Primary uncemented Harris-Galante acetabular components in patients 50 years old or younger: results at 10 to 12 years

Seventy-three patients (84 hips) 50 years or younger were treated with primary total hip arthroplasty using the Harris-Galante uncemented acetabular component. At a median followup of 10 years, there were seven acetabular metal shell revisions: five for osteolysis and one each for aseptic loosening and dislocation. There were 10 polyethylene exchanges without metal acetabular shell removal. None of the unrevised acetabular components was radiographically loose, but eight had pelvic osteolysis. The rate of 10-year survival without revision of the acetabular metal shell was 87.9% (95% confidence interval, 80.1%-95.7%). The same rate of survival without revision for aseptic acetabular component loosening was 97.3% (95% confidence interval, 92.9%-100%). Revision for aseptic acetabular loosening or polyethylene liner exchange or both was 84.5% (95% confidence interval, 75.8%-93.4%).     

Cementless total knee arthroplasty in patients 50 years or younger

Total knee arthroplasty now is being advocated for use in younger patients with posttraumatic and rheumatoid arthritis. Advances in technology, design, and materials potentially have allowed for more predictable results. There has been continued interest in cementless fixation for use in younger patients. Between 1986 and 1998, 75 total knee replacements in 57 patients 50 years or younger were done. All surgeries were done by one surgeon (AAH). There were 35 left knees and 40 right knees. The average age of the patients was 42 years (range, 31-50 years). Followup averaged 111 months. Preoperative range of motion was 5 degrees to 106 degrees and postoperative range of motion was 2 degrees to 113 degrees. Modified Hospital for Special Surgery knee scores improved from an average of 67 points preoperatively to an average of 97 points postoperatively. The majority of the diagnoses were posttraumatic arthritis or osteoarthritis (57%), indicating a young, active group of patients. There were two infections and 12 polyethylene exchanges. There were no revisions for loosening or implant failure. There was a correlation between prior knee surgeries and the need for a manipulation. Radiographically, there were no loose implants. Cementless fixation in the young patient with high physical demands was clinically reliable.     

Cementless total hip arthroplasty in patients 50 years or younger

This report examines the mean 9-year results of 100 second-generation cementless total hip arthroplasty in 91 patients 50 years or younger. The mean age at arthroplasty was 39 years (range, 14-50 years), and follow up averaged 9 years (range, 5-13 years). There were 13 revisions (7 related to polyethylene wear and/or osteolysis, 5 for instability, and 1 for infection). No femoral components were revised for loosening and none were radiographically loose. Two acetabular shells were revised for loosening secondary to extensive osteolysis. Ten-year survivorship using revision for any reason as the end point was 87.5%, using femoral component aseptic loosening as the end point was 100%, and using acetabular component aseptic loosening as the end point was 97.1%.     

Cementless alumina-on-alumina total hip arthroplasty in patients younger than 50 years: a 5-year minimum follow-up study

Sixty-seven patients (78 hips) who were younger than 50 years underwent cementless total hip arthroplasty using a porous-coated acetabular cup, an alumina liner, a 28-mm alumina head, and a proximally porous-coated femoral stem. One patient (1 hip) died and 2 patients (3 hips) were lost to follow-up. The remaining 64 patients (74 hips) were followed for 5 to 6 years. Their mean age at the index operation was 37 years. The mean Harris hip score was 94 points at the time of final follow-up. Four patients (4 hips) had mild thigh pain. All acetabular and femoral components were bone-ingrown, and neither pelvic nor femoral osteolysis was identified. No fracture of the ceramic liner or head was identified. Wear of the ceramic components was undetectable in 27 hips in which measurement was possible.     

Cementless acetabular fixation at fifteen years. A comparison with the same surgeon's results following acetabular fixation with cement

