The Harris-Galante uncemented femoral component in primary total hip replacement at 10 years

Eighty-eight primary femoral reconstructions in 80 patients were performed with the Harris-Galante uncemented femoral stem by 1 surgeon between March 1984 and December 1987. Seventy-seven femoral components in 72 patients were followed for an average 126 months or until femoral revisions. The average age at operation was 54 years (range, 30-70 years). Fifty-two patients were men, and 20 were women. The present article documents the incidence of femoral osteolysis and femoral revision in this series of this type of femoral component at an average of 10 years. Fifteen femoral components (15 of 77, 19%) were revised, 14 (14 of 77, 18%) for aseptic loosening, osteolysis, or fracture through osteolysis. The remaining 62 femoral components were functioning well (average Harris Hip Score 89 points), but 7 (11%) were loose, and 32 (52%) had femoral endosteal lysis. Overall, 19 (25%) were revised or loose, and 46 (46 of 77, 60%) had lysis. The high incidence of femoral lysis and aseptic loosening with this early design of uncemented femoral stem continues to increase at 10-year follow-up.     

Survival analysis of an uncemented ceramic acetabular component in total hip replacement

Follow-up examinations of 67 implants of cement-free ceramic sockets show the need for an exact definition of failure, to warrant comparable evaluations of results. Statistical survival analysis offers the possibility of presenting both the incidence of failures and the dates of their occurrence. If only revision surgery with removal of the socket is considered to be a failure, our material shows the "survival quota" of the ceramic socket after 8 years to be 96.7% +/- 2.2%. If radiological signs of loosening are included in the evaluation of failures, the "survival quota" of the stable implants is reduced to 81.9% +/- 6.9%.     

Survival analysis of an uncemented ceramic acetabular component in total hip replacement

Summary Follow-up examinations of 67 implants of cement-free ceramic sockets show the need for an exact definition of failure, to warrant comparable evaluations of results. Statistical survival analysis offers the possibility of presenting both the incidence of failures and the dates of their occurrence. If only revision surgery with removal of the socket is considered to be a failure, our material shows the survival quota of the ceramic socket after 8 years to be 96.7% ± 2.2%. If radiological signs of loosening are included in the evaluation of failures, the survival quota of the stable implants is reduced to 81.9% ±6.9%.

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Zusammenfassung Anhand der Nachuntersuchung von 67 zementfrei implantierten keramischen Füßchenpfannen wird die Notwendigkeit der genauen Definition des Fehlschlages aufgezeigt, um dadurch eine vergleichbare Beurteilung der Ergebnisse zu gewährleisten. Die statistische Methode der Überlebenszeitanalyse bietet die Möglichkeit, sowohl die Häufigkeit der Fehlschläge als such den Zeitpunkt ihres Auftretens darzustellen. Wird ausschließlich die Reoperation mit Austausch der Pfanne als Fehlschlag bewertet, so ergibt sich im eigenen Material nach 8 Jahren eine Überlebensquote der keramischen Pfanne von 96,7% ± 2,2. Werden zusätzlich radiologische Lockerungszeichen in die Fehlschlagbeurteilung aufgenommen, so reduziert sich die Überlebensquote der stabilen Implantate auf 81,9% ± 6,9.

     

Bulk femoral-head autografting in uncemented total hip arthroplasty for acetabular dysplasia: results at 8 to 11 years follow-up

Acetabular dysplasia causes difficulty in achieving adequate coverage of the acetabular component during total hip arthroplasty (THA). Bulk femoral-head autografting is one technique that has been used to achieve better coverage of the acetabular component. Long-term follow-up studies have shown a significant failure rate when this technique has been used in conjunction with a cemented acetabular component; however, with uncemented components, early results have been encouraging. In our study, 15 patients with acetabular dysplasia underwent uncemented THA, during which bulk femoral-head autografts were used. At an average follow-up of 10 years, no cases required revision, and radiologically, the bone graft had united. Our results support the use of bulk femoral-head autografting in patients with acetabular dysplasia requiring hip arthroplasty.     

