In endoprosthesis surgery there are typically a high percentage of implant defects, these can lead to failure of the whole prosthesis. One type of total hip replacement function loss is acetabular cup loosening from the pelvic bone. This disertation examines manufacture perturbations as one of the possible reasons for this kind of failure. Both dimension and geometry manufacturing perturbations of ceramic head and polyethylen cup were analyzed. We find that perturbations in the variables analysed here affect considered values of contact pressure and frictional moment. Furthermore, contact pressure and frictional moment are quantities affecting replacement success and durability. From obtained results it can be recommended to fit head and cup with a clearance of between 0 mm and 0.05 mm. It can not be recommend using interference type of fit because of strong deterioration of the contact conditions. Roundness perturbation of ceramic head should not exceed 0.025 mm.

Title: Human locomotion after total hip replacement Objectives: The aim of this thesis is to perform a gait analysis of patients after total hip replacement and to find out, how chosen temporo-spatial, kinetic and kinematic parameters change during the first half a year after the surgery. The deviations found in gait stereotypes of individual patients are further compared with results of international studies. Methods: The thesis is theoretical-empirical, with small number of patients. 3D kinematic gait analysis was performed by Qualisys system and ground reaction forces by two Kistler force plates. The following parameters are being monitored: length of step, stance phase duration, cadence, walking speed, lateral shift of the pelvis and trunk in standing phase, contralateral pelvic drop in standing phase of the leg, maximum range of motion of the hip joint in sagital plain, maximum of vertical and medio-lateral component of the ground reaction forces in the standing phase. Results: The highest side deviations between legs were found in 3 months after the surgery and remained until 6,5 months after the surgery. In this time period a lower value of the length of step, stance phase duration, maximum range of motion of the hip joint in sagital plain and also a higher lateral shift of the pelvis was...

Every year 16 000 individuals receive a total hip arthroplasty (THA) in Sweden. Even though THA is a common procedure, adverse events do occur. The most dramatic complication is death in the postoperative phase. The overall aim of this thesis was to describe and investigate early mortality after THA in Sweden. Sweden has an ideal platform for national observational registry studies, thanks to the use of personal identity numbers. Operation-specific information was collected from the Swedish Hip Arthroplasty Register, medical information from the National Board of Health and Welfare, and socioeconomic information was collected from Statistics Sweden. Main outcome was 90-day mortality. Study I was a prospective observational register study investigating the risk of mortality after a simultaneous bilateral THA compared with staged bilateral THA. There was no clinically relevant difference in early postoperative mortality between the two groups. Studies II and III were nation-wide matched cohort studies, with adjustment for comorbidity and socioeconomic background. Adjusted early mortality in femoral neck fracture patients receiving a THA is about double compared with a matched control population. Young (60-69 years) femoral neck fracture patients receiving a THA have a low absolute mortality risk, while those who are older than 80 years with a higher degree of medical comorbidity run a high risk of early death (II). In study III healthier, younger patients with higher socioeconomic status tended to be selected for cementless THA, resulting in selection bias. Even after accounting for this bias, however, there remains a small absolute and adjusted increase in the risk of death within 14 days after elective THA surgery using fully cemented implants. Study IV was a nationwide prospective cohort study comparing different comorbidity measures in terms of predicting early postoperative mortality after THA. A less data-demanding comorbidity measure is better at predicting 90-day mortality than more commonly used coding algorithms. In conclusion, socioeconomic background and the presence of comorbidities have an important influence on early mortality after THA, while the type of fixation is of less importance. Future mortality studies could benefit from the use of data that are routinely collected, and thus avoid the logistically complicated procedure now necessary to merge national databases.

