Primary Total Hip Arthroplasty With Ceramic-On-Ceramic Articulations: Analysis of a Single-Center Series of 1,083 Hips at a Minimum of 10-Year Follow-Up

BackgroundThere are limited long-term results of using ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA) in a large number of patient cohorts. The purpose of this study was to evaluate the minimum 10-year clinical and radiological outcomes and survivorship in a single surgeon series of CoC-THA.MethodsAmong the 1,039 patients (1,391 hips) who underwent primary THA at our institution between 2008 and 2011, 49 patients (69 hips) experienced paralysis or death, and 194 patients (239 hips, 19%) were lost to follow-up. The remaining 796 patients (1,083 hips) were assessed at a mean of 11 years (range, 10 to 13 years) using the modified Harris hip score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a questionnaire on articular noises. Survival analysis was used to estimate the survivorship. Radiological evaluation was performed on 869 hips at the final follow-up.ResultsSurvivorship at 11 years was 98.3% for revision or aseptic loosening, and 98.2% for reoperation. At the final follow-up, the mean mHHS and WOMAC scores were 93 (range, 12 to 100) and 14.4 (range, 3 to 66), respectively. There were 131 (12%) hips that experienced squeaking, but no patient required revision. No fracture of the ceramic was observed. Radiological evaluation at the final follow-up revealed that 3 (0.3%) hips exhibited loosening, 2 (0.2%) had femoral osteolysis, 81(9.3%) acquired radiolucencies, and 35 (4%) showed heterotopic ossification.ConclusionThis CoC bearing for THA had a high survivorship and excellent functional outcomes for at least 10 years.     

Long-Term Results of Revision Total Hip Arthroplasty Using a Modern Extensively Porous-Coated Femoral Stem

BackgroundThe use of an extensively porous-coated uncemented cobalt-chrome monoblock femoral stem for revision total hip arthroplasty (THA) is well established with excellent mid-term results. The aim of this study is to report the long-term survivorship of these implants in femoral stem revisions.MethodsThis is a long-term retrospective review of prospectively collected data of 55 femoral stem revisions in 55 patients using a contemporary, cementless extensively porous-coated cobalt-chrome monoblock stem. All patients between 2001 and 2006 who underwent first time femoral stem revision with a contemporary, cementless extensively porous-coated cobalt-chrome monoblock stem were included. Harris Hip Score, Western Ontario and McMaster Universities Index, and University of California Los Angeles activity scores were recorded preoperatively and at latest follow-up. Radiographs were analyzed for evidence of loosening, subsidence, osteolysis, and bony union. This study included 55 patients, comprising of 36 females (66%) and 19 males (34%) with a mean age of 66.4 ± 9.3 years at the time of surgery. The mean time interval from index procedure was 9.8 ± 2.9 years. Mean time from revision THA to final follow-up was 13.2 ± 2.17 years with a minimum of 10 years of follow-up.ResultsIndications for revision included aseptic loosening (33), prosthetic joint infection (13), and periprosthetic fracture (10). Significant improvement in Harris Hip Score (85.1 ± 1.77 vs 51.8 ± 2.3, P < .001), Western Ontario and McMaster Universities Index (17.6 ± 0.77 vs 33.3 ± 0.8, P < .001), and University of California Los Angeles (5.25 ± 0.2 vs 2.7 ± 0.36, P < .001) scores were found at latest follow-up compared to preoperative. Fifty-four patients (98%) achieved stable bony ingrowth on radiographic analysis. All 10 patients treated for periprosthetic fractures achieved bony union of their fractures. Two patients suffered intraoperative periprosthetic fractures and were treated with a cable-plating system. There were no mechanical failures and no femoral stem re-revisions. One patient was diagnosed with a deep infection and was treated with chronic suppressive antibiotic therapy due to significant medical comorbidities.ConclusionRevision of the femoral component with a contemporary extensively porous-coated cobalt-chrome femoral stem has excellent functional outcomes, radiographic outcomes, and long-term survivorship with minimal complications.     

Modular Fluted Tapered Stems in Aseptic Oncologic Revision Total Hip Arthroplasty: A Game Changer?

