p<0.0001). When was analyzed G2, statistically significant increase in the vertical misfit was found after ceramic pressing for all elements (p<0.0001) for different moments, except when the molar was not tightened, which showed similar misfit before and after pressing (p=0.052). In the analysis of torque loss, values expressed as percentage of loss are presented: Pre-molar - G1- before cycling: 31.04 ± 13.22%, G2- before cycling: 33.97 ± 13.41% (G1 x G2 before cycling: p=0.662), G1- after cycling: 42.36 ± 14.99%, G2- after cycling: 37.92 ± 9.32% (G1 x G2 after cycling: p=0.461). When the pre-molar was analyzed, statistical differences before and after cycling were not found for both groups (G1: p=0.067; G2: p=0.423); Molar - G1- before cycling: 30.77 ± 12.37%; G2- before cycling: 44.37 ± 11.14% (G1 x G2 before cycling: p=0.032); G1- after cycling: 39.28 ± 13.96%; G2- after cycling: 54.40 ± 26 , 39% (G1 x G2 after cycling: p=0.189). When the molar was analyzed, statistical differences were not found before and after cycling for both groups (G1: p=0.392; G2: p=0.233). Based on these results, it is possible to conclude that: G1 showed vertical misfit and passivity smaller than G2, but for both groups, the misfits are within acceptable standards for the literature; mechanical cycling did not change the vertical misfit and torque loss (%) for both groups; both techniques were not able to promote absolute passivity, in view of the higher values of misfit when compared to the side no tightened.

This thesis presents methods to statistically quantify data from fastener vibration life tests. Data from fastener vibration life tests with secondary locking features of threaded inserts is used. Threaded inserts in three different configurations are examined: no locking feature, prevailing torque locking feature, and adhesive locking feature. Useful composite plots were developed by extracting minimum preloads versus cycles from test data. Minimum preloads were extracted due to the overlapping of varying test data and because the minimum preload is of most interest in such tests. In addition to composite plots, descriptive statistics of the samples were determined including mean, median, quartiles, and extents. These descriptive statistics were plotted to illustrate variability within a sample as well as variability between samples. These plots also reveal that characteristics of loosening for a sample, such as preload loss and rates of preload loss, are preserved when summarizing such tests. Usually fastener vibration life tests are presented and compared with one test sample, which is why statistically quantifying them is needed and important. Methods to predict the sample population have been created as well. To predict populations, tests to determine the distribution of the sample, such as probability plots and probability plot correlation coefficient, have been conducted. Once samples were determined to be normal, confidence intervals were created for test samples, which provides a range of where the population mean should lie. It has been shown that characteristics of loosening are preserved in the confidence intervals. Populations of fastener vibration life tests have never before been presented or created. The evaluation of loosening has been conducted for fastener vibration life tests in the past with plots of one test sample; however, in this work statistically quantified results of multiple tests were used. This is important because evaluating loosening with more than one test sample can determine variation between tests. It has been found that secondary locking features do help reduce the loss of preload. The prevailing torque secondary locking feature is found to be more effective as preload is lost. The best secondary locking feature has been found to be the adhesive.

Introduction: Aseptic loosening is the most common indication for revision surgery of hipimplants. However, sometimes diagnosis from planar radiography is uncertain, makingdecision regarding revision surgery problematic. Implant Movement Analysis (IMA) is anewly introduced method of analysing uncertain aseptic loosening of hip prostheses. It usescomputer tomography with rotational provocation to expose movement of the implantrelatively to the surrounding bone. Aim: To evaluate the role of IMA as a complementary method to planar radiography indiagnosing aseptic loosening of total hip artroplasty (THA) at Lindesberg Hospital. 1) HasIMA improved diagnosing of uncertain cases of aseptic loosening? 2) Has IMA reduced thenumber of unnecessary THA revision surgeries? Methods: Retrospective cohort study analysing 43 cases of uncertain aseptic looseningexamined with IMA at Lindesberg Hospital. Paired results from planar radiography and IMAwere statistically compared with McNemar’s test, IMA held as the reference. Additional datawas also collected (i.e. age and symptoms). Results: Planar radiography had 70 % sensitivity and 65 % specificity compared to certainresults from IMA. IMA provided diagnoses in 84 % of the cases and changed the diagnosisfor 33 % compared to planar radiography. Eight cases got their diagnosis changed from looseto not loose. Conclusions: IMA has improved diagnosing cases of uncertain aseptic loosening and cantherefore be seen as a good complementary method to planar radiography in these cases.However, as it is a new method further evaluation is needed.