Die Zielsetzung dieser Arbeit besteht darin zu prüfen, ob die Luxationsrate bei Hochrisikopatienten durch den Einsatz von 40-mm- und 44-mm-Köpfen im Vergleich zu Patienten mit maximal 36-mm-Köpfen reduziert werden kann. Hierzu wurden die im Zeitraum von September 2009 bis Mai 2014 hüftendoprothetisch versorgten Patienten mit einem erhöhten Luxationsrisiko erfasst und die Verläufe auf Luxationen überprüft. Zur Risikobewertung diente eine eigens entwickelte Klassifikation. Des Weiteren erfolgte die Analyse der postoperativen Verläufe, der Röntgenbilder und eines Telefoninterviews in den Fällen, in denen Köpfe ≥ 40 mm zum Einsatz kamen. Im Untersuchungszeitraum wurden 288 Hüftendoprotheseneingriffe mit erhöhtem Luxationsrisiko durchgeführt. Bei 278 HTEP-Implantationen erfolgte der Einsatz von Gelenkköpfen ≤ 36 mm. In dieser Gruppe betrug die Luxationsrate 15,1% (n=42). Bei 10 Patienten wurden 40-mm- oder 44-mm-Gelenkköpfe eingesetzt. In diesen Fällen wurde das Luxationsrisiko entsprechend der vorgeschlagenen Klassifikation mit 3A (hoch) bis 4B (sehr hoch) bewertet. Bei einem mittleren Follow up von 22,8 Monaten wurde bei diesen Patienten keine Luxation festgestellt. Die mit 40-mm- sowie 44-mm-Köpfen erzielten Ergebnisse und die aktuelle Literatur sprechen für eine wesentlich höhere Gelenkstabilität und eine deutlich verminderte Luxationsneigung größerer Köpfe. Deren Einsatz ist daher gegenwärtig bei Risiko-patienten gerechtfertigt, sofern dieser in Abhängigkeit vom Pfannenaußendurch-messer konstruktiv möglich ist. In der weiteren Entwicklung der Hüftendoprothetik sollte die Verwendung größerer Köpfe angestrebt werden.

Tyrimo tikslas: įvertinti slaugos poreikį asmenims po klubo sąnario endoprotezavimo operacijos tolimuoju pooperaciniu laikotarpiu. Metodai. Tyrimas kiekybinis, atlikta anoniminė anketinė pacientų ir slaugytojų apklausa. Anketos pacientams dalintos gydymo įstaigoje, o pildomos namuose. Pacientams išdalintos 152 anketos. Bendruomenės slaugytojams anketos dalintos jų darbo vietoje ir pildomos iš karto. Viso slaugytojams išdalintos 220 anketų. Tyrimo duomenų statistinė analizė atlikta naudojant SPSS 17.0 programinį paketą. Rezultatai: Daugiau nei pusė pacientų savo būklę namuose vertina patenkinamai, daugumai (77 proc.) sunku nuvykti pas šeimos gydytoją, 15 proc. naudojosi slaugytojo teikiamomis slaugos paslaugomis namuose, pacientus namuose dažniausiai slaugo šeimos nariai (91proc.). Pacientams mažiausiai pakito fiziologinių poreikių tenkinimas. Pusė tiriamųjų pripažino (51 proc.), kad jautėsi priklausomi nuo kitų. Tyrimo pacientai dažnai norėtų iš slaugytojo bendravimo (26 proc.), pacientų mokymo (26 proc.), injekcijų į raumenis (21 proc.) ar į veną (26 proc.) paslaugų. Slaugytojų nuomone, pacientams vienodai svarbu patenkinti savimonės, vaidmens funkcijos bei abipusės (tarpusavio) priklausomybės poreikius. Tyrimo slaugytojai nurodo, kad jie dažnai įvertina paciento būklę namuose, aptaria slaugos tikslus (54proc.) ir sudaro slaugos planą (53 proc.). Priežastys trukdančios slaugytojui bendradarbiauti su pacientu namuose - per didelis darbo krūvis (83 proc.). Išvados: 1)... [toliau žr. visą tekstą] / The objective of the research: to evaluate the need of a care for the persons after hip replacement surgery in the remote postoperative period. Methods. The study is quantitative; anonymous questionnaire survey of patients and nurses has been conducted. The questionnaires were served to the patients at the medical institutions and they were filled at home. 152 questionnaires were distributed to the patients. The questionnaires were distributed to community nurses at their workplaces and filled immediately. In total 220 questionnaires were distributed to the nurses. The statistical analysis of research data was performed using SPSS 17.0 program package. Results: More than half of the patients evaluate their condition at home as satisfactory, the majority of them (77 percent) find difficulties to get to a family doctor, 15 percent used the home nursing services provided by the nurses, the patients at home are often being nursed by their family members (91 percent). Satisfaction of physiological needs is the least that changed to the patients. Half of the patients (51 percent) admitted they were feeling dependent on others. The patients of the research would often like to communicate with the nurses (26 percent), services of patients training (26 percent), injections to the muscles (21 percent) or vein (26 percent). The nurses believe that for the patients it is equally important to satisfy the needs of self-awareness, role function and reciprocal (mutual) dependence. The nurses... [to full text]

