Aseptic loosening due to polyethylene wear presents one of the most frequently occurring joint replacement complications requiring a revision surgery. Numerous scientific works and publications deal with the issue of morphology, determination and distribution of wear particles. Few studies, however, determine reliably amounts of particles in individual periprosthetic zones. The objective of this work was to evaluate the correlation between amounts of wear particles and periprosthetic osteolysis findings. Description of distribution of these particles in the surroundings of joint replacement presented further objectives of the work. Wear particles were isolated from granuloma obtained during revisions of total hip replacements. Amounts of wear particles were determined using IRc. These findings were correlated with X-ray examinations and intraoperative findings. Method of progressive enzymatic degradation of tissue was used in order to describe wear particles distribution in polyethylene granuloma and surrounding periprosthetic tissues. Results showed uneven incidence of wear particles in the surroundings of the total joint replacement. The incidence correlated with X-ray examinations and intraoperative findings. Distribution of particles was described as well as new determination methods and further...

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-14T11:51:08Z No. of bitstreams: 1 elmanodearaujoloures.pdf: 9149491 bytes, checksum: 08630dfeb5037d2bfef775000aee4585 (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-07-19T14:30:09Z (GMT) No. of bitstreams: 1 elmanodearaujoloures.pdf: 9149491 bytes, checksum: 08630dfeb5037d2bfef775000aee4585 (MD5) / Made available in DSpace on 2016-07-19T14:30:09Z (GMT). No. of bitstreams: 1 elmanodearaujoloures.pdf: 9149491 bytes, checksum: 08630dfeb5037d2bfef775000aee4585 (MD5) Previous issue date: 2011-10-20 / A artroplastia total do quadril possui uma das melhores relações custo-benefício dentre todas as intervenções realizadas no aparelho locomotor. Grande parte das publicações aborda somente os aspectos técnicos e o desempenho dos implantes e negligencia a repercussão sobre a qualidade de vida e as co-morbidades, tornando a medida correta dos benefícios do tratamento imprecisa. Atualmente, os parâmetros de medição da qualidade de vida associados às escalas funcionais tornaram-se imperativos para uma análise acurada de resultados e fatores influentes. O objetivo principal do estudo foi avaliar a qualidade de vida relacionada à saúde em pacientes afetados por osteoartrose do quadril e tratados por artroplastia total do quadril. Estudou-se prospectivamente uma coorte de 38 pacientes operados em hospital universitário de referência regional acompanhados durante, no mínimo, seis meses até atingirem reabilitação satisfatória. Secundáriamente, avaliou-se o desempenho de curto prazo do componente acetabular MD4® implantado em 35 indivíduos. Os dados foram obtidos por meio da aplicação de quatro instrumentos: 1) questionário para a caracterização sóciodemográfica e clínica da amostra; 2) escala de avaliação funcional do quadril – Harris Hip Score (HHS); 3) instrumento genérico de avaliação da qualidade de vida relacionada à saúde The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e 4) questionário de avaliação da satisfação individual com o procedimento. Os resultados dos testes pré e pós-operatórios foram submetidos à análise estatística descritiva e comparados com a literatura. Os resultados pré e pósoperatórios do SF-36 foram capacidade funcional: 13,4-53,7; limitação por aspectos físicos: 9,21-48,0; dor: 23,1-62,6; estado geral de saúde: 54,2-71,3; vitalidade: 40,3- 69,9; aspectos sociais: 40,8-74,3; limitação por aspectos emocionais: 23,7-64,9; saúde mental: 52,6-80,4. O Harris Hip Score variou de 36,1 a 92,1, em média. Todos os resultados foram estatisticamente significantes (p < 0,001). A combinação de duas escalas mostrou-se valiosa na identificação de vieses e conferiu maior confiabilidade na compreensão das diversas variáveis. O estudo demonstra uma significativa melhora na qualidade de vida relacionada à saúde em pacientes afetados por osteoartrose de diferentes etiologias submetidos à artroplastia total do quadril. A avaliação da qualidade de vida não substitui a avaliação clínica provida por instrumentos específicos e pela experiência do cirurgião, mas pode adicionar dados importantes ao valorizar o conjunto de expectativas do paciente perante um tratamento médico e ser considerada um instrumento eficiente na análise de resultados da artroplastia total do quadril. Adicionalmente, o componente acetabular avaliado mostrou estabilidade e indícios de osteointegração em todos os casos, o que pode ser considerado indicativo de bom desempenho a médio prazo do implante. / Total hip replacement is one of the most cost-effective procedures upon the locomotor system. Most of the publications covers only the technical aspects and the performance of implants and neglects the impact on the quality of life and comorbidities, making the correct measurement of a treatment benefits imprecise. Nowadays, the measurement of health-related quality of life associated with functional scales has become imperative for more accurate analysis of results and influencing factors. To assess the health – related quality of life in patients with osteoarthritis and undergoing total hip arthroplasty was the main goal in this study. A cohort of 38 patients from a regional referral teaching hospital was prospectively followed up for at least six months until they have achieved satisfactory rehabilitation. Secondarily, the short-term performance of the MD-4® acetabular component implanted in 35 individuals was evaluated. Data were obtained through the application of four instruments: 1) questionnaire for socio-demographic and clinical characteristics of the sample; 2) functional scale of the hip - Harris Hip Score (HHS); 3) generic instrument for assessing health-related quality of life The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and 4) questionnaire assessing individual satisfaction with the procedure. The results pre and postoperatively were analyzed using descriptive statistics and compared with the literature. The SF-36 results pre and post-operative were functional capacity: 13.4 to 53.7, limited by physical aspects: 9.21 to 48.0; pain: 23.1 to 62.6, general health: 54.2 to 71.3; vitality: 40.3 to 69.9; social aspects: from 40.8 to 74.3, limited by emotional aspects: from 23.7 to 64.9; mental health: 52.6 - 80.4. The Harris Hip Score ranged from 36.1 to 92.1 on average. All results were statistically significant (p < 0.001). The combination of two scales showed up to be valuable in bias identification and gave more reliability on the variables understanding. The study reports a significant improvement in health-related quality of life in patients affected by osteoarthritis of many etiologies that underwent total hip replacement. Healthrelated quality of life assessment does not replace clinical evaluation provided by specific instruments and the physician’s experience but can add important data and also can be considered an efficient tool in analyzing outcomes of total hip replacement due to the weight it gives to the patient’s expectations regarding a medical treatment.Additionally , the study showed up evidence of osteointegration and stability of the acetabular cup in all cases, which would be a predictor factor for mid-term survivorship of this acetabular component.

