Long-Term Survivorship Analysis of the Cementless Spotorno Femoral Component in Patients Less Than 50 Years of Age

The long-term survival of the cementless Spotorno (CLS) femoral component (Zimmer Inc, Warsaw, USA) was evaluated in a consecutive series of 85 patients (100 hips) less than 50 years of age. The mean follow-up was 12.3 years. Two patients (3 hips) were lost to follow-up, and 3 (4 hips) died. The survival rate of the CLS stem was 96.9% (confidence interval [CI], 93.6%-100%) after 13 years based on revision of the stem for any reason. The survival of the stem with revision for aseptic loosening as the end point was 97.9% (CI, 95.1%-100%) at 13 years. The mean Harris hip score at time of follow-up was 94. The long-term survival of the CLS stem is excellent in patients less than 50 years of age.     

Birmingham hip resurfacing at a mean of ten years: results from an independent centre

We report the findings of an independent review of 230 consecutive Birmingham hip resurfacings (BHRs) in 213 patients (230 hips) at a mean follow-up of 10.4 years (9.6 to 11.7). A total of 11 hips underwent revision; six patients (six hips) died from unrelated causes; and 13 patients (16 hips) were lost to follow-up. The survival rate for the whole cohort was 94.5% (95% confidence interval (CI) 90.1 to 96.9). The survival rate in women was 89.1% (95% CI 79.2 to 94.4) and in men was 97.5% (95% CI 92.4 to 99.2). Women were 1.4 times more likely to suffer failure than men. For each millimetre increase in component size there was a 19% lower chance of a failure. The mean Oxford hip score was 45.0 (median 47.0, 28 to 48); mean University of California, Los Angeles activity score was 7.4 (median 8.0, 3 to 9); mean patient satisfaction score was 1.4 (median 1.0, 0 to 9). A total of eight hips had lysis in the femoral neck and two hips had acetabular lysis. One hip had progressive radiological changes around the peg of the femoral component. There was no evidence of progressive neck narrowing between five and ten years. Our results confirm that BHR provides good functional outcome and durability for men, at a mean follow-up of ten years. We are now reluctant to undertake hip resurfacing in women with this implant.     

Cementless Total Hip Arthroplasty With Alumina-on-Highly Cross-Linked Polyethylene Bearing in Young Patients With Femoral Head Osteonecrosis

We asked whether total hip arthroplasties (THAs) using alumina-on-highly cross-linked polyethylene bearing would improve functional activity and reduce aseptic loosening, polyethylene wear, and osteolysis. Consecutive primary THAs were performed in 71 patients (73 hips) who were younger than 50 years (mean age, 45.5 years) with femoral head osteonecrosis. There were 48 men (50 hips) and 23 women (23 hips). Osteolysis was evaluated using radiographs and computed tomographic scanning. The average follow-up was 8.5 years (range, 7-9 years). The mean preoperative Harris hip score was 50.6 points, which improved to 96 points at the final follow-up. Preoperative functional activity was improved significantly at the latest follow-up. The mean polyethylene linear penetration was 0.05 ± 0.02 mm/y and no hip had aseptic loosening or osteolysis.     

Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips

The results of cemented total hip arthroplasty (THA) in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients. A total of 103 patients with ankylosing spondylitis underwent 181 THAs; 72 patients (69.9%) had bilateral surgery. The mean follow-up was 10.3 years. The mean age of patients at surgery was 47 years. Before surgery, 42 hips (23.2%) were ankylosed. Revision surgery was carried out in 25 hips (13.8%). Heterotopic ossification was present in 21 hips (11.6%); however, no patients had functional impairment or reankylosis. At final follow-up examination, 173 hips (96%) had an excellent (low) pain score, and 53 hips had a normal or near-normal function score (29.2%). The probability of survival of the implant was 71% at 27 years. THA provides long-term improvement in hip function for patients with ankylosing spondylitis.     

