Cemented total hip arthroplasty with contemporary techniques. A five-year minimum follow-up study

A retrospective clinical and roentgenographic review was performed on 251 consecutive cemented total hip arthroplasties (THA) performed from 1978 to 1980 that had been followed a minimum of five years (range, five to seven years). All arthroplasties involved the use of a Harris Design II femoral stem, an intramedullary plug, a cement gun, and pulsatile lavage of both the acetabulum and the femoral canal. At the final follow-up examination, 98% of the patients had excellent results. The average Harris hip score was 47 points preoperative and 97 points postoperative. There were three definitely loose femoral stems, one probably loose, and two possibly loose. There was one loose acetabular component, no revisions or operations were performed. When comparing this series with a similar study, there were statistically improved results in all parameters. Results from this study of cemented THAs using contemporary techniques and prosthetic stem design represent the standard for comparison when evaluating alternative THA systems.     

Femoral impaction grafting in revision total hip arthroplasty: a follow-up of 540 hips

Between 1987 and 1999, 540 revision total hip arthroplasties in 487 patients were performed at our institution using the femoral impaction grafting technique with a cemented femoral stem. All patients were prospectively followed up for 2 to 15 years postoperatively with no loss to follow-up. A total of 494 hips remained successfully in situ at an average of 6.7years. The 10-year survival rate was 98.0% (95% confidence interval, 96.2-99.8) with aseptic loosening as the end point and 84.2% (95% confidence interval, 78.5-89.9) for reoperation for any reason. Indication for surgery and the use of any kind of reinforcement significantly influenced outcome (P < .001). This is the largest known series of revision THA with femoral impaction grafting, and the results support continued use of this technique.     

Total hip arthroplasty with the MS-30 polished surface cemented stem: a single surgeon consecutive series study at 10 year follow-up

The Morscher-Sportorno femoral stem is a stainless steel, straight, three-dimensionally tapered, collarless implant for cemented fixation in total hip replacement. The clinical and radiographic results of this implant at a minimum of 5-year follow-up have been extremely encouraging. However, the results at 10 years have yet to be reported. Therefore, we wished to establish the clinical performance and survival of the polished surface MS-30 femoral stem at a minimum of 10-year follow-up. We report the results at a minimum follow-up of 10 years of a single surgeon series of 55 total hip replacements with the polished surface MS-30 cemented femoral component in 48 consecutive patients aged between 50 and 64. The median period of observation was 12 years (inter-quartile range, 10–13). Six patients died with their implant in situ, and one patient was unable to attend for follow-up. All the remaining 41 patients with 47 total hip replacements were reviewed. All patients were assessed clinically with the use of the Oxford hip score, and radiographs taken at the latest follow-up were evaluated by an independent specialist hip surgeon. To date, none of the implants have been revised. The median Oxford hip score was 13 (inter-quartile range, 12–14). Radiologically, no stems had evidence of loosening on assessment by the Harris criteria, and only 4 hips (8.5 %) had osteolysis adjacent to the stem, mostly in Gruen zone 7. The results of the polished surface MS-30 femoral stem were satisfactory with survivorship at a minimum of 10 years of 100 %. These findings support the continued use of this femoral component.     

Normalized and proportionalized cemented femoral stem survivorship at 15 years.

We reviewed the clinical and radiographic results of a series of 215 consecutive hip arthroplasties in which a normalized, proportionalized, cemented femoral component was implanted. This component design may encourage more efficient force transmission from prosthesis to cement to bone and lessen hoop stresses and resultant interface failure. A total of 127 hips in 103 patients with a follow-up of 13 to 17 years (average, 14.8 years) were available for evaluation, which included survivorship analysis. An aseptic failure loosening rate of 3.9% at 15 years for this stem favorably compares with other reported series of first-generation and second-generation stems at similar follow-up. Excluding the 8 stems placed in varus, of which 3 required revision (failure rate, 37.5%), the series has a failure rate of 1.6%.     