Background: Total hip replacement (THR) with post-operative surveillance is recommended for debilitating osteoarthritis (OA). Using self-reported pain, function or walking performance is one alternative to address increasing surveillance demands. Objective: A cross-sectional cohort study to evaluate the associations of pain, function and performance with two radiographic markers of potential THR failure. Participants: 110 patients, median 6 years after THR surgery for OA. Methods: Questionnaires assessed demographics, co-morbidity, arthritis severity, pain, pain catastrophizing, and functional status. Performance was measured using the six minute walk test. THR outcome was assessed radiographically. Results: Few patients had pain, functional impairment or radiographic markers of potential THR failure. A larger percentage of patients with some intermittent pain (10.7 versus 8.6%) and pain iii after walking performance (40.0 versus 27.6%) had higher wear, but these differences were not significant. Conclusion: Measures of pain are potentially important for larger studies aiming to develop alternative methods of post-operative surveillance.

Background: Total hip replacement (THR) with post-operative surveillance is recommended for debilitating osteoarthritis (OA). Using self-reported pain, function or walking performance is one alternative to address increasing surveillance demands. Objective: A cross-sectional cohort study to evaluate the associations of pain, function and performance with two radiographic markers of potential THR failure. Participants: 110 patients, median 6 years after THR surgery for OA. Methods: Questionnaires assessed demographics, co-morbidity, arthritis severity, pain, pain catastrophizing, and functional status. Performance was measured using the six minute walk test. THR outcome was assessed radiographically. Results: Few patients had pain, functional impairment or radiographic markers of potential THR failure. A larger percentage of patients with some intermittent pain (10.7 versus 8.6%) and pain iii after walking performance (40.0 versus 27.6%) had higher wear, but these differences were not significant. Conclusion: Measures of pain are potentially important for larger studies aiming to develop alternative methods of post-operative surveillance.

Total hip replacement is one of the most extensively and highly effective operating methods in orthopaedics. The patients are brought back the self-sufficiency, life without the pain and noticeably motion restriction. Irreplaceable function here is a role of the nurse, who helps the patient to return back to his common life...The aim of this work was to find out, how the patients feel the role of the nurse and its influence to given nursing care before and after the total hip replacement as the less fulfilled. There were following research questions set: How the patients feel the role of the nurse before and after the total hip replacement? How the patients before and after the total hip replacement feel the interpretation of the nurse roles? How the patients before and after the total hip replacement feel the role of the nurse and its influence to given nursing care. Which of the nurse roles are felt by the patient as the unsatisfactory in postoperative care? The patients before and after the total hip replacement feel through the everyday nurse activities the nurse in her role of the caregiver and education giving person, following the nurse vindicator and the nurse bearer of changes. The patients feel the care thanks these roles as a quality, holistic and continual. Nevertheless was the role of the education giving named as the least fulfilled. In connection with these research results was created a manual, a Guide book for the patients before and after the total hip replacement. This Guide book was given to testing purposes. This Guide book was appreciated by the patients very positive despite a large amount of information, which were surprising for many of them. We gained some data, which gave the impulse to complete the information in the Guide.The created Guide book can´t replace the effective communication of the patient with the medical staff, which could be always the most suitable "source" of information.

This work is focused on a solving of problems regarding a total hip replacement with a fractured femur. The fracture is located in the distal end of the total joint replacement stem and the fracture is spreading in the proximal direction on the boundary of the bone and cement. A proximal part of femur is reinforced by fixing tape. There is also briefly described how computer models were carried out. Furthermore a stress - strain analysis of solved system has been performed in this work. The solution was realized using the finite element method in computational program ANSYS Workbench. Different variants with change of a fracture range and number of fixing tapes were considered during the solving. Stress - strain analysis shows that due a application of fourth fixing tape occurs lowering of main stresses values in the femur in fracture region. Simultaneously occurs a reduction of Equivalent stress values on a distal part of stem.

This thesis deals with the experimental study of lubrication of hip joint replacements. The influence of the synovial fluid composition and the head material to the lubricating film thickness were asssesed by using a pendulum hip joint simulator. Both of these effects were assesed under static and dynamic loading conditions. The experimental results showed that the movement of the head against the cup is unnecessary for the separation of the rubbing surfaces by a layer of adsorbed proteins. Composition of the synovial fluid then significantly influences the thickness of the lubricating film. Two opposite extremes have been observed during tests with two model synovial fluids. The first fluid formed a very strong lubricating film. The second sample almost prevent adsorption of proteins and consequently formed only very thin lubricating film. The influence of the material is noticeable when comparing the results obtained with a metal head and ceramic heads. Metal head formes under the same conditions thicker lubricating film. This evidence may be partly influenced by different diametrical clearances, which were in the case of ceramic heads higher.