Long-term results of the threaded Mecron cup in primary total hip arthroplasty

In the 1970s, high failure rates of cemented acetabular components, especially in young patients, in the middle- and long-term prompted a search for alternatives. The Mecring was one of the most popular first generation uncemented, threaded cups widely used in the 1980s for arthroplasty of the hip. First generation threaded cups commonly had smooth surface treatment and showed unacceptably high failure rates in the mid-term. In a consecutive series of 209 patients, 221 threaded uncemented acetabular cups with smooth surface treatment (Mecring) had been implanted in combination with one type of uncemented stem. Patients were followed up clinically and radiographically. The mean time of follow-up was 17 (range 15–20) years. In 91 (41%) hips the acetabular component had been revised or was awaiting revision: two hips for infection and 84 (38%) for aseptic loosening. Five hips were awaiting revision. The survival rate for all revisions including hips awaiting revision was 49% (95% CI: 41–57%) at 17 years. These results support the view that smooth, threaded acetabular components do not provide satisfactory long-term fixation and should be abandoned. Patients with these components must be closely monitored as the failure rate remains high in the long-term.     

Long-term fate of uncemented,threaded acetabular components with smooth surface treatment: minimum 10-year follow-up of two different designs

Introduction In the 1970s and 1980s, uncemented, threaded acetabular components with smooth surface treatment were widely used in continental Europe for arthroplasty of the hip to overcome the high rate of aseptic loosening in cemented hip arthroplasty in young patients. There were several reports on short- and intermediate-term results, but information on survival in the longer term is not available at present.Materials and methods In a consecutive series of 320 patients, 348 threaded cups with smooth surface treatment (221 Mecring and 127 Weill) had been implanted in combination with one type of uncemented stem. Patients were followed clinically and radiographically. The mean time of follow-up was 12.4 (range 10–15) years (Mecring 11.9 years, Weill 13.3 years).Results In 76 hips the acetabular component had been revised (Mecring 56, Weill 20): 7 hips for infection and 69 for aseptic loosening. Of the remainder, the cup had migrated in 55 hips, and 32 hips were awaiting revision. Survival at 14 years was 63.8% (95%CI: 52.5–75.0%) for the Mecring and 76.2% (95%CI: 65.6–86.7%) for the Weill component. Radiolucent lines were present in 59 hips (31.9%). The median Harris Hip Score at follow-up was 84 points (Mecring 85, Weill 82). Radiographic loosening did not correlate with clinical outcome.Conclusion These results support the view that smooth, threaded acetabular components do not provide satisfactory long-term fixation and should be abandoned.     

Poor results of the cementless total hip arthroplasty with a nonporous coated acetabular component: AcSys Shearer Cup

Background This study followed patients for a minimum of 7 years after primary total hip arthroplasty using cementless acetabular components and evaluated their outcomes. Methods We followed 73 patients (75 hips), who had undergone total hip arthroplasty with cementless nonporous coated acetabular components (3M AcSys Shearer Cup) for a mean of 9.8 years (range 7–13 years). There were 61 women and 12 men with a mean age of 53 years (range 27–69 years) at surgery. The diagnosis was primary osteoarthritis in 9 hips, osteoarthritis secondary to developmental dysplasia in 58 hips, osteonecrosis of the femoral head in 6 hips, and rheumatoid arthritis in 2 hips. Results Three cups were revised because of aseptic loosening, and one cup was revised following removal of the prosthesis due to deep infection. Radiographic loosening was observed in 22 hips at the latest follow-up. The survival rate at 10 years was 94.7% with revision as the endpoint and 72% with radiographic loosening as the endpoint. The Merle d'Aubigné and Postel hip score showed significant improvement postoperatively and was maintained well even in cases showing radiographic loosening. Conclusions The intermediate radiological results with the AcSys Shearer Cup were unsatisfactory because of the high loosening rate, although the revision rate was low. The nonporous outer surface and the poor fixation mechanism between the metal shell and liner may have contributed to the high failure rate. Regular radiological review is recommended when this cup is used because early loosening is often painless.     

Bipolar revision arthroplasty for failed threaded acetabular components: radiographic evaluation of cup migration

 We studied the radiographic results of bipolar revision hip arthroplasty in 25 patients (25 hips). These patients had suffered from osteoarthrosis of the hip due to acetabular dysplasia and had undergone total hip replacement using smooth threaded acetabular components. In the revision surgery, these components were replaced by bipolar cups; autografts were implanted in 23 patients and hydroxyapatite grains were added in 7. At the time of follow-up, the severity of migration was radiographically graded from I to IV: grade I, 5 mm or less; grade II, 6 to 10 mm; grade III, 11 to 15 mm; and grade IV, 16 mm or more. Five to 11 years (average, 7.0 years) after surgery, 9 patients were classified as grade I, 6 as grade II, 4 as grade III, and 6 as grade IV. Among the 6 individuals with grade IV migration, hydroxyapatite grains had been used in 5. There was a significant negative correlation between the distance of migration and the increase in size of the threaded acetabular components used in the primary total hip replacement and the bipolar cups in the revision surgery. Because of the tendency to migrate, we concluded that this procedure has a limited role in revision surgery. Received: November 9, 2001 / Accepted: March 15, 2002     

