Hip hemiarthroplasty for senile femoral neck fractures: Minimally invasive SuperPath approach versus traditional posterior approach

BackgroundThe supercapsular percutaneously-assisted total hip (SuperPATH®) approach was created by combining the percutaneous preparation of the acetabulum using the percutaneously-assisted total hip (PATH), femoral reaming, and broaching of superior capsulotomy (SuperCap) approach. This technique reported a low complication rate, excellent gait kinematics, low transfusion rate, a shorter length of hospital stay, and a high proportion of discharge from the hospital. As minimally invasive SuperPath approach is designed for both trauma and end-stage degenerative joint disease, we investigated if this technique and standard surgical tools can replace artificial femoral head in elderly patients with femoral neck fracture. We also tested if it has advantages over the traditional posterior approach.MethodsA prospective study was performed in 100 cases of eligible femoral neck fractures from May 01, 2015 to October 31, 2016. They were randomly divided into SuperPath and traditional group. The outcomes were evaluated using preoperative index, intraoperative data, and postoperative function data.ResultsNo significant difference was detected in the operation time between the two groups. Compared with the traditional group, SuperPath group had smaller incision length, less intraoperative bleeding, lower transfusion rate, and a shorter starting time of weight-bearing activity. Harris Hip Score, Barthel Index, and VAS for pain-level scores in the SuperPath group at 1-week follow-up intervals were significantly lower than the conventional group, but not significantly different at 3-month and 2-year follow-up post-operation.ConclusionsSuperPath approach for artificial femoral head replacement can reduce surgical injury due to smaller size of incision and accelerate weight-bearing activities post-operation to treat senile femoral neck fractures compared with traditional posterior approach surgeries.     

微创 SuperPath 入路全髋关节置换术后的关节功能及生命质量

目的：观察经微创 SuperPath 入路行全髋关节置换术后患者的关节功能及生命质量,并与传统后外侧入路做随机对照研究。方法：选取拟行全髋关节置换术的患者 54 例,按数字随机表法分为观察组和对照组各 27 例,分别行 SuperPath 和传统后外侧入路全髋关节置换术,记录两组手术前后的 Harris 髋关节功能评分、计时“起立 - 行走”测试时间、单腿站立测试时间、6 min 步行测试距离、术后下地负重行走时间、住院时间、健康调查简表 SF-36 评分及并发症,并进行对比。结果：观察组术后 1 周及 3 个月的 Harris 评分（70.5±5.6,83.1±5.5）分别高于对照组（63.8±6.1,78.0±5.6）（P<0.05）,6 个月及 12 个月两组间差异无统计学意义（P>0.05）。相较于对照组,观察组术后 1 个月及 3 个月的计时“起立 - 行走”时间 [(36.5±7.3) s,(24.4±4.9) s] 更短,术后 1 个月的单腿站立时间 [(14.4±3.6) s] 更长,术后 3 个月的 6 min 步行距离 [(395.1±27.7) m] 更远（P<0.05）。观察组术后下地时间及住院时间 [(20.0±3.6) h,(9.7±2.8) d] 分别短于对照组[(33.2±5.4) h,(13.2±3.7) d]（P<0.05）。SF-36 评分,术后 12 个月观察组心理健康及总体健康两个维度评分（78.1±9.3,82.0±8.8）分别高于对照组（73.1±8.7,76.3±10.2）（P<0.05）;躯体疼痛及社会功能两个维度评分无统计学差异（P>0.05）。对照组 2 例出现无症状下肢深静脉血栓。结论：相比较于传统后外侧入路,微创 SuperPath 入路的全髋关节置换术能更快、更有效地恢复髋关节功能,提高患者术后的生命质量,符合现代快速康复理念。     