BackgroundModular fluted tapered (MFT) stems are the most frequently used femoral component in revision total hip arthroplasties (THAs). Despite this, no data are available on how they perform in revision THA for oncologic salvage. This is a unique population, often with severe bone loss and prior radiation that extends the limits of uncemented femoral reconstruction. The aims of this study were to evaluate the implant survivorship, radiographic results, and clinical outcomes of MFT stems used for revision oncologic salvage.MethodsWe identified 17 patients treated initially with primary THA for an oncologic diagnosis (15 primary oncologic, 2 metastatic disease) who underwent subsequent femoral revision with an MFT stem. Mean age at revision was 66 years and 35% of patients were female. Mean follow-up was 4 years. Before revision, 5 of 17 had undergone local radiation.ResultsTen-year survivorship free from aseptic loosening was 100%. The survivorship free of any reoperation was 76%. There were no femoral component fractures. Three patients were revised for recurrent instability, and 1 patient underwent irrigation and debridement for an acute infection. At most recent follow-up, no patient had radiographic evidence of progressive femoral component subsidence or failure of osteointegration. The mean Harris Hip Score improved from 29 preoperatively to 76 postoperatively (P < .0001).ConclusionIn this series of patients with cancer, many of whom had severe bone loss and/or prior local radiation, being treated with revision THA, there were no revisions for femoral component loosening and no cases of implant fracture.Level of EvidenceIII.     

Mid-Term Outcomes of Dual Mobility Acetabular Cups for Revision Total Hip Arthroplasty

Background

This study evaluated (1) survivorship, (2) clinical outcomes, (3) complications, and (4) radiographic outcomes of dual mobility (DM) systems when compared to fixed-bearing prostheses in revision total hip arthroplasty (THA).

Contemporary Porous Titanium Acetabular Components for Total Hip Arthroplasty After Pelvic Radiation

BackgroundPatients undergoing primary total hip arthroplasty (THA) following pelvic radiation have historically had poor survivorship free of aseptic acetabular component loosening. However, several series have reported improved results with tantalum acetabular components. The purpose of this study is to assess implant survivorship, radiographic results, and clinical outcomes of contemporary, porous titanium acetabular components in the setting of prior pelvic radiation.MethodsWe retrospectively reviewed 33 patients (38 hips) with prior pelvic radiation between 2006 and 2016 who underwent primary THA. The mean overall pelvic radiation dose was 6300 cGy with a mean latency period to THA of 5 years. The most common acetabular component was Pinnacle (DePuy Synthes) in 76%. Eight-seven percent of cups were fixed with screws. The mean age at primary THA was 74 years, 76% were male, and the mean body mass index was 30 kg/m². Mean follow-up was 5 years.ResultsThe 10-year survivorship free of revision for aseptic loosening, free of any revision, and free of any reoperation were 100%, 89%, and 89%, respectively, when accounting for death as a competing risk. There were 3 revisions; one each for taper corrosion, recurrent dislocation, and infection. Radiographically, all cups had evidence of osteointegration and none had radiographic evidence of loosening. The mean Harris Hip Score improved from 50 to 84 postoperatively (P < .0001).ConclusionContemporary porous titanium acetabular components with supplemental screws provided excellent implant fixation in patients with prior therapeutic pelvic radiation. At 10 years, 100% of these components were free of revision for aseptic loosening and 100% were radiographically well-fixed.Level of EvidenceLevel IV, Therapeutic.     

Survivorship and Risk Factors for Re-Revision after Aseptic Revision Total Hip Arthroplasty in Patients Aged ≤55 Years