Acetabular reconstruction with impacted morcellized cancellous bone autograft and cemented primary total hip arthroplasty: a 10- to 17-year follow-up study

During the period 1979 through 1986, 69 acetabular reconstructions in 63 patients were performed with the use of autologous morcellized bone-grafts because of acetabular bone stock loss. Nine cases (10 hips) were lost to follow-up. Eleven patients (12 hips) died <10 years after surgery; none had a revision. The results for the remaining 43 patients (47 hips) were reviewed at an average interval of 12.3 years (range, 10-17 years). No preoperative Harris hip score was available. The average Harris hip score at follow-up was 88 (range, 60-100). Radiographically, all grafts united. One hip developed a deep infection. Three other hips (6%) were revised because of aseptic loosening of the acetabular component. An additional 3 acetabular components were considered radiographic failures. Excluding the infected case, the overall survival rate of these acetabular reconstructions with a revision as endpoint was 94% at an average follow-up of 12.3 years. Reconstruction of acetabular bone stock loss with autologous morcellized bone-grafts is an attractive technique with a good potential for long-term success.     

Cementless acetabular cup: 6-year follow-up

The aim of this study was to evaluate the long-term outcome of cementless acetabular cups used in primary total hip arthroplasty. From November 1993 to December 1998, we implanted 403 cementless acetabular cups. Here we present a review of 160 patients (97 women) who received cementless acetabular cups with a porous-coated surface. The average postoperative follow-up period was 6 years (range, 4–8 years). The mean age of patients was 68 years for cemented stems (65 hips) and 59 for uncemented stems (95 hips). A total of 104 patients received ceramic-polyethylene components and 56 had ceramic-ceramic components. One patient presented acetabular migration and needed revision after 5 months indicating a failure rate of 0.6%. We believe that our results provides quite good perspectives for future work with this acetabular component. Received: 3 May 2002, Accepted: 10 May 2002     

Revision of a cemented acetabular component to a cementless acetabular component. A ten to fourteen-year follow-up study.

BACKGROUND: Although cementless acetabular components are routinely used in revision hip surgery, few investigators have evaluated the retention and efficacy of these components in the long term. In the current study, the clinical and radiographic outcomes of a series of arthroplasties performed by one surgeon with a cementless acetabular component were assessed at a minimum of ten years. METHODS: From 1986 through 1988, sixty-one consecutive revision total hip arthroplasties were performed in fifty-five patients because of aseptic failure of one or both components of a prosthesis in which both components had been cemented. Twenty-eight patients (thirty-two hips) were alive at a mean of 12.9 years (range, 11.5 to 14.3 years) after the operation. In all of the patients, the acetabular component was revised to a porous-coated Harris-Galante component inserted without cement, and the femoral component was revised to an Iowa component affixed with contemporary cementing techniques. The hips were evaluated clinically and radiographically at a minimum of ten years subsequent to the index revision. No hips were lost to follow-up. RESULTS: None of the acetabular components required revision because of aseptic loosening. Two hips (3%) demonstrated radiographic evidence of aseptic loosening of the acetabular component. The polyethylene liner was exchanged during the follow-up period in eight hips. CONCLUSION: After a minimum of ten years of follow-up, cementless acetabular fixation in revision hip arthroplasty had produced durable results that were markedly better than those reported for acetabular fixation with cement.     

The Exeter Universal stem: a minimum ten-year review from an independent centre

We reviewed 142 consecutive primary total hip replacements implanted into 123 patients between 1988 and 1993 using the Exeter Universal femoral stem. A total of 74 patients (88 hips) had survived for ten years or more and were reviewed at a mean of 12.7 years (10 to 17). There was no loss to follow-up. The rate of revision of the femoral component for aseptic loosening and osteolysis was 1.1% (1 stem), that for revision for any cause was 2.2% (2 stems), and for re-operation for any cause was 21.6% (19 hips). Re-operation was because of failure of the acetabular component in all but two hips. All but one femoral component subsided within the cement mantle to a mean of 1.52 mm (0 to 8.3) at the final follow-up. One further stem had subsided excessively (8 mm) and had lucent lines at the cement-stem and cement-bone interfaces. This was classified as a radiological failure and is awaiting revision. One stem was revised for deep infection and one for excessive peri-articular osteolysis. Defects of the cement mantle (Barrack grade C and D) were found in 28% of stems (25 hips), associated with increased subsidence (p = 0.01), but were not associated with endosteal lysis or failure. Peri-articular osteolysis was significantly related to the degree of polyethylene wear (p < 0.001), which was in turn associated with a younger age (p = 0.01) and male gender (p < 0.001). The use of the Exeter metal-backed acetabular component was a notable failure with 12 of 32 hips (37.5%) revised for loosening. The Harris-Galante components failed with excessive wear, osteolysis and dislocation with 15% revised (5 of 33 hips). Only one of 23 hips with a cemented Elite component (4%) was revised for loosening and osteolysis. Our findings show that the Exeter Universal stem implanted outside the originating centre has excellent medium-term results.     