BACKGROUND: Loosening of the acetabular component is the major long-term problem associated with total hip arthroplasty with cement. The purpose of the present study was to evaluate the minimum thirteen-year results associated with cementless acetabular components that had been inserted by a single surgeon and to compare them with the results associated with cemented acetabular components that had been inserted by the same surgeon. METHODS: One hundred and twenty consecutive, nonselected primary total hip replacements were performed in 108 patients with use of a Harris-Galante-I cementless acetabular component and a cemented femoral component with a 28-mm head. The patients were evaluated clinically with use of a standard terminology questionnaire, and they were evaluated radiographically for loosening, component migration, wear, and osteolysis. The rates of revision for aseptic loosening and radiographic evidence of loosening for this cohort were compared with the rates for four previously reviewed consecutive series of hips in which the acetabular component had been inserted with cement. All patients were managed by the same surgeon, were followed for thirteen to fifteen years, and were evaluated with use of the same two criteria (revision and loosening) as the end points for Kaplan-Meier analysis. RESULTS: Sixty-six patients (seventy-two hips) were living and forty-two patients (forty-eight hips) had died after thirteen to fifteen years of follow-up. No acetabular component had been revised because of aseptic loosening, and no acetabular component had migrated. With revision of the acetabular component for any reason as the end point, the survival rate was 81% +/- 8% at fifteen years. With revision of the acetabular component for clinical failure (osteolysis, wear, loosening, or dislocation) as the end point, the survival rate was 94% +/- 8% at fifteen years. Among the seventy hips with at least thirteen years of radiographic follow-up, five had pelvic osteolysis and three had had revision of a well-fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm/yr (0.12 mm/yr when one outlier was excluded). CONCLUSIONS: In terms of fixation, Harris-Galante-I cementless acetabular components performed better than did cemented 22-mm-inner-diameter Charnley acetabular components as well as 28-mm-inner-diameter all-polyethylene and metal-backed acetabular components that had been inserted by the same surgeon. However, the rate of wear was greater in association with the Harris-Galante-I cementless components than it was in association with the Charnley cemented all-polyethylene components.     

Favorable results of acetabular reconstruction with impacted morsellized bone grafts in patients younger than 50 years: A 10- to 18-year follow-up study of 34 cemented total hip arthroplasties

We report a long-term review of 41 acetabular reconstructions using impacted morsellized bone grafts and a cemented total hip arthroplasty (THA) in patients younger than 50 (22-49; average 38) years. Reconstruction was performed in 23 primary THA (19 patients) and 18 revision THA (17 patients). 3 patients were lost to follow-up and 3 (4 hips) died within 10 years of surgery; none had a revision. Thus, 34 hips (30 patients) were reviewed with an average follow-up of 13 (10-18) years. In 2 hips, a revision was performed for aseptic loosening of the acetabular component 7 and 11 years after surgery. One additional cup was revised after 12 years during a femoral stem revision due to wear and matching problems, but was well fixed. The survival rate of the acetabular reconstruction technique was 94% (95% CI: 90-98%).     

Favorable results of acetabular reconstruction with impacted morsellized bone grafts in patients younger than 50 years: a 10- to 18-year follow-up study of 34 cemented total hip arthroplasties

We report a long-term review of 41 acetabular reconstructions using impacted morsellized bone grafts and a cemented total hip arthroplasty (THA) in patients younger than 50 (22-49; average 38) years. Reconstruction was performed in 23 primary THA (19 patients) and 18 revision THA (17 patients). 3 patients were lost to follow-up and 3 (4 hips) died within 10 years of surgery; none had a revision. Thus, 34 hips (30 patients) were reviewed with an average follow-up of 13 (10-18) years. In 2 hips, a revision was performed for aseptic loosening of the acetabular component 7 and 11 years after surgery. One additional cup was revised after 12 years during a femoral stem revision due to wear and matching problems, but was well fixed. The survival rate of the acetabular reconstruction technique was 94% (95% CI: 90-98%).     

Cementless total hip arthroplasty with a metal-on-metal bearing in patients younger than 50 years

Total hip arthroplasty (THA) longevity is the primary concern in young patients. Metal-on-metal articulations were reintroduced to reduce polyethylene particle-induced osteolysis and improve survivorship; to date, based on issued reports, this strategy appears to have been successful. In this study, the authors investigated metal-on-metal articulation survivorship and osteolysis incidence in young patients (19-50 years old at index operations) and retrospectively reviewed cementless metal-on-metal THAs in 70 patients (78 hips) with a mean follow-up of 12.4 years. Metasul articulation was used with the Wagner acetabular component in all. Survivorship with revision for any cause was 98.7% (95% confidence interval, 98%-100%), and survivorship due to the development of osteolysis for any lesion was 97.5% (95% confidence interval, 95%-99%). Mean Harris hip score improved from 51 to 95 points at final follow-up. The findings of this study indicate that outcomes of cementless THA with a metal-on-metal bearing in young patients are satisfactory. However, longer-term studies in larger cohorts are required to determine whether metal-on-metal articulations are really a favorable option in young patients.     