BackgroundThere is a relative paucity of literature on the outcomes after revision total hip arthroplasty (rTHA) in young patients. This study reports the survivorship and risk factors for re-revision in patients aged ≤55 years.MethodsWe identified 354 patients undergoing aseptic nononcologic rTHA at mean follow-up of 5 years after revision, with mean age of 48 years, body mass index of 28 kg/m², and 64% female. Thirty-five (10%) patients underwent at least 1 previous rTHA. The main indications for rTHA included wear/osteolysis (21%), adverse local tissue reaction (21%), recurrent instability (20%), acetabular loosening (16%), and femoral loosening (7%); and included acetabular component-only rTHA in 149 patients (42%), femoral component-only rTHA in 46 patients (13%), both component rTHA in 44 patients (12%), and head/liner exchanges in patients 115 (33%). The Kaplan-Meier method was used to measure survivorship free from re-revision THA, and multivariate regression was used to identify risk factors for re-revision THA.ResultsSixty-two patients (18%) underwent re-revision THA at the mean time of 2.5 years, most commonly for instability (37%), aseptic loosening (27%), and prosthetic joint infection (15%). The rTHA survivorship from all-cause re-revision and reoperation was 83% and 79% at 5 years, respectively. Multivariate analysis demonstrated that patients undergoing femoral component only (hazard ratio 4.8, P = .014) and head/liner exchange rTHA (hazard ratio 2.5, P = .022) as risk factors for re-revision THA.ConclusionAbout 1 in 5 patients aged ≤55 years undergoing rTHA required re-revision THA at 5 years, most commonly for instability. The highest risk group included patients undergoing head/liner exchanges and isolated femoral component revisions.     

Cause-Specific Stem Revision Risk in Primary Total Hip Arthroplasty Using Cemented vs Cementless Femoral Stem Fixation in a US Cohort

BackgroundWe sought to evaluate the cause-specific revision risk following hybrid (cemented stem mated to a cementless acetabular implant) vs cementless total hip arthroplasty (THA) in a US cohort.MethodsPrimary elective THA for osteoarthritis was identified using Kaiser Permanente’s Total Joint Replacement Registry (2001-2018). Multivariable Cox regression was used to evaluate cause-specific revision, including aseptic loosening, infection, instability, and periprosthetic fracture (PPF), for hybrid vs cementless THA. Analysis was stratified by age (<65, 65-74, and ≥75 years) and gender.ResultsThe study cohort comprised 88,830 THAs, including 4539 (5.1%) hybrid THAs. In stratified analysis, hybrid THA had a higher revision risk for loosening in females in all 3 age subgroups. A lower risk of revision for PPF was observed following hybrid THA in females aged ≥75 years. For females ≥75 years, cementless THA had an excess PPF risk of 0.9% while hybrid THA had an excess loosening risk of 0.2%, translating to a theoretical prevention of 10 PPF revisions but a price of 3 loosening revisions per 1000 hybrid THAs. No difference in revision risk was observed in males.ConclusionWe observed differences in cause-specific revision risks by method of stem fixation which depended upon patient age and gender. Although the trend toward all cementless fixation continue, there may be a role for hybrid fixation in females ≥75 years to mitigate risk for revision due to PPF at the potential cost of a slight increase in longer term aseptic loosening.Level of EvidenceLevel III.     

Outcome and Risk Factors Associated with Failures of Isolated Bearing Exchange for Osteolysis in Well-Fixed Cementless Total Hip Arthroplasty

BackgroundIt is often challenging to decide whether to revise only the bearing or femoral acetabular component in the setting of progressive osteolysis without component loosening in revision total hip arthroplasty (THA). In this study, we aimed to (1) compare the survivorship of isolated bearing exchange and single/both component revision for patients with periprosthetic osteolysis without component loosening, and (2) identify potential risk factors associated with failures of isolated bearing exchange.MethodsA total of 228 consecutive cases of revision THA for progressive osteolysis without component loosening was evaluated in 2 groups: (1) 124 component revision and (2) 104 isolated bearing exchange. The primary outcome was survival, with failure defined as repeat revision or reoperation for any reason. Patient risk factors, such as demographics and medical comorbidities, were also analyzed.ResultsThere was no significant difference in survivorship between the component revision group and the bearing exchange group at 10 years (85% vs 82%; P = .89). There was no progression of osteolysis on radiographs at last follow-up for patients with isolated bearing change. Univariate regression modeling demonstrated that renal disease was associated with failure of isolated bearing exchange after revision THA.ConclusionThis study demonstrated that isolated bearing exchange is associated with similar outcomes compared with component revision for aseptic osteolysis without loosening, demonstrating that isolated bearing exchange is a viable option for selected patients with osteolysis in the setting of well-fixed THA components. This provides clinically useful information for surgeons in the surgical treatment of THA patients with wear and osteolysis without component loosening.     