SuperPATH和后外侧小切口入路THA治疗股骨头缺血性坏死的近期疗效比较

目的比较SuperPATH入路与后外侧小切口入路初次单侧全髋关节置换术(THA)治疗股骨头缺血性坏死的近期临床疗效。方法纳入自2014-07—2015-07诊治的80例股骨头缺血性坏死,40例行SuperPATH入路THA治疗(SuperPATH组),40例行后外侧小切口入路THA治疗(小切口组)。比较2组切口长度、手术时间、术中出血量、术后引流量、住院时间,术后24 h肌酸磷酸激酶(CK)、血沉(ESR)、C反应蛋白(CRP)、大腿周径与术前的差值,以及术后3、6、9个月髋关节功能Harris评分。结果 80例均获得平均10(6~12)个月随访。SuperPATH组术后24 h CK、大腿周径与术前的差值明显小于小切口组,差异有统计学意义(P0.05);但2组术后24 h ESR、CRP与术前的差值比较差异无统计学意义(P0.05)。SuperPATH组术中出血量、术后引流量和住院时间较小切口组少,但是手术时间较小切口组长,差异有统计学意义(P0.05)。SuperPATH组术后3、6个月髋关节功能Harris评分高于小切口组,差异有统计学意义(P0.05);但术后9个月2组Harris评分差异无统计学意义(P0.05)。结论 SuperPATH入路与后外侧小切口入路THA术后均可获得良好的髋关节功能,但SuperPATH入路因保留外旋肌群及可完整重建关节囊,关节稳定性好、创伤小、术后恢复快。     

直接前侧入路与后外侧入路全髋关节置换术的疗效比较

目的 比较直接前侧入路(DAA)与后外侧入路(PA)行全髋关节置换术(THA)的疗效.方法 将60例行THA患者按随机数字表法分为PA组和DAA组,每组30例.比较两组切口长度、术中出血量、手术时间、住院时间、下床时间、部分负重锻炼时间和术后并发症情况.术后6、12个月采用髋关节Harris评分标准评价髋关节功能.结果...     

Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty

Background — The surgical approach in total hip arthroplasty (THA) is often based on surgeon preference and local traditions. The anterior muscle-sparing approach has recently gained popularity in Europe. We tested the hypothesis that patient satisfaction, pain, function, and health-related quality of life (HRQoL) after THA is not related to the surgical approach.

Patients — 1,476 patients identified through the Norwegian Arthroplasty Register were sent questionnaires 1–3 years after undergoing THA in the period from January 2008 to June 2010. Patient-reported outcome measures (PROMs) included the hip disability osteoarthritis outcome score (HOOS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), health-related quality of life (EQ-5D-3L), visual analog scales (VAS) addressing pain and satisfaction, and questions about complications. 1,273 patients completed the questionnaires and were included in the analysis.

Results — Adjusted HOOS scores for pain, other symptoms, activities of daily living (ADL), sport/recreation, and quality of life were significantly worse (p < 0.001 to p = 0.03) for the lateral approach than for the anterior approach and the posterolateral approach (mean differences: 3.2–5.0). These results were related to more patient-reported limping with the lateral approach than with the anterior and posterolateral approaches (25% vs. 12% and 13%, respectively; p < 0.001).

Interpretation — Patients operated with the lateral approach reported worse outcomes 1–3 years after THA surgery. Self-reported limping occurred twice as often in patients who underwent THA with a lateral approach than in those who underwent THA with an anterior or posterolateral approach. There were no significant differences in patient-reported outcomes after THA between those who underwent THA with a posterolateral approach and those who underwent THA with an anterior approach.     

仰卧位常规器械OCM入路与后外侧入路全髋关节置换术的疗效对照

目的:比较仰卧位常规器械OCM入路与后外侧入路全髋关节置换术的临床疗效。方法 :2017年2月至2019年1月因髋关节疾病行髋关节置换患者67例,其中微创组21例采用OCM入路,男12例,女9例;股骨颈骨折10例,股骨头无菌性坏死5例,髋关节骨性关节炎6例。传统组46例采用传统后外侧入路,男28例,女18例;股骨颈骨折24例,股骨头无菌性坏死12例,髋关节骨性关节炎10例。所有患者使用生物型陶-陶人工关节假体。观察比较两组患者手术时间、术中出血量、切口长度、手术前后肌酸激酶(CK-NAC)、下地活动时间、住院时间、术后假体的外展角及前倾角。比较两组术前及术后12个月Harris评分。结果:所有病例获得随访,时间14～26(18.4±3.6)个月。两组患者术中出血、术后前倾角及外展角比较,差异均无统计学意义(P0.05)。两组病例手术时间、切口长度、术后肌酸激酶、下地时间、住院时间差异均有统计学意义(P0.05)。两组术前及术后12个月Harris功能评分差异均无统计学意义(P0.05)。结论:两种入路人工全髋关节置换术均可获得满意的疗效,OCM入路损伤小,术后康复快,是可靠的手术入路。     