Cementless acetabular revision. Evaluation at an average of 10.5 years

This study reviews the clinical and radiographic results of 138 consecutive cementless acetabular revisions in 131 patients performed for aseptic loosening at a mean of 10.5 years followup. Kaplan-Meier survivorship of these components was 84% at 11.5 years. Two components (1.8%) in two patients were considered aseptically loose based on radiographic criteria; one patient was symptomatic but the component was not revised because of the patient's poor health, and the other patient was asymptomatic. Pelvic osteolysis was present in 19 hips (17%), appearing at a mean of 103 months. All but two of these were small lesions (< 2 cm) at the periphery of the components. Nevertheless, the incidence of osteolysis has increased with time, and continued followup is warranted. Separation or fragmentation of the fiber-metal porous pads was uncommon (8.3%), but was significantly associated with pelvic osteolysis; this finding has not been reported before with this component. Five patients underwent late revision surgery (after 100 months), one for deep infection, one for periprosthetic femur fracture, and three for late recurrent dislocation. Harris hip scores averaged 81 points (good) at final followup, which is unchanged from the authors' last report on this group. Acetabular revision with a fiber-metal hemispherical component appears durable at a mean followup of more than 10 years.     

Ten- to twelve-year follow-up of the furlong hydroxyapatite-coated femoral stem and threaded acetabular cup in patients younger than 65 years

We reviewed 82 patients who had 92 primary Furlong uncemented hydroxyapatite (HA)-coated total hip replacements inserted between 1988 and 1992. All patients had the Furlong HA-coated stem and screw in acetabular cup with a 28-mm alumina oxide ceramic modular head. The mean age at the time of primary total hip arthroplasty was 54 years (range, 31-67 years). At 10 years, we reviewed 64 patients (72 total hip arthroplasties). Eight had died (10 total hip arthroplasties), 3 could not attend for follow-up, 2 were lost to follow-up, and 5 were revised (2 for infection and 3 for acetabular loosening and recurrent dislocation). We conclude that the Furlong HA-coated total hip replacement is a good prosthesis for patients younger than 65 years, with a cumulative survival rate of 94.29% at 10 to 12 years using revision as the end point.     

Total hip arthroplasty in patients 50 years and younger

Because the young patient with a total hip arthroplasty is presumed to place increased demands on a reconstruction for a longer period than the average patient with a hip replacement, long-term results are expected to be inferior. To determine the efficacy of total hip replacements in this population, the current authors reviewed the long-term results of patients who were 50 years and younger who had cementless total hip arthroplasties at their institution, and reviewed the literature on total hip arthroplasty in younger patients. The results from the study population and the literature were encouraging. At the author's institute, during the past 20 years, 561 hip replacements were done on 488 patients in this age group, using extensively porous-coated cobalt-chromium stems matched with beaded, press-fit acetabular components of cobalt-chrome or titanium. Using the Kaplan-Meier technique, the survival rates for femoral and acetabular components, using any revision as an end point, were 89% at 10-year followup and 60% at 15-year followup. A subset of the authors' patients who were 40 years and younger (256 hips, 223 patients) had slightly inferior results, with 85% 10-year survivorship and 54% 15-year survivorship, using any revision as an end point. A comprehensive literature review also showed that long-term success can be achieved with cemented or cementless total hip arthroplasties in young patients. Because some reconstructions exhibited inferior results in younger patients, the authors recommend that surgeons be much more critical of the components used in these patients and allow long-term data to guide their decisions.     

Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years

There have been comparatively few studies of the incidence of osteolysis and the survival of hybrid and cementless total hip replacements (THRs) in patients younger than 50 years of age. We prospectively reviewed 78 patients (109 hips) with a hybrid THR having a mean age of 43.4 years (21 to 50) and 79 patients (110 hips) with a cementless THR with a mean age of 46.8 years (21 to 49). The patients were evaluated clinically using the Harris hip score, the Western Ontario and McMaster Universities (WOMAC) osteoarthritis score and the University of California, Los Angeles (UCLA) activity score. Radiographs and CT scans were assessed for loosening and osteolysis. The mean follow-up was for 18.4 years (16 to 19) in both groups. The mean post-operative Harris hip scores (91 points versus 90 points), the mean WOMAC scores (11 points versus 13 points) and UCLA activity scores (6.9 points versus 7.1 points) were similar in both groups. The revision rates of the acetabular component (13% versus 16%) and the femoral component (3% versus 4%), and the survival of the acetabular component (87% versus 84%) and the femoral component (97% versus 96%) were similar in both groups. Although the long-term fixation of the acetabular metallic shell and the cemented and cementless femoral components was outstanding, wear and peri-acetabular osteolysis constitute the major challenges of THR in young patients.     

