Radiological features predictive of aseptic loosening in cemented Charnley femoral stems

The radiological features of the cement mantle around total hip replacements (THRs) have been used to assess aseptic loosening. In this case-control study we investigated the risk of failure of THR as predictable by a range of such features using data from patients recruited to the Trent Regional Arthroplasty Study (TRAS). An independent radiological assessment was undertaken on Charnley THRs with aseptic loosening within five years of surgery and on a control group from the TRAS database. Chi-squared tests were used to test the probability of obtaining the observed data by chance, and odds ratios were calculated to estimate the strength of association for different features. Several features were associated with a clinically important increase (>twofold) in the risk of loosening, which was statistically significant for four features (p < 0.01). Inadequate cementation (Barrack C and D grades) was the most significant feature, with an estimated odds ratio of 9.5 (95% confidence interval 3.2 to 28.4, p < 0.0001) for failure.     

Long-term results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years

The results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years are presented. Eighty-three arthroplasties were performed on 55 patients with an average age of 24.9 years (range, 17–29 years) and an average follow-up period of 240 months (20 years; range, 62–360 months). There were 2 nonfatal pulmonary emboli, 2 cases of deep sepsis, and 3 fractured femoral implants. Twenty-eight acetabular components migrated (34%), 25 have been revised (30%), and the average annual acetabular wear rate was 0.12 mm. Sixteen femoral implants subsided (19%), and fracture of the tip of the cement mantle occurred in 8 hips (10%). Nineteen femoral components (23%) were revised; femoral osteolysis was seen in 15 hips (18%) and changes in the calcar in 33 (38%). Acetabular component survivorship was 92% (95% confidence interval, 85–98%) at 10 years, 70% (60–81%) at 20 years, and 68% (57–79%) at 25 years, with the figures for the femoral implant being 93% (87–98%), 76% (66–86%), and 73% (62–85%), respectively.     

Cementless revisions of failed aseptic cemented and cementless total hip arthroplasties. 284 cases

Over the past 13 years, 284 revisions of aseptic total hip arthroplasty failures have been performed with cementless implants. There were 213 cases involving cemented implant failures and 71 involving cementless ones. Considered as salvage procedures, these revisions provided a satisfactory result in about 70% of the reviewed patients after five years. A biologic fixation by bony ingrowth can be expected under certain conditions from decorticated living bone, a tight mechanical fitting, and a retentive corrugated surface of the implant. A prosthetic reimplantation, safely done without cement, appears more economical for the bone stock and prevents the long-term complications related with cement. Bone grafts are often required but cannot ensure the incoming osteogenic fixation of the implant. Long-term results and complications mandate harmless extractability of the revisional implant, a forged stem, an easy exchange of the plastic liner (in a two-part acetabular component), and an updated low-friction system (high-density polyethylene wear being a potential long-term problem).     

Long-term results of bilateral Charnley total hip arthroplasty

The results of 58 bilateral Charnley total hip arthroplasties in 29 patients operated on were assessed at an average of 62 and 145 months after operation (5-year and 10-year follow-up evaluations). At the 5-year follow-up evaluation, 96% of the available hips were graded as clinically successful. At 10 years, 94% of the successes at 5 years were again thus graded. All clinical failures (4) were caused by fracture of the stem.     

Long-term results of Charnley low-friction arthroplasty of the hip

The long-term results of 73 Charnley low-friction arthroplasties with follow-up of 10-14 years are presented. Eight hips required revision for socket migration resulting from excessive medialisation of the cup (2, 2.7%); breakage of the femoral stem (5, 6.8%); and loosening (1). A further 5 hips had radiological changes suggesting that they would require revision in the foreseeable future. Sixty hips (82.2%) remained clinically excellent with minimal radiological changes.     

Long-term results of cemented total knee arthroplasty

Excellent long-term results recently have been reported for cemented total knee arthroplasties. This success results from well-established principles of surgical technique, implant materials, and prosthetic design. These are described in their historical context.     

Long-term results of cemented total hip arthroplasty

Long-term results of total hip replacement by low-friction arthroplasty show a consistent and reproducible outcome for relief of pain, increased mobility, and function in most patients followed for five to 15 years after surgery. In a review of 1009 consecutive operations, the rate of reoperation and potential failures for mechanical and infectious causes was 4.5%, which compares favorably with similar results in the literature. Seven series of operations employing the Charnley low-friction arthroplasty technique were compared. The failure rate was less than 10% in these series, provided that the operations had been performed either at a center dedicated to hip arthroplasty or by a surgeon devoting his career to hip replacement surgery.     