Outcomes of total hip arthroplasty in the octogenarian population

BackgroundThe outcomes of total hip arthroplasty (THA) in the elderly population are uncertain. With the rapid expansion of this population group, this study aims to determine whether increasing age affects the outcomes of THA by utilising the largest patient cohort and follow-up period within the literature.Patients and methodsAll patients of 80 years and over who underwent primary THA between 1994 and 2004 at the authors' institution were compared to a cohort aged under 80 with the same diagnoses and during the same time period. Mean follow-up time was 5.9 years with a select group being reviewed at year 10.ResultsPain scores were comparable at year five, whilst mean Harris hip scores were significantly lower in the octogenarians. Median hospital stay was three days longer in the elderly group. Complication rates were also higher (38.1% cf 28.7%) however fewer cases of revision were noted (1.4% cf 3.8%). Patient satisfaction was comparable between groups.ConclusionThis study suggests pain improvement, low revision rates and high satisfaction are sufficient to justify THA in the elderly population.     

Which is more invasive—mini versus standard incisions in total hip arthroplasty?

In this study, interleukin-6 (IL-6), C-reactive protein (CRP), and haemoglobin levels were evaluated to compare the degree of surgical invasion between mini and standard incisions in total hip arthroplasty (THA). Sixty-two patients admitted for primary cementless THA were enrolled in this randomised study. The patients were allocated to have surgery through either a mini incision of <10 cm or a standard incision of 15 cm. In each group, inflammatory responses were evaluated by IL-6, CRP, and haemoglobin levels before operation and one day after operation. Significant differences were not found in IL-6, CRP, and haemoglobin levels between both groups. At six months after surgery, there were no significant differences in postoperative Harris hip scores or radiographic evaluations between both groups. In conclusion, a 5.0 cm difference in the skin incision to the hip joint seemed to have no influence on the degree of surgical invasion during THA.     

两种小切口入路在人工全髋关节置换术中的疗效研究

目的比较前外侧与后外侧入路在人工全髋关节置换术（total hip arthroplasty,THA）中的临床效果。方法2010年1月～2012年12月在我院行THA患者50例共57髋,随机分为两组,其中前外侧组25例（28髋）采用前外侧入路,后外侧组25例（29髋）采用后外侧入路,比较两组切口长度、手术时间、术中出血量、输血量、术后并发症及髋关节Harris评分。结果前外侧组和后外侧组切口长度、手术时间、术中出血量和输血量比较均无统计学差异（P〉0．05）。组内比较,两组术后3月、6月Harris评分均较术前改善显著,差异具有统计学意义（P〈0．05）;组间比较,两组均无统计学差异（P〉0．05）。前外侧组术后3周出现髋关节后脱位1例,予复位后恢复正常。后外侧组均未出现术后并发症。结论前外侧与后外侧入路在THA术中不影响疗效,选择何种方式入路应根据患者的个体情况而定。     

Open reduction and internal fixation alone versus open reduction and internal fixation plus total hip arthroplasty for displaced acetabular fractures in patients older than 60 years: A prospective clinical trial

IntroductionThe optimal treatment of elderly patients with an acetabular fracture is unknown. We conducted a prospective clinical trial to compare functional outcomes and reoperation rates in patients older than 60 years with acetabular fracture treated with open reduction and internal fixation (ORIF) alone versus ORIF plus concomitant total hip arthroplasty (ORIF + THA). Our hypothesis was that patients who had ORIF + THA would have better patient reported outcomes and lower reoperation rates postoperatively.MethodsInclusion criteria were patients older than 60 years with acetabular fracture plus at least one of three fracture characteristics: dome impaction, femoral head fracture, or posterior wall component. Eligible patients were operative candidates based on fracture displacement, ambulatory status, and physiological appropriateness. Patients received either ORIF alone or ORIF + THA (accomplished at same surgery through same incision). Outcome measurements included Western Ontario and McMaster Universities Osteoarthritis Index hip score, Short Form 36, Harris Hip Score, and Patient Satisfaction Questionnaire Short Form scores. Additionally, patients were monitored for any unplanned reoperation within 2 years.ResultsForty-seven of 165 eligible patients with an average age of 70.7 years were included. The mean Harris Hip Score difference favored ORIF + THA (mean difference, 12.3, [95% confidence interval (CI), -0.3 to 24.9, p = 0.07]). No clinically important differences were detected in any other validated outcome score or patient satisfaction score 1 year after surgery. ORIF + THA decreased the absolute risk of reoperation by 28% (95% CI, 13% to 44%, p < 0.01). No postoperative hip dislocation occurred in either group.ConclusionsIn patients older than 60 years with an operative displaced acetabular fracture with specific fracture features (dome impaction, femoral head fracture, or posterior wall component), treatment with ORIF + THA resulted in fewer reoperations than treatment with ORIF alone. No differences in patient satisfaction and other validated outcome measures were detected.     