Mid-term results with primary uncemented total hip replacement: a 7- to 11-year follow-up

We reviewed 102 uncemented total hip replacements (THRs) in 90 patients with a mean age of 66 years (range, 33–87 years) and with an average postoperative follow-up period of 8.5 years (range, 7–11 years). The patients were prospectively observed clinically using the Harris hip score (HHS). The excellent and good results totaled over 90%. We had two serious complications treated by revisions, one for an “alarming” stem migration and a second one for an improper stem neck height. We had one late infection, and one early postoperative death. We had no mechanical loosenings or osteolysis. We found a common, up to 2 mm, slow migration of the cup and stem during the first 2 postoperative years. This was symptomless and was considered to be adaptive. Early, rapid, painful, severd, progressive, multidirectional migration is of concern. We used this uncemented prosthesis for patients of all ages. The rate of radiolucent, non-sclerotic demarcation was minimal (2%), limited, less than 2 mm wide and resolving. The occurrence of thigh pain was minimal (2%) and resolved. We believe that our results reflect the properties of this prosthesis and our surgical technique. Received: 14 January 2000/Accepted in revised form: 15 April 2000     

The concentric all-polyethylene Exeter acetabular component in primary total hip replacement

We report the outcome of the flangeless, cemented all-polyethylene Exeter acetabular component at a mean of 14.6 years (10 to 17) after operation. Of the 263 hips in 243 patients, 122 prostheses are still in situ; 112 patients (119 hips) have died, 18 hips have been revised, and three patients (four hips) were lost to follow-up. Radiographs at the final review were available for 110 of the 122 surviving hips. There were acetabular radiolucent lines in 54 hips (49%). Two acetabular components had migrated but neither patient required revision. The Kaplan-Meier survivorship at 15 years with 61 hips at risk with revision for any cause as the endpoint was 89.9% (95% confidence interval (CI) 84.6 to 95.2) and for aseptic loosening of the acetabular component or lysis 91.7% (95% CI 86.6 to 96.8). In 210 hips with a diagnosis of primary osteoarthritis, survivorship with revision for any cause as the endpoint was 93.2% (95% CI 88.1 to 98.3), and for aseptic loosening of the acetabular component 95.0% (95% CI 90.3 to 99.7). The cemented all-polyethylene Exeter acetabular component has an excellent long-term survivorship.     

Primary total hip replacement with a noncemented acetabular component: minimum 5-year clinical follow-up

The results of 123 total hip replacements with a noncemented Harris-Galante I acetabular component were reviewed (minimum 5-year clinical follow-up). The average clinical follow-up was 7 years (range, 5-10.8 years). No acetabular components were revised for loosening. One cup was revised for recurrent dislocation. In 3 cases, the acetabular liner was replaced at the time of femoral component revision (aseptic loosening), and in 1 case, a liner was revised because of recurrent dislocations. Of the hips, 92 had a complete set of radiographs for analysis. None of the acetabular components had migrated. Of the 92 acetabular components, 90 were considered radiographically stable (98%). Of these hips, 24 had linear radiolucencies of < or =2 mm in < or =2 of 4 zones and were considered stable. Two cups (2%) were considered possibly unstable. One of these had a linear radiolucent line in 3 zones, and the other had an osteolytic lesion measuring 6 x 11 mm in greatest dimensions. No acetabular components were definitely unstable. The average Harris Hip Score improved from 50 points (range, 17-89 points) preoperatively to 95 points (range, 74-99 points) at the latest follow-up examination. The average Hospital for Special Surgery hip score improved from 21 points (range, 10-31 points) preoperatively to 38 points (range, 27-40) at the last follow-up examination. Noncemented acetabular fixation with the Harris-Galante I component showed excellent clinical results at a minimum of 5 years' follow-up.     

The Ring uncemented plastic-on-metal total hip replacement. Five-year results

The Ring plastic-on-metal total hip replacement was introduced with the intention of combining the advantages of the cemented low-friction arthroplasty with those of a cementless system. Fourteen hundred and eighty-eight of these procedures have been reviewed. The results of a two to seven-year follow-up, and of a group which has completed at least five years are presented. There was an excellent clinical result in 93% of the whole series, and in 87% of the five-year group. When graded on the Charnley scale there was an average score of 5.86 for pain, 5.96 for function and 5.9 for range of movement, which compares favourably with cemented replacements. The deep infection rate was zero, and the revision rate 1.5% for the whole series. Erosive problems occurred with the smaller acetabular components and the reasons are discussed. The ease and success of exchange have been maintained.     

Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft: results at a mean follow-up of 8.7 years

We retrospectively evaluated 42 hips which had undergone acetabular reconstruction using the Kerboull acetabular reinforcement device between September 1994 and December 1998. We used autogenous bone chips from the ilium and ceramic particle morsellised grafts, even in large acetabular bone defects, in the early stages of the study. Thereafter, femoral head allograft was used as bulk graft in patients with large acetabular defects. Ceramic blocks and the patients' contralateral femoral head were also used as bulk graft. The mean follow-up period was 8.7 years (4.3 to 12). Survivorship analysis was performed using radiological failure of the acetabular component, irrespective of whether it was revised, or not, as the end-point. The survival rate of the morsellised graft group (25 hips) and the bulk graft group (17 hips) at ten years was 53% (95% confidence interval (CI) 42.5% to 63.5%) and 82% (95% CI 72.4% to 91.6%), respectively. The mid-term results of revision total hip replacement with the Kerboull device were better when bulk graft was used in any size of bone defect.     

Alumina ceramic-on-ceramic total hip replacement with a layered acetabular component

A modular layered acetabular component (metal-polyethylene-ceramic) was developed in Japan for use in alumina ceramic-on-ceramic total hip replacement. Between May 1999 and July 2000, we performed 35 alumina ceramic-on-ceramic total hip replacements in 30 consecutive patients, using this layered component and evaluated the clinical and radiological results over a mean follow-up of 5.8 years (5 to 6.5). A total of six hips underwent revision, one for infection, two for dislocation with loosening of the acetabular component, two for alumina liner fractures and one for component dissociation with pelvic osteolysis. There were no fractures of the ceramic heads, and no loosening of the femoral or acetabular component in the unrevised hips was seen at final follow-up. Osteolysis was not observed in any of the unrevised hips. The survivorship analysis at six years after surgery was 83%. The layered acetabular component in our experience, has poor durability because of unexpected mechanical failures including alumina liner fracture and component dissociation.     

解剖型羟基磷灰石喷涂Ribbed股骨柄和臼杯全髋关节置换术患者的8年随访观察

目的探讨解剖柄羟基磷灰石(HA)涂层Ribbed髋假体行全髋关节置换(THA)术后的中期疗效。方法自1999年6月至2002年5月,采用解剖柄HA涂层Ribbed髋假体施行非骨水泥固定THA手术患者126例,获随访71例84髋,男29例,女42例;年龄39～76岁,平均58岁。术前诊断包括股骨头缺血坏死18例(双侧9例),股骨颈骨折23例,髋关节发育不良14例(双侧4例),髋关节骨关节炎16例。术后7～10d,6个月和每年1次随访X线拍片,对髋关节功能依末次随访状况行Harris评分。结果依末次随访时取Harris评价法,获85～100分39例(46髋),75～84分32例(38髋)。轻微大腿痛3例3髋(4.2%),X线片显示轻微骨吸收3例(3髋)(4.2%),无一患髋需行翻修术。术后1～2年内股骨柄下沉1.5～2mm者2例(3髋),下沉2～2.5mm者1例(1髋),此后再无发现明显下沉患者。术后6个月至3年X线显示于HA涂层部位近段骨吸收于Gruen5、6区2例(2髋)和3、5区1例(1髋),所有患者的骨锚固和松质骨、皮质骨骨密度轻度增高现象,显示髋假体-骨固定良好。结论解剖柄HA涂层Ribbed髋假体的初始固定能促进早期骨长入达到生物固定目标,并阻遏聚乙烯磨屑髓内迁徙致大腿痛和骨吸收,其中期疗效肯定。     

Primary total hip arthroplasty with a flanged, cemented all-polyethylene acetabular component: evaluation at a minimum of 20 years

One hundred twenty-three consecutive primary total hip arthroplasties in 107 patients were performed with the insertion of a cemented, all polyethylene, flanged acetabular component. At a minimum of 20 years, 66 patients had died (75 hips) and 8 patients (8 hips) were lost to follow-up evaluation, leaving 40 hips in 33 patients. At a mean of 21.1 years, 2 cups had been revised for aseptic loosening, one well-fixed cup was revised at the time of femoral component revision, and 4 additional cups had definite evidence of radiographic loosening. Survivorship analysis revealed a 77.3% survivorship for the component at 21 years, with revision or definite loosening as an endpoint (95% confidence interval, 67.8%-86.8%).     