Long-term clinical results of cemented revision of primary cemented total hip arthroplasties

Seventy-six patients who had undergone revision of a cemented total hip replacement were reviewed with an average follow-up of almost ten years. The average age at primary total hip replacement (PTHR) was 63.3 years. The average time between primary total hip replacement and revision was 62.5 months. Revision surgery was performed without using special techniques such as acetabulum reconstruction or femoral bone grafting. We evaluated patients pre- and postoperatively using the Merle d'Aubigné-Postel(M d'A) hip score. Clinically we observed an improvement of the hip score after total hip revision, particularly regarding pain. Thirty hips required a second, and six a third revision. If re-revision is used as an end-point, our results are unsatisfactory, as we had a cumulative failure rate of 54% after 12 years. This is mainly due to not using special techniques adapted to revision situations.     

Long-term results after revisions of failed primary vertical banded gastroplasty

AIM: To compare the results after revision of primary vertical banded gastroplasty(Re-VBG) and conversion to sleeve gastrectomy(cS G) or gastric bypass(cR YGB).METHODS: In this retrospective single-center study, all patients with a failed VBG who underwent revisional surgery were included. Medical charts were reviewed and additional postal questionnaires were sent to update follow-up. Weight loss, postoperative complications and long-term outcome were assessed. RESULTS: A total 152 patients were included in this study, of which 21 underwent Re-VBG, 16 underwent c SG and 115 patients underwent c RYGB. Sixteen patients necessitated a second revisional procedure. No patients were lost-to-follow-up. Two patients deceased during the follow-up period, 23 patients did not return the questionnaire. Main reasons for revision were dysphagia/vomiting, weight regain and insufficient weight loss. Excess weight loss(%EWL) after Re-VBG, cS G and cR YGB was, respectively, 45%, 57% and 72%. Eighteen patients(11.8%) reported postoperative complications and 27% reported long-term complaints. CONCLUSION: In terms of additional weight loss, postoperative complaints and reintervention rate, Rouxen-Y gastric bypass seems feasible as a revision for a failed VBG.     

Similar outcomes between two-stage revisions for infection and aseptic hip revisions

Purpose

Two-stage revision hip arthroplasty using an antibiotic-loaded spacer is the most widely performed procedure for infected hip arthroplasties. The clinical outcome of this type of surgery compared with aseptic joint revision with exchange of femoral and acetabular components is still controversial due to the relative lack of medium- to long-term follow-up. Therefore, we analysed clinical and radiological outcomes of septic two-stage revisions compared with aseptic hip revision surgeries.

Methods

In this retrospective study we assessed 82 consecutive patients who underwent two-stage revision for septic total hip (45 patients) or one-stage aseptic revision arthroplasty (37 patients). The average follow-up was 53 months for the aseptic group and 55 months for the septic group. For clinical evaluation, we used the Harris Hip Score (HHS) and the Merle d’Aubigné and Postel score. The postoperative pain level was determined with the visual analogue pain scale.

Results

The surgeries were performed 124 months (aseptic group) and 119 months (septic group) after primary total hip arthroplasty on average. The main indications for aseptic revision surgeries were aseptic loosening (96 %), dislocation (2.2 %), and periprosthetic fracture (2.2 %). In the clinical outcome patients achieved 75.5 points in the aseptic group and 73.4 points in the septic group in the Harris Hip Score. The Merle d’Aubigné and Postel Score revealed 12.5 points for the aseptic group and 13.1 points for the septic group. Mean level of persisting pain was 0.8 (aseptic group) and 0.4 (septic group) on the visual analogue scale (VAS). Overall survival in the aseptic group was 85.6 % at 9.8 years 82.7 % at 10.1 years for the septic group, with a repeat revision rate of 8.1 % and 6.7 %, respectively.

Conclusions

Performing aseptic acetabular and femoral revision hip arthroplasty showed equal clinical outcomes in relation to septic two-stage revision hip surgeries. Our results showed a tendency for better outcome in comparison with the information given in the literature for septic and nonseptic exchange arthroplasties, including a lower rate of re-revisions.

     

Loosening of the Charnley hip Radiographic analysis of 102 revisions

This retrospective study was based on 102 Charnley hip arthroplasties that underwent a revision operation. Radiographs of hips with loose prosthetic components were compared with those with firm components. Migration and tilting of the socket and subsidence and varus shift of the stem were associated with loosening.     