Total Hip Arthroplasty via direct anterior approach for osteonecrosis; comparison with primary hip osteoarthritis in a mid term follow up

BackgroundTo determine the mid-term outcomes of conventional cementless Total Hip Arthroplasty (THA) in patients with avascular necrosis (AVN) of the femoral head and compare to patients with primary hip osteoarthritis (OA).MethodA total of 330 consecutive primary THA procedures (AVN and OA) performed between 2010 and 2013 by a single surgeon and in a single center using the direct anterior approach (DAA) were included. Assessments including SF-36, WOMAC, and Harris Hip Scores (HHS) were retrieved from patients before the surgery and at the latest follow-up. Clinical and functional outcomes were compared between the AVN and OA groups.ResultsA total of 294 consecutive THA (AVN = 107, OA = 187) with 104.4 ± 6.2 months follow-up were analyzed, which AVN patients were significantly younger (32.0 vs. 59.6 y/o). Corticosteroid 34 (31.8%), idiopathic AVN 31 (29.0%) and use of unapproved weight gain supplements (UWGS) 23 (21.5%) were the main reasons for AVN. Despite that preoperative scores were comparable (P > 0.05), the HHS, SF-36, and WOMAC scores are significantly higher in the AVN group after THA surgery (P < 0.05). Moreover, flexion and abduction ROM were significantly higher in the AVN group (P < 0.05). Regarding each complication, no significant difference was observed between groups. In the whole sample, there were 5 (1.7%) revisions due to loosening of acetabular components, all the OA group (P > 0.05).ConclusionConventional cementless THA with highly cross-linked polyethylene provides satisfactory mid-term results in patients with AVN with a low rate of postoperative complications. Compared to primary OA patients, this group reaches superior postoperative scores.     

手术入路对髋关节置换术后髋关节功能恢复的影响

目的探讨手术入路对髋关节置换术后髋关节功能恢复的影响。方法对386例(392髋)髋关节疾病患者行髋关节置换术,分别采用不同手术入路,并且于术前,术后2周、4周、8周、24周进行Harris评分,分析髋关节功能恢复情况。结果前外侧入路组、外侧入路组、后外侧入路组、后侧入路组及小切口入路组总有效率分别为91%、94%、97%、100%、100%。结论不同手术入路对髋关节置换术后髋关节功能恢复有一定的影响。创伤小、对髋关节干预性较小的后侧入路及小切口手术入路是髋关节功能恢复较满意的选择。     

三种手术入路行全髋关节置换术的比较

[目的]探究直接前方入路(DAA)、直接外侧入路(DLA)及后外侧入路(PLA)进行全髋关节置换(total hip arthroplasty,THA)的临床效果。[方法]选取2015年4月~2019年1月本院骨科收治的146例首次行THA的患者,依据微创入路途径分为DAA组(50例)、DLA组(48例)和PLA组(48例),DAA组采用DAA入路进行全髋关节置换,DLA组采用DLA入路行全髋关节置换,PLA组采用PLA入路进行全髋关节置换。比较三组的临床资料。[结果]三组患者均顺利完成手术。三组手术时间、切口长度和术中出血量差异均无统计学意义(P>0.05)。三组间患者的Harris评分均随时间推移显著增加,不同时间点间的差异均有统计学意义(P<0.05),但相同时间点三组间的差异均无统计学意义(P>0.05)。影像测量方面,DAA组髋臼假体外展角大于DLA组和PLA组(P<0.05),而三组前倾角、双下肢长度差别及股骨偏心距差异均无统计学意义(P>0.05)。[结论]对于实施全髋关节置换术的患者,DAA入路具有更好的髋臼假体外展角。     