Etiology and Complications of Early Aseptic Revision Total Hip Arthroplasty Within 90 Days

BackgroundThe etiology, complications, and rerevision risks of early aseptic revision total hip arthroplasty (THA) within 90 days are insufficiently documented.MethodsA national insurance claims database (PearlDiver Technologies, Fort Wayne, IN) was queried for patients who underwent unilateral aseptic revision THA within 90 days of the index procedure using administrative codes. Patients who underwent revision for infection, without minimum 2-year follow-up, and younger than 18 years were excluded. This cohort was matched based on gender, age, and Charlson Comorbidity Index to a control group of patients who underwent primary THA without revision within 90 days. Two-year rerevision and 90-day complication rates were recorded. Chi-square and Fisher exact tests were used as appropriate for statistical comparison.ResultsFour hundred two patients met the inclusion criteria for early aseptic revision within 90 days of the index procedure and were matched to the control group. The overall 2-year rerevision rate was higher in the early revision group compared with control group (14.9% vs 2.5%, P < .001). Complications within 90 days occurred more frequently in the early revision group, including blood transfusion (10.2% vs 3.2%, P < .001), deep vein thrombosis (9.0% vs 3.2%, P = .001), and pulmonary embolism (2.74% vs 0.75%, P = .031). The most common reasons for early aseptic revision were dislocation (41.5%), fracture (38.1%), and loosening (17.4%).ConclusionEarly aseptic revision THA is associated with significantly higher 90-day complication rates and 2-year rerevision rates compared with a control group of primary THA without revision. The most common reasons for acute early revision were dislocation, fracture, and mechanical loosening.Level of EvidenceLevel III.     

A Large-Scale Fifteen-Year Minimum Survivorship of a Cementless Triple Tapered Femoral Stem

BackgroundThis study reports the long-term outcomes of a metaphyseal fit-and-fill cementless femoral component in total hip arthroplasty (THA) with a follow-up of 15-19 years.MethodsWe conducted a retrospective review of 376 consecutive THAs (345 patients), using a triple tapered stem performed between 2000 and 2003 with a view to assessing survivorship and radiological and functional outcomes. Images were assessed for initial alignment, terminal osteolysis, or subsidence, while clinical outcomes were assessed using the St Michael’s Hip Score.ResultsForty-five (11.9%) hips were lost to follow-up, 20 (5.31%) had died before our 15-year cutoff follow-up, and 4 (1.06%) had declined follow-up early on, leaving 307 hips (81.64%, 276 patients) available for both clinical and radiological follow-up at a minimum of 15 years (range 15-19). The mean age at the time of operation was 49.6 years (range 19-71) and the cohort included 131 (42.67%) male and 145 (47.23%) female patients. Seven stems (2.28%) were revised: 4 due to periprosthetic fractures, 2 for periprosthetic joint infection, and 1 for adverse reaction to metal debris at the trunnion. The St Michael’s Hip Score improved from 14.2 (range 9-23) preoperatively to 22.3 (range 13 to 25) at the last documented follow-up (P = .000). Kaplan-Meier survivorship with stem revision for any reason as the end point was 97.70%. Worst-case scenario Kaplan-Meier survivorship, where all lost to follow-up are considered as failures, was 85.3%. No stem was revised for aseptic loosening.ConclusionThis triple tapered stem in THA shows excellent survivorship beyond a minimum of 15 years.     