Charnley total hip arthroplasty in Chinese patients less than 40 years old

Forty-seven total hip arthroplasties were reviewed in 33 Chinese patients who were <40 years old at the time of operation. The preoperative diagnosis was avascular necrosis in 40% of the hips. A Charnley prosthesis was inserted using early cementing techniques in every hip. The average follow-up was 14.9 years (range, 6.9-21.1 years). The mean preoperative Harris hip score was 43.8 (range, 26-74), and the mean score at latest follow-up was 87.7 (range, 74-99) for the surviving hips. Thirty hips (63%) were revised, and 1 hip was removed because of late deep infection. The main cause of failure was aseptic loosening of the acetabular component. Using revision and radiologic loosening as endpoints, the cumulative survival rate for the acetabular component was 86.3% at 10 years and 27.0% at 15 years. The survival of the femoral components was 81.3% at 15 years. Patients with avascular necrosis had a higher failure rate than patients with other diagnoses (P =.001). An area of cement mantle that was <2 mm thick affected adversely the survival rate of the acetabular components (P =.04).     

Long-term results of bulk femoral head autograft in cementless THA for developmental hip dysplasia

We evaluated the fate of bulk femoral head autograft in cementless total hip arthroplasty (THA) for developmental hip dysplasia. Of 87 hips (80 patients) studied, 37 hips (32 patients) were available for follow-up at a mean of 18.5 years (range, 15-24 years) postoperatively. The mean age of these 32 patients at the index procedure was 53.8 years (range, 40-65 years). The initial diagnosis was osteoarthritis in all 32 patients. The degree of acetabular dysplasia according to Crowe classification was type I in 18 hips (48.6%), type II in 14 (37.8%), type III in 5 (13.5%). The mean percentage of horizontal coverage of the acetabular components with graft bone was 34% (range, 25%-45%). Trabecular bridging across the graft-host interface was seen at a mean of 4 months (range, 2-6 months) postoperatively. Trabecular reorientation of the grafted bone was seen in all hips at a mean of 27 months (range, 12-36 months) postoperatively. There was no evidence of collapse and bony resorption of the grafted bone in the weight-bearing portion. Acetabular component fixation was stable in all hips at final follow-up. Of the 37 hips (32 patients), 2 acetabular components required revision: 1 for a late postoperative deep infection and 1 for dissociation of the polyethylene liner. The survival rate was 94.5% (95% confidence interval, 91.3-96.5) for the acetabular component at 18.5 years of follow-up. This study found that bulk femoral head autograft in cementless THA for developmental hip dysplasia produces excellent long-term results.     

A ten- to 15-year follow-up of the cementless spotorno stem

We followed the first 354 consecutive implantations of a cementless, double-tapered straight femoral stem in 326 patients. Follow-up was at a mean of 12 years (10 to 15). The mean age of the patients was 57 years (13 to 81). At follow-up, 56 patients (59 hips) had died, and eight (eight hips) had been lost to follow-up. Twenty-five hips underwent femoral revision, eight for infection, three for periprosthetic fracture and 14 for aseptic loosening. The overall survival was 92% at 12 years (95% CI 88 to 95). Survival with femoral revision for aseptic loosening as an endpoint was 95% (95% CI 92 to 98). The median Harris hip score at follow-up was 84 points (23 to 100). Radiolucent lines (< 2 mm) in Gruen zones 1 and 7 were present in 38 (16%) and 34 hips (14%), respectively. Radiolucencies in zones 2 to 6 were found in five hips (2%). The results for mid- to long-term survival with this femoral component are encouraging and compare with those achieved in primary cemented total hip arthroplasty. The high rate of loosening of the cup and the high rate of pain are, however, a source of concern.     

Second-generation cementless total hip arthroplasty. Eight to eleven-year results.