High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach

Background and purpose There is growing interest in minimally invasive surgery techniques in total hip arthroplasty (THA). In this study, we investigated the learning curve and the early complications of the direct anterior approach in hip replacement. Methods In the period January through December 2010, THA was performed in 46 patients for primary osteoarthritis, using the direct anterior approach. These cases were compared to a matched cohort of 46 patients who were operated on with a conventional posterolateral approach. All patients were followed for at least 1 year. Results Operating time was almost twice as long and mean blood loss was almost twice as much in the group with anterior approach. No learning effect was observed in this group regarding operating time or blood loss. Radiographic evaluation showed adequate placement of the implants in both groups. The early complication rate was higher in the anterior approach group. Mean time of hospital stay and functional outcome (with Harris hip score and Oxford hip score) were similar in both groups at the 1-year follow-up. Interpretation The direct anterior approach is a difficult technique, but adequate hip placement was achieved radiographically. Early results showed no improvement in functional outcome compared to the posterolateral approach, but there was a higher early complication rate. We did not observe any learning effect after 46 patients.     

Clinical results of short external rotators preserving posterolateral approach for hemiarthroplasty after femoral neck fractures in elderly patients

IntroductionEven though the dislocation rate is lower in the hemiarthroplasty (HA) than total hip arthroplasty, it has still developed as one of serious complications in elderly patients. We have used short external rotators (SER) preserving posterolateral approach to reduce dislocation after hip arthroplasty, especially in elderly patients. The present study was conducted to introduce SER preserving posterolateral approach and report the dislocation rate after HA via this approach in elderly patients with femoral neck fractures.MethodsBetween January 2015 and July 2019, 307 consecutive elderly patients aged over 70 years who underwent cementless bipolar HA for femoral neck fractures and were followed up for at least one year, were enrolled in this study. All surgeries were performed using the SER preserving posterolateral approach. The demographic and perioperative data were examined and the complications including dislocation were investigated.ResultsMean operation time was 54.3 min, and mean estimated blood loss was 252.4 cc. The mean follow-up time was 22.1 months, HHS was 67.5 points at the final examination Dislocation following HA developed in only one patient (0.3%) with dementia during hospital stay, which was reduced closely with no subsequent recurrence. Periprosthetic femoral fracture occurred in two patients, which was treated with internal fixation in one patient and with stem revision in the other patient. There was no surgical site infection or periprosthetic infection as complications.ConclusionThe SER preserving technique in posterolateral approach effectively can be effective for reducing the dislocation after HA in elderly patients with femoral neck fracture. It can be encouraged in posterolateral approach for HA, especially in elderly patients under the risk of dislocation.     

髋部手术继发髋关节感染的二期全髋关节置换

 目的 探讨应用抗生素骨水泥间隔体二期全髋关节置换治疗髋部手术继发髋关节感染的疗效。方法 从2005年1月至2010年1月应用二期全髋关节置换连续治疗髋部手术继发髋关节感染患者6例,男2例,女4例;年龄43～68岁,平均(59.7±9.2)岁。股骨颈骨折行加压螺钉固定3例,股骨头坏死骨瓣移植1例,早期股骨头坏死行中心钻孔减压及局部介入治疗各1例。一期手术彻底清创,植入抗生素(万古霉素)骨水泥间隔体,感染控制后二期植入全髋关节假体。术后定期随访,常规复查红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP),摄髋关节正侧位X线片,采用Harris髋关节评分评估髋关节功能。结果 所有患者均获得随访,随访时间24～81个月,平均46个月。5例患者在一期清创后平均14周(12～18周)行二期全髋关节置换,1例患者在一期清创后7个月行二次清创及重新植入骨水泥间隔体,12周后行二期全髋关节置换。Harris髋关节评分从术前平均(35.6±3.3)分,间隔期平均(57.8±5.4)分,提高至末次随访平均(92.3±5.7)分,差异有统计学意义。1例患者于间隔期出现下肢深静脉血栓形成及左下肺栓塞。随访期间未出现感染复发及新发感染病例。结论 对继发于髋部手术的髋关节感染,应用抗生素骨水泥间隔体行二期全髋关节置换可以获得较满意的近中期疗效。     