Fifteen-year survivorship of a collarless,cemented, normalized femoral stem in primary hybrid total hip arthroplasty with a modified third-generation cement technique

This prospective review aimed to evaluate 15-year survivorship of the collarless, third-generation cemented, normalized, Omnifit (Osteonics, Allendale, NJ) femoral stem in hybrid total hip arthroplasty (THA). Between January 1986 and June 1990, a single surgeon prospectively implanted 250 consecutive hybrid THAs (215 patients) using a modified third-generation cement technique in selected patients. A Harris-Galante (I or II) (Zimmer, Warsaw, IN) cementless shell with modular polyethylene (4150 resin) liners gamma-sterilized in air were implanted. Kaplan-Meier survivorship of the femoral or acetabular component with mechanical failure (revision for aseptic loosening) as the end-point was 100% ± 0% at 15 years. Wear couple exchange and bone grafting was performed in 1 case (0.4%) for progressive acetabular osteolysis. This report supports femoral component centralization and good cement mantle to ensure durability of the collarless, cemented, normalized femoral stem with a surface roughness of 30–40 microinches.     

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.     

Revision total hip arthroplasty in juvenile chronic arthritis: 17 revisions in 11 patients followed for 4-12 years

BACKGROUND: Revision total hip arthroplasty (THA) in patients with juvenile chronic arthritis (JCA) is complicated by the young age of the patient, poor bone stock and small physical proportions. We report the complications and outcome of a prospective series of 17 revision THAs in Charnley class C JCA patients. METHODS: 15 acetabular components and 10 femoral components were revised. 13 cementless cups, 2 reconstruction/roof rings and cemented cups, and 4 cemented and 6 cementless femoral stems were implanted. 2 proximal femoral allografts and 1 strut allograft were used. Age at revision was 32 (21-53) years. Follow-up averaged 7 (4-12) years. RESULTS: 2 patients with cemented femoral stems developed loosening, osteolysis and fracture. Both were successfully revised to long-stem cementless implants with strut/proximal femoral allografts. 1 loose, worn cementless cup with osteolysis was revised. 1 patient with a peri-operative infection and late acetabular fracture had a loose, non-revised cementless cup. 1 case of sciatic nerve palsy occurred after revision using a reconstruction ring. 1 late infection necessitated resection arthroplasty. Harris hip scores improved from 53 (34-85) to 76 (47-96). INTERPRETATION: Revision THA in JCA has a substantial complication rate, even in experienced hands. The problem of obtaining long-term stable fixation, osteolysis, and replenishment of lost bone stock are major difficulties.     

Minimum 20-Year Follow-Up Results of Revision Total Hip Arthroplasty With Improved Cementing Technique

A consecutive, non-selective cohort of 83 (77 patients) cemented total hip arthroplasty revisions using contemporary cementing techniques was analyzed at a minimum of 20 years following the index procedure. No patients were lost to follow-up. The average age at revision was 62.4 years (23 to 89). Twenty-two hips (26.5%) had had a reoperation, eighteen (21.7%) for aseptic loosening, 3 (3.6%) for femoral prosthesis fracture and 1 (1.2%) for dislocation. The incidence of re-revision for aseptic femoral loosening was 7.5% and for aseptic acetabular loosening was 21.7%. These results confirm that cemented femoral revision using improved cementing techniques is a durable option in revision hip surgery. In contrast to this, THA revisions using a cemented acetabular component have been less durable at this length of follow-up.     

Hip arthroplasty after failed free vascularized fibular grafting for osteonecrosis in young patients

This study reports the results of total hip arthroplasty (THA) for osteonecrosis after failed free vascularized fibular grafting (FVFG) at a 5-year minimum follow-up. In this study, 73 patients (89 THA) were treated for failed FVFG, and survival of THA was discussed. Clinical outcome was measured using a pain and function survey (possible 91 points) in 84 hips and Harris Hip scores (HHS, 100 possible points) for 52 hips. Survival was 94.4% at 5 years, 85.4% at 10 years, and 82% overall. Average HHS at final follow-up improved to 77.5 (P <.05). The average clinical result after THA was 68 of 91 points. In this study, 58% of patients had a good or excellent HHS. The overall revision rate for proximal ingrowth stems was 13% at an average follow-up of 9.1 years. Only 4 patients required stem revision for loosening (7.4%). THA after FVFG provides improved functional results comparable to the published results of primary THA in osteonecrosis in young patients.     