Predložená dizertačná práca sa zaoberá analýzou opotrebenia totálnych bedrových endoprotéz za použitia optických metód. V práci bol predstavený nový prístup hodnotenia objemového úbytku materiálu pomocou 3D optického skeneru. Tento nový prístup je časovo efektívny, poskytuje veľké množstvo snímaných bodov na povrchu implantátu. Množstvo bodov umožňuje presnejšiu rekonštrukciu pôvodnej geometrie a prípadné rekonštrukcie nežiaducich poškodení polyetylénovej vložky pri extrakcii. Predstavené metóda bola validovaná za pomoci štandardizovanej gravimetrickej metódy v súlade s ISO 14242. Následne bol optická skenovacia metóda použitá v troch štúdiách zameraných na analýzu opotrebenia, mechanické zmeny artikulujúceho povrchu a mikroštruktúrne zmeny v dôsledku zlyhania implantátu. Analýza 23 extrahovaných polyetylénových vložiek typ Bicon - plus s rozšíreným použitím v Českej republike poukázala na niektoré problémy spojené so zlyhaním implantátu. Adhezívno - abrazívne opotrebenie bolo identifikované v oblasti penetrácie femurálnej hlavice a následné poškodenia ako delaminácia materiálu , plastické deformácie a pitting boli pozorované v okolí tejto oblasti. Analýza materiálových vlastností poukázala na degradáciu mechanických a chemických vlastností, čo bolo prevažne závislé od rozsahu opotrebenia implantátu. U implantátov boli pozorované výrazné plastické deformácie , nárast oxidačného indexu a nižší pomer tvrdosti voči modulu elasticity, v porovnaní s novými vzorkami. Tečenie materiálu a plastické deformácie, ktoré vykazovali všetky extrahované vzorky boli analyzované v závere predloženej dizertačnej práce, na základe testov na nových implantátoch v zábehovom cykle. Cieľom práce je uviesť nový prístup analýzy opotrebenia polyetylénových vložiek za pomoci optických skenovacích metód a preukázať jeho použiteľnosť na analýze súboru extrahovaných implantátov. Výsledky získané pomocou tejto metódy sa ukázali ako vhodné a môžu viesť k lepšiemu pochopeniu procesov opotrebenia a zlyhávania implantátov.

This master's thesis deals with stress-strain analysis of hip joint after total hip replacement. These stress-strain states are compared between four variable stems. A research study of available literature is presented with the focus on finite element analysis of hip joints. Basics of hip's joint anatomy is described along with total endoprostheses' variants and properties. Computational modeling was chosen as a solution method using finite element analysis. The solution was executed using ANSYS software. For each stem there was created a computational model which consists of several submodels such as model of geometry, material, contacts and loading. The assesed variables were total hip displacement, contact pressure between the head and liner, stress on each stem and strain on femur. The evaluation of femur's bone tissue was accomplished on basis of Frost's mechanostat in seven Gruen zones.