全髋关节置换术小切口与传统切口临床比较研究

目的比较后外侧小切口全髋关节置换术(THA)与传统THA的临床疗效及并发症。方法 2004年11月至2009年6月,对38例(40髋)患者行后外侧小切口(6～10cm)THA,47例(48髋)患者行传统切口(11～15cm)THA。所有病例均由同一位主刀医生完成手术。结果术后随访平均21.2个月(18～24个月),两组病例均未出现感染、假体脱位及神经损伤等并发症,小切口THA组有2例患者术中发生切口近端皮肤擦伤,传统THA组有1例患者术后发生深静脉血栓。小切口THA组和传统THA组手术时间分别为72(60～100)min和69(70～175)min,术中出血量分别为350(250～520)ml和393(270～600)ml,差异均无统计学意义(P>0.05);手术切口分别为9.2(6.8～10)cm和16.4(14～24)cm,术后12h引流量分别为211(120～300)ml和249(140～400)ml,平均住院时间分别为6.6d和7.5d,差异均有统计学意义(P<0.05);术后第1、2、3天疼痛视觉模拟评分(VAS)分别为4.0分、3.1分、2.3分和4.6分、3.7分、2.4分,术后1、3个月Har...     

改良Watson-Jones入路与改良Hardinge 入路全髋关节置换术的疗效比较

目的 比较改良Watson-Jones入路与改良Hardinge入路全髋关节置换术(THA)的疗效.方法 对2005年1月至2008年2月行THA治疗且获得随访的90例患者资料进行回顾性研究,其中采用改良Watson-Jones入路行微创THA(A组)44例,男20例,女24例;平均年龄(68.2±8.0)岁.病因:股骨颈骨折23例,股骨头坏死9例等.采用改良Hardinge入路行THA(B组)46例,男21例,女25例;平均年龄(69.1±9.2)岁.病因:股骨颈骨折21例,股骨头坏死6例等.手术均由同一组医生完成.临床评估包括术后3个月和末次随访时Harris髋关节功能评分及Barthel指数等,放射学评估包括髋臼外展角,记录并发症的发生情况.结果 所有患者术后获平均(50.9±10.1)个月随访.A组患者切口长度较B组短,失血量较B组少,术后3d内下床例数较B组多,两组比较差异均有统计学意义(p＜0.05).两组患者髋臼外展角差异无统计学意义(P＞ 0.05).术后3个月A组患者Harris评分[(82.4±3.3)分]及Barthel指数(85.4±3.8)均高于B组患者[(72.3±3.7)分、77.2±5.4],差异均有统计学意义(P＜0.05).但末次随访时两组患者的Harris评分及Barthel指数比较差异均无统计学意义(P＞0.05).两组患者均末出现伤口感染、假体松动、髋关节脱位、血管神经损伤或深静脉血栓形成等并发症.结论 改良Watson-Jones入路与改良Hardinge入路均能满意应用于THA,但改良Watson-Jones入路微创THA术后前3个月内功能恢复更佳.     

Eighteen-Year Follow-Up Study of 2 Alternative Bearing Surfaces Used in Total Hip Arthroplasty in the Same Young Patients

BackgroundThis study compares the long-term functional, radiographic, and computed tomography scan outcomes and implant survivorship of ceramic-on-ceramic total hip arthroplasty (C-O-C THA) and ceramic-on-highly cross-linked polyethylene total hip arthroplasty (C-O-HXLPE THA) in the same patients.MethodsIn this randomized, prospective trial conducted between January 1999 and April 2003, 133 patients (266 hips) younger than 55 years were enrolled. Each patient received C-O-C THA in 1 hip and a C-O-HXLPE THA in the other. The mean follow-up was 17.1 years (range, 15-18 years); there were 84 men and 49 women with a mean age of 53 ± 7 years (range, 25-55 years).ResultsAt the latest follow-up, mean Harris hip scores (94 vs 93 points; P = .861), pain scores (43 vs 42 points; P = .651), and patient satisfaction scores (7.8 vs 7.6 points; P = .379) were not different between the 2 groups. Eight hips (3%) in the C-O-C THA had an audible squeaking sound. The mean annual penetration rate of HXLPE was 0.0162 ± 0.032 mm per year. No osteolysis was recorded on radiographs or computed tomography scans in either group. At 17.1 years, the survival rate of the acetabular component was 97% in the C-O-C bearing group and 98% in the C-O-HXLPE bearing group (P = .923). The survival rate of the femoral component was 99% in both groups.ConclusionBoth C-O-C THA and C-O-HXLPE THA functioned well, with no osteolysis at mean of 17.1-year follow-up.