Cementless Modular Total Hip Arthroplasty in Patients Younger than Fifty with Femoral Head Osteonecrosis: Minimum Fifteen-Year Follow-Up

This study aimed to report the outcome of total hip arthroplasty (THA) with a modular femoral component in patients younger than fifty years with osteonecrosis of femoral head. Sixty-four osteonecrotic hips in fifty-five patients were available for clinical and radiographic analyses at minimum follow-up of fifteen-years. The mean Harris hip score improved from 36 points preoperatively to 92.7 points at final follow-up. Sixty-two (95.3%) hips demonstrated stable bone ingrowth. No hips showed loosening or required revision for aseptic loosening. Survivorship with an end point of stem revision for any reason was 93.8% and for aseptic loosening was 100% at 16.8 years. We believe that cementless THA with a modular stem is a promising procedure for young and active patients with osteonecrosis of the femoral head.     

Periprosthetic femoral fractures treated with a modular distally cemented stem

PURPOSE: To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. METHODS: 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery. RESULTS: Patients were followed up for a mean of 14 (range, 8-18) years. The mean Harris hip score improved from 29 (range, 5-40) to 78 (range, 56-88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6-14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations. CONCLUSION: Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.     

Total hip arthroplasty in patients less than 40 years old with avascular necrosis of the femoral head. A 5 to 19-year follow-up study

We evaluated 34 total hip arthroplasties (THA) for avascular necrosis of the femoral head in 26 patients who were younger than 40 years at the time of the index operation. The average age at the time of THA was 283 (17-38) years. The mean follow-up was 10.9 (5-19) years. We used 6 cemented and 28 cementless acetabular components and a cemented polished tapered stem in all hips. The mean Charnley modified Merle d' Aubigné Postel score was 8.9 points preoperatively and 16.6 points at final follow-up. Two cemented metal-backed cups were revised because of aseptic loosening at 10 years, one cemented polyethylene cup failed at 12 years and 2 more all polyethylene cups had pending failure. The metal-backed cemented cups and the all polyethylene cups had a longer follow-up than the uncemented cups. Therefore and because of the proven unfavourable long-term outcome of the cemented metal-backed Exeter cup we are not able to draw any firm conclusions regarding the preferred choice between cemented and uncemented cups in this particular group of patients. On the femoral site none of the stems had to be revised. Our results show that a cemented polished tapered femoral component has an excellent survival in primary total hip replacement in young patients with avascular necrosis of the femoral head.     

Long-term outcome of cemented total hip arthroplasty with the Charnley-type femoral stem made of titanium alloy

BackgroundTotal hip arthroplasty is a successful treatment for hip diseases including osteoarthritis, osteonecrosis of the femoral head, and rheumatoid arthritis. Various designs of cemented femoral stems made of stainless steel and titanium alloy have been used. Among them, Charnley-type femoral stems made of stainless steel have often been reported to have good long-term outcome. However, the long-term outcome of the Charnley-type femoral stem made of Ti alloy is yet to be reported. We conducted a retrospective study to assess the long-term outcome of cemented primary total hip arthroplasty with the Charnley-type femoral stem made of Ti alloy.MethodsBetween October 1988 and February 1997, 341 cemented primary total hip arthroplasties with the Charnley-type femoral stem made of Ti alloy were consecutively performed in our hospital. Among these, 164 patients (211 hips) who underwent this procedure were followed up for more than 12 years, and the surgical hips were analysed clinically and radiologically. The mean follow-up period was 20.6 years. Kaplan–Meier survival analyses were performed to assess femoral component survival. Factors affecting stem revision for aseptic loosening were also investigated using log-rank tests.ResultsIn the functional assessment, the preoperative Japanese Orthopaedic Association score significantly improved from 47.2 points preoperatively to 79.0 points at the final follow-up. Eventually, 33 femoral stems were revised, of which 12 were revised for aseptic loosening. In the Kaplan–Meier survival analysis, the 20-year survival rates with stem revision for aseptic loosening and radiological stem loosening at the end points were 95.9% and 97.1%, respectively. Original diagnosis (non-osteoarthritis) was the only significant factor for aseptic loosening of the femoral stem.ConclusionsCemented primary total hip arthroplasty with the Charnley-type femoral stem made of Ti alloy showed excellent outcomes for more than 20 years.     