Dual-mobility cups in total hip arthroplasty after femoral neck fractures: A retrospective study comparing outcomes between cemented and cementless fixation

IntroductionTotal hip arthroplasty (THA) after femoral neck fracture (FNF) is associated with an increased risk of dislocation. The goals of our study were (1) to determine dislocation and revision rates when dual-mobility cups (DMCs) are used in these patients, (2) to analyze clinical and radiographic outcomes, survivorship, complications and mortality rate, and (3) to compare results between cemented and cementless cups.Patients and methodsWe retrospectively reviewed patients with FNF treated using DMC-THA between 2011 and 2018. A minimum 2-year follow-up was required for clinical and radiographic assessment. The clinical outcome was assessed using the Harris Hip Score (HHS) and Merlé D´Aubigné-Postel score (MDP). Radiolucent lines, osteolysis and cup loosening were analyzed.ResultsWe included 105 patients (105 hips) with a mean age of 75.5 years. There were no dislocations. One patient (1.0%) underwent cup revision at 39 months for aseptic cup loosening. The mean HHS and MDP were 80.5 and 14.2 respectively at a mean follow-up of 4.1 years. A higher MDP was found in patients with cementless rather than cemented cups (15.0 vs. 13.1; p = 0.006). Four patients had radiolucent lines > 1 mm, around cemented cups. At 6.8 years, estimated cup survival was 98.2% for revision for aseptic loosening and 97.3% for revision for any reason. The mortality rates were 6.7% at 1 year and 23.8% at last follow-up.ConclusionOur findings suggest that using DMC in THA for FNF may prevent dislocation with a low revision rate. Cementless cups had a higher MDP than cemented cups.     

Revision Total Hip Arthroplasty With a Modular Cementless Femoral Stem

We retrospectively reviewed 123 patients who underwent cementless THA with modular femoral stem designs for revision THA or conversion of failed ORIF and found 75 patients available for analysis. The Harris Hip Score (HHS) improved from 52 ± 14 to 86 ± 11 (P < 0.001). The femoral stem was re-revised in eight patients (11%). The mean time to re-revision was 1.1 years (0.13–2.54). Reasons for re-revision included infection (n = 5, 7%), aseptic loosening (n = 2, 3%) and significant pain (n = 1, 1%). There were no failures of the modular junctions. PC stems had an increased rate of intraoperative fractures (PC 28% vs. STS 9%, P = 0.04). Modular cementless femoral stems provide acceptable mid-term results in revision THA.     

Clinical Outcomes and Midterm Survivorship of an Uncemented Primary Total Hip Arthroplasty System

BackgroundThe rise in total hip arthroplasty (THA) has led to a concomitant increase in revision THAs. Tracking implant performance therefore remains a significant element of scientific inquiry to garner and maintain public trust in this procedure. There are few available reports of outcomes of a single manufacturer’s total hip system outside registry data.MethodsWe performed a retrospective review of a prospectively generated database to evaluate outcomes of a single manufacturer’s femoral stem and acetabular shell for THA. We report the functional outcomes, revision data, and survivorship for this total hip system.ResultsA total of 1942 primary THAs were implanted into 1672 patients. There were of 57 revisions. There were no cases of acetabular failure at 10-year follow-up. All functional outcome scores demonstrated significant improvements following THA. Kaplan-Meier survival analysis for all-cause revisions demonstrated 2-year implant survival of 97.6% (95% confidence interval [CI], 96.9-98.3), 5-year implant survival of 97.3% (95% CI, 96.5-98.1), and 10-year implant survival of 97.0% (95% CI, 96.0-98.0). When infection was excluded, implant survivorship improved to 99.2% (95% CI, 98.8-99.6) at 2 years, 98.9% (95% CI, 98.5-99.4) at 5 years, and 98.7% (95% CI, 98.1-99.4) at 10 years.ConclusionThis THA implant system comprising an uncemented press-fit acetabulum used alongside a triple-tapered femoral stem is an excellent option for THA. Implant survivorship at 2, 5, and 10 years is among the best reported for any total hip system in the world.     

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.     