Charnley low-friction arthroplasty of the hip. Long-term results in South Africa

Long-term results of 98 Charnley low-friction arthroplasties were followed for a period of a mean of 12 years; 98 of 470 operations qualified for this strict long-term study, 78 (79.6%) with excellent results. If excessive medialization of the cup is avoided, socket complications appear to be minimal (4%). The majority of femoral component failures resulted from femoral stem breakage. Only four hips (4.08%) developed loosening of the femoral stem.     

Loosening of the Charnley hip. Radiographic analysis of 102 revisions

This retrospective study was based on 102 Charnley hip arthroplasties that underwent a revision operation. Radiographs of hips with loose prosthetic components were compared with those with firm components. Migration and tilting of the socket and subsidence and varus shift of the stem were associated with loosening.     

Survivorship of the Charnley Elite Plus cemented femoral stem

We report the results of the Charnley Elite Plus femoral stem in multiple surgeons hands at a minimum of 3 years after implantation. Over a 4-year period, 244 patients underwent 268 primary hip arthroplasty procedures using this particular stem. Patients underwent postal and radiographic review at a mean of 4.5 (3.0–6.8) years following their arthroplasty. There were five revision procedures for aseptic loosening (5/268; 1.9%). Radiological assessment revealed gross radiological failure in a further 12 femoral stems (12/208; 5.8%). In the best case scenario, using revision for aseptic loosening as the endpoint, the survivorship for this period was 98.1%. If radiographic failures are incorporated into this endpoint, survivorship is 93.1%. This failure rate at an early stage raises concerns as to the long-term survivorship of this prosthesis.

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Résumé Nous rapportons les résultats de la tige fémorale Charnley Élite Plus dans les mains de multiples chirurgiens après un minimum dimplantation de trois années. Sur une période de quatre années, 244 malades ont subi 268 arthroplasties primaires de la hanche utilisant cette tige particulière. Les malades ont eu un examen postal et radiographique à une moyenne de 4,5 ans (3,0–6,8) aprés leur arthroplastie. Il y avait cinq révisions pour descellement aseptique (5/268 : 1,9%). Lestimation radiologique a révélé un échec certain pour 12 tiges fémorales supplémentaires (12/208 : 5,8%). Dans le meilleur scénario, en utilisant la révision pour descellement aseptique comme point final, la survie pour cette période est de 98,1%. Si les échecs radiographiques sont incorporés comme événement final, la survie est de 93,1%. Ce taux déchec à un stade précoce de lévolution est une inquiétude pour la survie à long terme de cette prothèse.

     

Long-term results of cemented Steffee arthroplasty of the thumb metacarpophalangeal joint

A retrospective evaluation of the Steffee metacarpophalangeal (MCP) thumb joint prostheses was performed to determine the long-term outcome and survivorship of the prosthesis. Fifty-four primary thumb arthroplasties (49 patients) were performed for pain, weakness, or instability involving the thumb MCP joint secondary to arthritis. Underlying etiology included rheumatoid (49 thumbs), psoriatic (1 thumb), scleroderma (2 thumbs), and degenerative (2 thumbs) arthritis. Thirty-one thumbs had concomitant interphalangeal joint instability and underwent interphalangeal joint fusions. At an average follow-up period of 57 months, the average motion of the MCP joint was 21 degrees (range, 0 degrees to 40 degrees ), with a significant improvement in position and stability. Thumb axis length was maintained or increased in 98%. Although there was not a consistent long-term improvement in grip or pinch strength, 87% of the patients reported subjective improvement in strength and function as a result of surgery. Pain was relieved in all thumbs with preoperative pain. Complications included a periprosthetic fracture, 2 late infections, and 1 gross loosening of the implant. The survivorship of the implant was 93% survivorship at 5 years and 89% survivorship at 10 years, with only 4 failures in 54 thumbs. The Steffee thumb MCP arthroplasty resulted in excellent long-term survivorship, patient satisfaction, and functional outcome.     