Minimum 25-Year Results of a Tapered Titanium Porous Plasma Spray Coated Femoral Component

BackgroundPrevious studies have reported excellent results with tapered, titanium, porous plasma-sprayed components in patients undergoing uncemented primary total hip arthroplasty (THA). The purpose of this study was to examine survival and clinical results at a minimum 25-year follow-up.MethodsWe reviewed all patients who underwent primary THA at our center through 1995 with a specific femoral component that was essentially unchanged since its 1984 introduction, except porous coating was continued circumferentially in 1987, a hydroxyapatite-coated option was offered in 1988, and an offset option was added in 1999. There were 332 patients (396 THA) who had a minimum 25-year follow-up (range, 25 to 37). Mean age at surgery was 48 years (range, 21 to 70 years). Mean follow-up in nonfailed patients was 29 years (range, 25 to 37 years).ResultsThere were 31 femoral revisions (7.8%): 9 infections, 3 failures of ingrowth, 5 aseptic loosening, 8 osteolysis well-fixed, 2 periprosthetic fractures, 2 polyethylene wear with trochanteric avulsion, 1 component breakage, and 1 malalignment well-fixed. Kaplan-Meier survival with the endpoint of all-cause stem revision was 94.8% (95% confidence interval: ±0.9%) at 37 years, and with the endpoint of aseptic loosening/failure of ingrowth was 98.7% (95% confidence interval: ±0.5) at 37 years. Harris hip scores improved significantly from 43 preoperatively to 76 most recently.ConclusionThis tapered, titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth.     

Impact of Femoral Stem Design on Failure After Anterior Approach Total Hip Arthroplasty

Background

An increased rate of complications related to femoral component failure has been described with less invasive total hip arthroplasty (THA). This study evaluated the incidence of femoral complications associated with the direct anterior approach for THA.

Minimum 30-Year Results of Bilaterally Implanted Cemented and Cementless Total Hip Arthroplasty in Patients Younger Than 50 Years

BackgroundThe rate of failure of cemented and cementless total hip arthroplasty (THA) in younger patients is higher than that in elderly patients. The purpose of this study is to document the long-term clinical results of THA with the so-called third-generation cementing and the results of second-generation cementless THA in patients <50 years of age.MethodsThis study included 106 patients who had had bilateral THA with a cemented stem in one hip and a cementless stem in the other. There were 78 men and 28 women. Their mean age was 47 years (range, 21-49). The average follow-up duration was 31 years (range, 30-32.5).ResultsThere were similar mean Harris Hip Scores (90 versus 91 points) between the groups at the final follow-up. Forty-six acetabular components (43%) in the cemented group and 48 acetabular components (45%) in the cementless group were revised. Five femoral components (5%) in the cemented group and 4 femoral components (4%) in the cementless group were revised. Survivorship of the acetabular component at 30.8 years was similar in both groups (57% in the cemented group versus 55% in the cementless group). Survivorship of the femoral component at 30.8 years was also similar in both groups (95% in the cemented group versus 96% in the cementless group).ConclusionLong-term fixation of the cemented or cementless femoral stem was outstanding. There was a high rate of the acetabular component revision due to conventional polyethylene wear and periacetabular osteolysis in both hybrid and fully cementless THA groups.     

Periacetabular osteolysis is the problem in contemporary total hip arthroplasty in young patients

We retrospectively reviewed 474 patients (492 hips) with a contemporary cemented total hip arthroplasty (THA) (mean age, 38.9 years) and 504 patients (532 hips) with a cementless THA (mean age, 39.3 years). Patients were evaluated clinically and radiographically. The mean follow-up was similar (14.5 vs 14.8 years) in both groups. The mean postoperative Harris hip scores (93.6 vs 94.7 points), the mean Western Ontario and McMaster Universities Osteoarthritis Index scores (12 vs 13 points), and the mean University of California, Los Angeles activity scores (6.9 vs 7.1 points) were similar between the 2 groups. Incidence of acetabular osteolysis (16% vs 20%) and femoral osteolysis (8% vs 9%) was similar between the 2 groups. Survivorship of cup (86% vs 82%) and stem (98% vs 98.5%) was similar between the 2 groups. Periacetabular osteolysis constitutes the major challenge in modern THAs in young patients.     