陶瓷对陶瓷与金属对聚乙烯全髋关节置换的10年随访研究

目的 比较陶瓷对陶瓷（ceramic-on-ceramic, COC）与金属对聚乙烯（metal-on-polyethylene, MOP）全髋关节置换的10年随访临床结果。 方法 对114例接受初次THA的患者进行回顾性研究,其中COC组48例（54髋）,MOP组66例（67髋）,比较COC与MOP两种不同摩擦界面假体的术后髋关节功能、翻修率以及不良事件发生率。 结果 末次随访时患者COC组与MOP组术后髋关节Harris评分分别为89.9±7.5和92.3±8.2,无显著性差异（P＞0.05）;COC组1例翻修（翻修时间术后3年）,MOP组4例翻修（翻修时间平均6年）。两者在翻修、脱位、假体破碎、关节异响、无菌性松动、假体周围骨溶解、深部感染、异化骨化发生率的比较,无显著性差异（P＞0.05）。结论 COC与MOP假体均能提供较好的临床疗效,两者在术后髋关节功能及并发症方面疗效相当。     

Dual Mobility for Monoblock Metal-on-Metal Revision—Is It Safe?

BackgroundRevision of monoblock metal-on-metal (MoM) total hip arthroplasty (THA) is associated with high complication rates. Limited revision by conversion to a dual mobility (DM) without acetabular component extraction may mitigate these complications. However, the concern for polyethylene wear and osteolysis remains unsettled. This study investigates the results of DM conversion of monoblock MoM THA compared to formal acetabular revision.MethodsOne hundred forty-three revisions of monoblock MoM THA were reviewed. Twenty-nine were revisions to a DM construct, and 114 were complete revisions of the acetabular component. Mean patient age was 61, 54% were women. Components used, acetabular cup position, radiographic outcomes, serum metal ion levels, and HOOS Jr clinical outcome scores were investigated.ResultsAt 3.9 years of follow-up (range 2-5), there were 2 revisions (6.9%) in the DM cohort, 1 for instability and another for periprosthetic fracture. Among the formal acetabular revision group there was a 20% major complication rate (23/114) and 16% underwent revision surgery (18/114) for aseptic loosening of the acetabular component (6%), deep infection (6%), dislocation (4%), acetabular fracture (3%), or delayed wound healing (6%). In the DM cohort, there were no radiographic signs of aseptic loosening, component migration, or polyethylene wear. One DM patient had a small posterior metadiaphyseal femur lesion that will require close monitoring. There were no other radiographic signs of osteolysis. There were no clinically significant elevations of serum metal ion levels. HOOS Jr scores were favorable.ConclusionLimited revision with conversion to DM is a viable treatment option for failed monoblock MoM THA with lower complication rates than formal revision. Limited revision to DM appears to be a safe option for revision of monoblock MoM THA with a cup in good position and an internal geometry free of sharp edges or articular surface damage. Longer follow-up is needed to demonstrate any potential wear implications of these articulations.     

Long-Term Survivorship of Modular Cementless Femoral Stem in Complex Primary Total Hip Arthroplasty: A Concise Minimum 15-Year Follow-Up Report

BackgroundS-ROM hip is a well-established and versatile prosthesis that offers extensive metaphyseal and diaphyseal geometries providing solutions for a variety of surgical scenarios. The aim of this study is to report on long-term survivorship and radiographic outcomes of complex primary total hip arthroplasty (THA) using a modular cementless stem (S-ROM).MethodsRetrospective consecutive study was conducted of 167 patients (167 hips): 97 males and 70 females with average age at the time of surgery of 55 years (range 22-76). All patients underwent complex THA by the senior author from 1987 to 1999. Patients were identified using a prospective database. Demographic, clinical, and surgical data were collected from health records. All patients received a cementless acetabular component with a standard polyethylene liner. The primary outcome measure was survivorship beyond 15 years using stem revision for any cause as an end point. Secondary outcome measure was rate of radiographic loosening using Engh classification.ResultsOnly 3 patients required stem revision for aseptic loosening and 1 for periprosthetic fracture. Isolated acetabular revision was undertaken in 23 of 167 patients (13.8%) due to polythene wear, osteolysis, and aseptic loosening. Proximal femoral stress shielding (zone 1, 7) was noted in 34 of 167 hips (20.4%). Stable bony ingrowth was noted in 144 hips (86.2%) and the remaining 23 hips had stable fibrous ingrowth (13.8%). Using stem “any-cause revision” as an endpoint, the mean stem survivorship was 31.5 years (95% confidence interval 31.007-31.985) with 30-year estimated survivorship of 97.6%.ConclusionIn a single designer surgeon series, S-ROM stem has stood the test of time with long-term, 30-year survivorship of 97.6% and continues to play an important role in modern hip surgery providing longevity and versatility. However, further comparative long-term studies from independent centers are needed for a definitive conclusion.Level of EvidenceIV.     