This work analyzes problems of friction and lubrication of total hip replacement (THR). At first, experimental study of friction coefficient under various conditions was conducted using hip joint simulator based on principle of pendulum. After that, lubrication film development was observed, using colorimetric interferometry with head from THR and glass cup with respect of geometry and clearance to cups made originally for THR. With respect to research study [25] it was found that increasing contact conformity leads to increased film thickness. Also protein adsorption on articulating surfaces was observed. Thanks to adsorption 80 nm film thickness was measured even if relative surface speed was zero. Furthermore protein aggregation was observed on the border of contact zone, similar aggregations were observed by Myant et al. [29] or Vrbka et al. [25]. These aggregations are formed when lubricant is under shear stress and it can positively affect film thickness. If the relative motion of articulating surfaces is not sufficient, the protein layer can`t be refreshed enough and film thickness start decreasing. Coefficient of friction 0,13 was measured when lubricating film development was observed. Close to this value are material combinations metal on polyethylene and metal on metal.

Dizertační práce se zabývá mechanismy mazání v náhradách kyčelního kloubu. Byla provedena systematická studie formování proteinového filmu při zahrnutí různých materiálů a provozních podmínek. Hlavní pozornost je přitom věnována roli jednotlivých proteinů obsažených v synoviální kapalině při současné přítomnosti dalších proteinů. Jelikož metody aplikované v předchozích studiích neumožňovaly separovat jednotlivé složky maziva, byla vyvinuta optická měřící metoda na principu fluorescenční mikroskopie. Z důvodu verifikace metody byly provedeny dvě nezávislé studie zaměřené na měření tloušťky mazacího filmu a dělení maziva na výstupu mazaného kontaktu. Z důvodu určitých limitací fluorescenční mikroskopie byla dále využita i metoda optické interferometrie, jejíž využití je ilustrováno ve studii zabývající se formováním mazacího filmu v náhradách kyčelního klubu při uvažování reálné konformity třecích povrchů. Závěrečná část práce představuje nový metodologický přístup založený na in situ pozorování kontaktní oblasti umožňující popsat roli jednotlivých proteinů ve vztahu k vývoji tloušťky mazacího filmu. Práce obsahuje originální výsledky, které přináší nové poznání v oblasti biotribologie náhrad kyčelního kloubu vedoucí k dalšímu vývoji implantátů při snaze zabránit jejich selhání v důsledku omezené životnosti.

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.:Inhaltsverzeichnis Bibliographische Beschreibung Abkürzungsverzeichnis 1. Einleitung 1.1 Bedeutung der Hüftendoprothetik 1.2 Hüftendoprothesenluxation 1.2.1 Definition und Häufigkeit 1.2.2 Ursachen 1.2.3 Einteilung und Klassifikation 1.2.4 Risikofaktoren 1.2.5 Beurteilung des Luxationsrisikos bei hüftendoprothetischen Eingriffen 1.2.6 Ursachen des luxations-mindernden Effektes großer Köpfe 1.2.7 Vorgehen nach Luxation 1.2.7.1 Diagnostik 1.2.7.2 Therapie 1.3 Zielsetzung der Arbeit 2. Publikation 3. Zusammenfassung 4. Literaturverzeichnis 5. Tabellenverzeichnis 6. Abbildungsverzeichnis 7. Erklärung über die eigenständige Abfassung der Arbeit 8. Lebenslauf und wissenschaftlicher Werdegang 9. Danksagung 10. Anlagen Anlage 1 - Dokumentationsbogen Patienten mit Großköpfen Anlage 2 - Telefoninterviewbogen zu 40/44mm Köpfen

Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery.

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1 PURPOSE OF THE STUDY Heterotopic ossification is frequent and well known complication after primary total hip arthroplasty. Prophylaxis is crucial, ohterwise when ossification is matured, the only treatment option is surgical removal during revision hip surgery. Prophylaxis options are pre, peri- and postoperative modalities. Effectiveness of the profylaxis step sis the aim of this disertation. The goal of Study 1 was to prove the positive side effect of tranexamic acid application to reduce the heterotopic ossification ratio after elective total hip replacement. The goal of Study 2 was to prove the reduction in HO ratio with experimental modification of anterolateral approach with electrosurgery. The goal of Study 3 was to detect the knowledge among czech orthopaedic surgeons in ossification issues and compare the results of questionnaire with german results. 2 MATERIAL AND METHODS Study 1 Cohort of 401 total hip replacements were assessed prospectivelly. Stratification of particular degrees in Brooker scale, sex, laterality and fixation type were evaluated. The average follow up was 6,10 year (40m to 113m). Hips from 2012 are referential and hips from 2016 are administered to tranexamic acid procotol. Other secondary prophylactic modalities (farmacoprophylaxy or radiotherapy), tertiary...