Primary hybrid total hip arthroplasty with a roughened femoral stem: integrity of the stem-cement interface

One hundred and two consecutive cemented femoral stems were evaluated in 92 patients at an average 9-year follow-up and a minimum 5-year follow-up (range, 5-14 years). The stem used was cobalt chromium with a collar, normalization steps, and a roughened surface (Ra 40); the stem was inserted using contemporary cementing techniques. This series demonstrated a femoral component aseptic loosening rate of 2.0% and a femoral component survivorship of 97.2 +/- 2.0% at 10 years. One of 2 failed stems was revised at 95 months for failure at the cement-bone interface. The second failed stem showed failure at the cement-bone interface with incomplete debonding radiographically at 65 months. The remaining femoral components did not demonstrate any evidence of debonding at the stem-cement interface. These results compare favorably with other series of cemented femoral stems, as well as with those with a polished surface.     

Charnley型人工全髋置换术后10年以上随访的X线分析

目的:通过对骨水泥固定的Charnley型人工全髋置换术患者10年以上X线随访,探讨骨水泥型人工全髋的固定效果、松动及影响寿命的因素等。方法:获得10年以上随访的38例45髋作为研究对象,平均随访14.6年。X线包括术后及最后随访时髋关节正侧位片。结果:髋臼假体松动有24髋(53％),其中明显松动(definite loosening)14髋(13％),可能松动(possible loosening)10髋(22％)。臼杯磨损共35髋(78％),平均磨损率为0.123mm/年;股骨假体柄松动有12髋(27％),其中明显松动8髋(18％),可能松动4髋(9％)。假体柄周围骨溶解18髋(40％)。本组45髋中8髋(18％)行翻修术,其中4髋因髋臼假体松动单纯髋臼假体翻修,其余4例行髋臼和股骨假体全部翻修。结论:骨水泥固定的Charnley型人工全髋置换术后10年以上长期随访结果,股骨假体的固定效果较好,但髋臼假体的固定效果并不满意。聚乙烯臼杯磨损不可避免,作为人工关节材料,聚乙烯对金属的关节组合应重新考虑。采用改良的骨水泥固定方法对人工全髋假体的早期稳定性和长期寿命非常重要。从髋臼假体的固定效果来看,金属臼(metal shell)假体的非骨水泥固定效果优于聚乙烯臼的骨水泥固定效果。     

10 year results with a cemented fine-grit-blasted titanium-aluminum-vanadium hip endoprosthesis shaft

PURPOSE: Are the results of cemented titanium hip arthroplasty as bad as described in literature? We present the 10-year results of a cemented mild grid blasted Titanium-Aluminium-Vanadium Stem in Total-Hip-Arthroplasty. METHODS: The clinical and radiological reexamination was documented in standardized questionnaire in which several scores were integrated. All X-rays were stored and analysed by a special hardware and software computer system. RESULTS: 35% of all patients could be reexamined both clinically and roentgenologically. 71 patients were male (mean age 56.1 years) and 130 female (mean age 59.3 years). The average follow-up period was 11 years and 4 months. The mean Merle d'Aubigné hip score increased from 10.5 to 16.0 points at the follow-up evaluation. Radiolucent lines were according to the zones of Gruen seen in 1% to 22% depending on the zone and the size of the femoral component. 18 reoperations of the femoral component (2.9%) had to be performed. The survivorship analysis (Kaplan-Meier) showed a 95.4% survival of the femoral component after 10 years. CONCLUSION: Our findings with a cemented mild grid blasted Titanium-Aluminum-Vanadium stem demonstrate excellent results unlike it was reported for cemented femoral components of similar alloy but different design and cementation philosophy.