Total hip arthroplasty using cementless grit-blasted femoral component: a minimum 10-year follow-up study

The grit-blasted cementless Spotorno (CLS) stem, which has excellent survival rates up to 10 years, is widely used in total hip arthroplasty (THA). We investigated the survivorships of CLS stems in THA at a minimum follow-up of 10 years and sought to identify factors that influence outcomes. A total of 227 hips of 191 patients who underwent cementless THA with a CLS stem were retrospectively reviewed at a mean follow-up of 12.3 years. All patients were evaluated clinically and radiographically according to implant type and surgery-related and patient-related factors. Survivorship was 97.2% when femoral revision for any reason was defined as the end point. Femoral revisions were performed in 3 hips because of periprosthetic fractures. Survivorship for all hips, using revision for any reason as the end point, was 92.6%. Two metal-on-metal THAs were revised because of aseptic loosening or osteolysis around the cup. No significant differences were evident for type of stem, type of bearing surface, stem alignment, or patient-related factors. However, a canal fill index of 80% or less was found to affect cortical remodeling, subsidence, and a change in stem position of 5° or more, which indicates that care must be taken not to undersize stems. In addition, in view of the revisions performed, bearing surfaces appear to importantly influence THA survivorship.     

Satisfactory Results of the Exeter Revision Femoral Stem Used for Primary Total Hip Arthroplasty

Background

The Exeter cemented femoral stem has demonstrated excellent clinical and radiographic outcomes as well as long-term survivorship free from aseptic loosening. A shorter revision stem (125 mm) with a 44 offset became available for the purpose of cement-in-cement revision situations. In certain cases, this shorter revision stem may be used for various primary total hip arthroplasties (THAs) where the standard length stem would require distally reaming the femoral canal. We sought to report on the early to midterm results of this specific stem when used for primary THA regarding (1) clinical and radiographic outcomes, (2) complications, and (3) survivorship.

Long-Term Results of Total Hip Arthroplasty in Young Patients With Osteonecrosis After Allogeneic Bone Marrow Transplantation for Hematological Disease: A Multicenter,Propensity-Matched Cohort Study With a Mean 11-Year Follow-Up

BackgroundThe number of young patients with hematological disease requiring total hip arthroplasty (THA) is expected to increase. We aimed to investigate the long-term THA outcomes in patients with osteonecrosis of the femoral head (ONFH) following allogeneic bone marrow transplantation (BMT) for hematological disease.MethodsAll patients who underwent THA for osteonecrosis after BMT from 1997 to 2012 were identified at 2 institutions. Using propensity scores, 75 THAs in 45 patients were matched for age, gender, body mass index, American Society of Anesthesiologists score, and year of surgery with 75 THAs in 58 patients with idiopathic ONFH without a history of hematological disease (1:1 ratio). The mean age at surgery was 36.7 years and 52% were men. Clinical and radiographic evaluations were performed and clinical scores were obtained at last follow-up. Kaplan-Meier analyses were used to compare survivorship.ResultsAt a mean follow-up of 10.6 ± 3.5 years, clinical, radiographic, and survivorship outcomes, and the Harris hip scores were similar between both groups. The 13-year survivorship for all-cause revision was 93.4% for the BMT group and 95% for the control group (P = .928). No significant differences were observed between groups in the rates of reoperation (4% vs 5.3%, P = 1.000), 90-day readmission (all 5.3%), or overall mortality (4.4% vs 1.7%, P = .681). No hips had periprosthetic joint infection or septic loosening in either group. Osteolysis occurred in none of the BMT patients and in 2 hips (2.7%) of the control patients (P = .497).ConclusionThis large cohort multicenter survey at 11-year follow-up shows that contemporary cementless THA in young hematological disease patients after allogeneic BMT is not associated with a higher risk for surgical complications, revision, reoperation, readmission, and mortality compared to a matched cohort of idiopathic ONFH.