Acetabular reconstruction with impacted bone allografts and cemented acetabular components: a 2- to 13-year follow-up study of 142 aseptic revisions

We reviewed the clinical and radiological results of 131 patients who underwent acetabular revision for aseptic loosening with impacted bone allograft and a cemented acetabular component. The mean follow-up was 51.7 months (24 to 156). The mean post-operative Merle D'Aubigné and Postel scores were 5.7 points (4 to 6) for pain, 5.2 (3 to 6) for gait and 4.5 (2 to 6) for mobility. Radiological evaluation revealed migration greater than 5 mm in four acetabular components. Radiological failure matched clinical failure. Asymptomatic radiolucent lines were observed in 31 of 426 areas assessed (7%). Further revision was required in six patients (4.5%), this was due to infection in three and mechanical failure in three. The survival rate for the reconstruction was 95.8% (95% confidence interval 92.3 to 99.1) overall, and 98%, excluding revision due to sepsis. Our study, from an independent centre, has reproduced the results of the originators of the method.     

Human leukocyte antigen and aseptic loosening in Charnley total hip arthroplasty

Human leukocyte antigen phenotypes and radiographic course were studied in 70 Japanese patients (90 hips) who had Charnley low friction arthroplasty. Of the 28 hips diagnosed as radiographically loose less than 15 years after surgery, seven hips (25.0%) were in patients who had a positive human leukocyte antigen A31(19). Of the 62 hips that were radiographically stable more than 15 years, two hips (3.2%) were in patients who had a positive human leukocyte antigen A31(19). Of the nine hips in patients who were positive to human leukocyte antigen A31(19), seven hips were diagnosed as radiographically loose (loosening rate was 77.8%) 15 years after surgery. On the other hand, of the 81 hips in the patients who were negative to human leukocyte antigen A31(19), only 21 hips were diagnosed as radiographically loose (loosening rate was 25.9%) 15 years after surgery. These data suggest that individual immune response to implant materials, linked to human leukocyte antigen, may participate in the process of aseptic loosening in Charnley low friction arthroplasty.     

Long-term function after Charnley total hip arthroplasty

The purpose of this study was to report the functional results and mortality rates of a consecutive series of patients younger than 50 years after Charnley total hip arthroplasty. The original group of 69 patients (93 hips) was followed up until death or a minimum of 25 years after surgery. Of the original 93 hips, 29 had been revised at some point. Functional outcomes included the Short Form-36, Western Ontario and McMaster University University Osteoarthritis Index (WOMAC), 6-minute walk distance, Noyes activity scale, and Harris hip scores and included followup in 42 of 43 living patients. The functional outcome of patients was good, with comparable Short Form-36 scores compared with normative values of healthy age-matched subjects. The 6-minute walk distances and WOMAC scores were slightly lower than healthy normatives but were thought to be influenced by medical comorbidities. Although comorbid medical and musculoskeletal conditions significantly hindered most measures of function, revision surgery or radiographic loosening of components had no significant influence on function. The mortality rates of this cohort of patients were similar to normative values at both 10 and 25 years after surgery.     

Prediction of Charnley femoral stem aseptic loosening by early post-operative radiological features

We describe the association between immediate post-operative radiological appearances and early aseptic failure of total hip replacement. Sixty-three hips were entered into the aseptic failure group and 138 into the control group. Alignment of the femoral stem was not associated with failure (p=0.283). Thickness of the cement mantle was associated with failure in Gruen zones 6 (p=0.040) and 7 (p=0.003). A significant association for the presence of radiolucent lines was found for Gruen zones 3 (p=0.0001) and 5 (p=0.0001). Grade of cementation was associated with failure for Barrack grades C (p=0.001) and D (p=0.001). This study has demonstrated that easily applied radiological criteria can be used to identify hip arthroplasties at risk from the immediate post-operative radiograph.

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Résumé Nous décrivons lassociation entre laspect radiologique postopératoire immédiat et léchec aseptique précoce de larthroplastie totale de la hanche. Soixante-trois hanches sont entrées dans le groupe de léchec aseptique et 138 dans le groupe témoin. Lalignement de la tige fémorale nétait associé à l› échec (p=0.283). Lépaisseur du manteau de ciment était associé à l› échec dans les zones de Gruen 6 (p=0.040) et 7 (p=0.003). Une association significative a été trouvée avec la présence de liserés dans les zones de Gruen 3 (p=0.0001) et 5 (p=0.0001). Le niveau de cimentation a été associé à léchec pour les grades C (p=0.001) et D (p=0.001) de Barrack. Cette étude montre que des critères radiologiques simples peuvent être utilisés pour identifier les ‹ arthroplasties à risque› sur les clichés post-opératoires immédiats.