Cementless total knee replacement in patients 50 years old and under

In this article, the authors present their initial experience with a cementless total knee prosthesis implanted in a young, active group of patients. The results compare favorably to reported cemented series.     

非骨水泥型全髋关节成形术在小于60岁国人中应用的研究（英文）

目的探讨非骨水泥型全髋关节成形术（THA）在小于60岁国人中应用的长期结果。方法从1998年到2001年,一项前瞻性调查58例初次THA在小于60岁患者的结果,平均随访时间为11.1年（3.3~13.3年）。结果本组患者手术前的Harris评分平均为36.9（6~62）分,在最后评估的Harris评分平均为88.3（35~100）分。采用无菌性松动为失败标准,这种非骨水泥型THA在13.3年的假体生存率为97.9%。结论非骨水泥型THA在小于60岁患者有优良的长期结果。     

16- to 25-year follow-up study of cemented arthroplasty of the hip in patients aged 50 years or younger

The clinical outcome of the cemented Charnley hip arthroplasty at follow-up periods of 16–25 years was evaluated retrospectively in patients aged 50 years or younger. One hundred thirty-two of a total of 167 hip arthroplasties were studied. The overall probability of survival of the implant at 20 years was 75%. Survival of those with rheumatoid disease was 80% compared with 64% for those with osteoarthritis. Female sex was associated with a better prognosis. Accelerated wear was associated with decreased survival of the prosthesis. Varus orientation of the femoral component significantly influenced failure (P < .01). Radiographic loosening of the acetabular component was well tolerated, but loosening of the femoral component was significantly associated with pain (P = .01)     

Ankle arthroplasty in patients younger and older than 50 years: a prospective series with long-term follow-up.

One hundred consecutive cases treated with ankle arthroplasty for osteoarthritis (OA) or rheumatoid arthritis were followed prospectively and annually for up to 15 years. Survivorship analysis was performed, with the endpoint being prosthesis revision or change to arthrodesis. Patients who were younger than 50 years at the first implantation constituted one group (group A, 30 ankles). The other group (group B, 70 ankles) consisted of patients aged 50 years or older at the first implantation. All patients were assessed clinically according to the Kofoed Ankle Score. The distribution of OA/rheumatoid arthritis in group A was 18/12, and in group B it was 43/27 (not significant). The median age in group A was 46 years (range, 22-49 years), and in group B it was 63 years (range, 51-83 years). In group A, one case was revised, and three cases were converted to arthrodesis after a median of 5 years (range, 5-9 years). In group B, four cases were revised, and four cases were converted to arthrodesis after a median of 5.5 years (range, 2-8 years). The results of cases with traumatic OA did not differ between groups A and B. It was concluded that the results of ankle arthroplasty were of equal quality in patients younger than 50 years and those who were older.     

Cementless hemispheric acetabular component for acetabular revision arthroplasty: a 5- to 19-year follow-up study

This study evaluated the 5- to 19-year clinical and radiographic results of cementless acetabular revision. Between 1986 and 1998, 130 hips (125 patients) underwent cementless acetabular revisions. Ten patients were lost to follow-up; 6 patients died. One hundred nine patients (114 hips) were reviewed at a mean follow-up of 8.8 years. The mean Harris hip score improved from 62.1 to 90.7 at final follow-up. Two hips underwent repeat revision. Twenty-two hips developed cavitary osteolysis. Kaplan-Meier survivorship at 121 months was 98.2% with repeat revision for any reason as the end point and 89.5% with repeat revision or radiographic loosening as the end point. Cementless acetabular revision provides favorable clinical and radiographic results, and the initial disease and age may adversely affect the outcomes.     

5- to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger

Seventy-two cemented total knee arthroplasties were performed on 52 patients who were 55 years old or younger. Results on 68 knees in 50 patients with an average follow-up period of 9.92 years are reported. The average age of the patients was 50.7 years (range, 30–55) at the time of surgery. The diagnosis was osteoarthritis in 37 knees, rheumatoid arthritis in 29 knees, and ankylosing spondylitis in 2 knees. The average preoperative Knee Society knee score was 23, and the average follow-up knee score was 97. All knees were rated as good or excellent for knee score. The average latest function score was 75 (preoperative, 36). Both knees in one patient required revision for loose components. This review demonstrates that cemented total knee arthroplasty in younger patients with osteoarthritis and rheumatoid arthritis can attain results comparable to the excellent results obtained in the older age groups.