Long-term results with the Atlas IIIp elastic cementless acetabular component in total hip replacement

Purpose

Modular cementless elastic acetabular systems have advantages over cemented and hard shell cementless acetabular systems. There are few reports on the medium-term and long-term follow up of this particular type of implant. This study describes our experience with the Atlas IIIp modular acetabular system, which is a thin shell cementless elastic acetabular implant for total hip replacement commercialized under this name in many countries.

Methods

We prospectively followed 244 patients treated with Atlas IIIp acetabular system between 2001 and 2004. Minimum ten year follow up was available for 148 hips (139 patients) from the original cohort of 263 hips (244 patients). One hundred five patients had died from unrelated causes and were excluded from the results. Post-operative and follow up radiographs of patients were assessed; and Harris hip scores were used as clinical outcome. Revision for any reason was defined as the end point for survivorship analysis.

Results

The mean pre-operative Harris hip score was 48 (S.D. 16) and the average post-operative score was 82 (S.D. 12). The mean follow up in our series was 11.5 years, ranging from ten to 13.5 years. Thirteen hips required further surgery in our cohort; of which ten cases required cup revision. The 13-years cumulative implant survival was 91.2 % and the risk of implant revision was 8.8 % at 13 years in 148 hips (139 patients). Kaplan-Meier analysis showed the implant survival rate of 95.2 % at ten years for revision for any reason and 99.4 % for aseptic loosening.

Conclusions

Our clinical experience with this acetabular cup suggests good long-term survival rates that are similar to other cups on the market. The clinical experience in this study shows long-term survival rates that are consistent, acceptable and good results achieved with a low revision rate.Level of evidence: Therapeutic III; therapeutic study.

     

Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem

The purpose of the current study was to evaluate the long-term result of a tapered, uncemented femoral component. We retrospectively reviewed the clinical and radiographic records of 121 patients (129 hips) who underwent primary total hip arthroplasty with the use of the Taperloc uncemented stem. Follow-up averaged 11 years (range, 6-15 years). The mean Harris Hip Score at the latest follow-up was 92.1. Thigh pain was reported in 5 patients (3.6%). One stem was revised at 6 years because of severe proximal femoral osteolysis. There was no evidence of radiographic subsidence or loosening around any stems. The overall medium- to long-term outcome of the Taperloc stem is excellent, with a low revision rate and high patient satisfaction.     

Precoated femoral component in primary hybrid total hip arthroplasty: results at a mean 10-year follow-up

This is a mid-term report at 10 years' mean follow-up of a study of a precoated femoral component used in primary hybrid total hip arthroplasty (THA). Of an original cohort of 98 hips undergoing THA performed by one surgeon, 75 hips in 65 patients (mean age, 67 years) were prospectively followed up for 7 to 12 years (mean, 10 years). All hips had the same porous coated acetabular component and a precoated femoral component (with an oval cross-section) implanted using Simplex bone cement (Howmedica, Rutherford, NJ). There was no femoral component loosening or revision. Two acetabular components in patients with rheumatoid arthritis and protrusio acetabulae had radiographic loosening; however, only 1 was symptomatic and was revised. Acetabular osteolysis was seen in 4 hips (5.3%), and minor femoral osteolysis was seen in 3 hips (4%). Used in this manner in this patient population, precoating is not detrimental to successful fixation at 10 years' mean follow-up of primary hybrid THA.     

Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow-up study

A retrospective review was undertaken of thirty-seven hips (thirty-four patients) that had had a complex cemented total hip arthroplasty. In these hips, circumstances had necessitated that the center of the hip be placed farther proximally, as measured from the interteardrop line, than the anatomical position that is normally used. The mean duration of clinical and roentgenographic follow-up was eleven years (range, seven to seventeen years), and the mean age of the patients was fifty-one years (range, sixteen to seventy-three years). Most of these hips had a major deficiency or defect of the acetabular bone stock, or both. Of the six acetabular components (16 per cent) that became loose and were followed for ten years, only one needed revision. Because this study was aimed specifically at assessment of the acetabular component, if the femoral component alone needed revision, the final clinical rating that was used was the one obtained after the femoral revision. Thirty-one hips (84 per cent) were rated as having a good or excellent result; they had an average Harris hip-rating score of 43 points preoperatively and 93 points postoperatively. Thirty-three of the thirty-seven acetabular components were not substantially displaced laterally as compared with the anatomical location that is normally used. Our findings suggest that, when circumstances dictate, proximal positioning of the acetabular component without lateral displacement can give an acceptable result in cemented total hip-replacement procedures.