BACKGROUND: Second-generation cementless femoral components were designed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces. We examined the eight to eleven-year results of total hip arthroplasty with a cementless, anatomically designed femoral component and a cementless hemispheric acetabular component. METHODS: Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating (Anatomic Hip) and a cementless hemispheric porous-coated acetabular component (Harris-Galante II) were performed in eighty-five patients. These patients were prospectively followed clinically and radiographically. Six patients (seven hips) died and five patients (seven hips) were lost to follow-up, leaving seventy-four patients (seventy-eight hips) who had been followed for a mean of ten years (range, eight to eleven years). The mean age at the time of the arthroplasty was fifty-two years. RESULTS: The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up; 86% of the hips had a good or excellent result. Thigh pain was reported as mild to severe after seven hip arthroplasties. No femoral component was revised for any reason, and none were loose radiographically at the time of the last follow-up. Two hips underwent acetabular revision (one because of dislocation and one because of loosening). Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point. The ten-year survival rate was 96.4% +/- 2.1% for the total hip prosthesis, 100% for the femoral component, and 96.4% +/- 2.1% for the acetabular component. Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight (93%) of the -seventy-three hips with complete radiographic follow-up. Femoral osteolysis proximal to the lesser trochanter was noted in four hips (5%). No osteolysis was identified distal to the lesser trochanter. Periacetabular osteolysis was identified in twelve hips (16%). Five patients underwent exchange of the acetabular liner because of polyethylene wear. CONCLUSIONS: This second-generation cementless, anatomically designed femoral component provided excellent clinical and radiographic results with a 100% survival rate at ten years. The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty.     

Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy

Introduction Inferior survival of cemented total hip arthroplasty has been reported after previous femoral osteotomy. The purpose of this study was to evaluate the long-term survival of uncemented stems after femoral osteotomy.Materials and methods Forty-eight hips in 45 patients had undergone conversion THA for a failed intertrochanteric osteotomy of the hip after a mean of 12 years (2–33 years). Mean time of follow-up was 11 years (5–15 years).Results At follow-up, two patients (three hips) had died, and one patient (one hip) was not located. Three patients (three hips) underwent femoral revision—one for infection and two for aseptic loosening of the stem. Survival of the stem was 94% at 10 years, and survival with femoral revision for aseptic loosening as an end point was 96%. The median Harris Hip Score at follow-up was 80 points. Radiolucent lines in Gruen zones 1 and 7 were present in 14 and 18% of hips, respectively. Radiolucencies in other zones were not detected. There was no radiographic evidence of femoral osteolysis, stress-shielding or loosening.Conclusion The results with this type of uncemented tapered titanium femoral component after proximal femoral osteotomy are encouraging and compare to those achieved in patients with regular femoral anatomy.     

Cementless Spotorno tapered titanium stems: excellent 10-15-year survival in 141 young patients

We evaluated the clinical and radiographic results of the first consecutive 154 implantations of a cementless, double-tapered straight femoral stem (cementless Spotorno (CLS), Sulzer Orthopedics) in 141 patients under the age of 55 (mean 47 (13-55)) years. After a mean follow-up of 12 (10-15) years, 11 patients (11 hips) had died and 7 (7 hips) could not be located. 5 patients (5 hips) underwent femoral revision-1 for infection, 1 for periprosthetic fracture and 3 for aseptic loosening of the stem. The overall survival rate of the stem was 97% at 12 years (95% confidence limits, 93%-100%), and survival with femoral revision for aseptic loosening as an end point 98 (95-100)%. The survival rate of the acetabular components was 78 (71-85)% after 12 years. The median Harris hip score at follow-up was 84 points. None of the patients had thigh pain. Radiolucent lines in Gruen regions 1 and 7 were present in 21 hips (17%). 2 hips had radiolucent lines in regions 2-6 on anteroposterior (AP) radiographs. No femoral osteolysis was detected. The mid- to long-term survival with this type of femoral component is excellent and compares favorably with cemented stems in this age group. However, the high rate of cup loosening and the low Harris hip scores are a concern in this subgroup of young patients.