20-year experience with cemented primary and conversion total hip arthroplasty using so-called second-generation cementing techniques in patients aged 50 years or younger

We present the 20-year experience of 47 hips in 40 patients aged 50 years or younger with cemented primary total hip arthroplasty using second-generation femoral cementing techniques. Average follow-up duration in the 23 patients living at least 17 years was 18.2 years. Overall, 18 hips (38%) had components revised or removed for any reason, at an average duration of 12.6 years. Every revision or reoperation involved removing the acetabular component. Of these 18 acetabular components, 15 (32%) were revised for aseptic loosening. Eleven additional acetabular components were loose by radiographic criteria at final follow-up, yielding prevalence of aseptic acetabular loosening (55%). Four femoral components (8%) were revised for osteolysis without loosening, and 3 (6%) were revised for aseptic loosening. Femoral osteolysis, with or without component loosening, led to revision in 5 ( 11%) hips compared with 6% for aseptic loosening alone. Osteolysis was the primary problem leading to acetabular and femoral component revision in this series of people < or = 50 years old over the first 20 years after the index operation.     

Fifteen-year clinical survivorship of Harris-Galante total hip arthroplasty

We studied the long-term outcome of uncemented total hip arthroplasty using HG-I components in 90 hips (80 patients) with an average age of 57.5 years who were operated on between 1984 and 1986 at our institution. Average follow-up was 14.9 years, and no patient was lost to follow-up. Hip scores improved significantly, and there was clinical and radiographic evidence of bony ingrowth on the acetabular components in all patients. There were 11 revisions in the study population for reasons related to failure of the femoral component (8 hips), acetabular liner dissociation (2 hips), and deep infection (1 hip). At the latest follow-up, 3 femoral components were determined to be loose. No acetabular component was revised for aseptic loosening. In addition to the revisions, there were 2 reoperations, 1 for psoas tendon release, and 1 for excision of heterotopic ossification. Thus, the survivorship free of revision and free of mechanical failure for the acetabular component at 15 years was 95.7% (95% confidence interval [CI], 0.89-1.0) and 91.9% (95% CI, 0.83-0.98), respectively. The survivorship at 15 years for the femoral component was 86.8% (95% CI, 0.78-0.95) free of revision and 82.0% (95% CI, 0.71-0.92) free of mechanical failure.     

Primary total hip arthroplasty with the Karl Zweymüller first-generation cementless prosthesis: A 5- to 9-year retrospective study

A consecutive series of 72 primary total hip arthroplasties were performed in 70 patients using the first-generation Zweymüller cementless titanium press-fit femoral and threaded acetabular components (AlloPro, Baar, Switzerland). Twelve hips were excluded from the study because of insufficient follow-up evaluation, including one patient who underwent a socket revision within the first 2 weeks. Sixty total hip arthroplasties with an average follow-up period of 80 months (range, 60–108 months) were retrospectively reviewed. Clinical results were graded excellent or good in 54 cases (90%), fair in 3 (5%), and poor in 3 (5%) with 2 early implant failures (1 acetabular cup and 1 femoral stem in 2 hips). Cumulative survival rates at the 6- to 7-year interval, with failure defined as revision and/or loosening are 98.47% (SD, 2.0%) for the femoral component (1 single septic and loose stem, revised at 5 years), 97.08% (SD, 2.72%) for the screw ring (2 unstable but only 1 revised), and 95.56% (SD, 3.36%) for both components. This encouraging experience with the first-generation prosthesis supports the rationale for continued use of the new Zweymüller Alloclassic stem and open-back screw ring available since 1988.     

High complication rate in reconstruction of Paprosky type IIIa acetabular defects using an oblong implant with modular side plates and a hook

We report the results of 62 hips in 62 patients (17 males, 45 females) with mean age of 62.4?years (37 to 81), who underwent revision of the acetabular component of a total hip replacement due to aseptic loosening between May 2003 and November 2007. All hips had a Paprosky type IIIa acetabular defect. Acetabular revision was undertaken using a Procotyl E cementless oblong implant with modular side plates and a hook combined with impaction allografting. At a mean follow-up of 60.5 months (36 to 94) with no patients lost to follow-up and one died due to unrelated illness, the complication rate was 38.7%. Complications included aseptic loosening (19 hips), deep infection (3 hips), broken hook and side plate (one hip) and a femoral nerve palsy (one hip). Further revision of the acetabular component was required in 18 hips (29.0%) and a further four hips (6.4%) are currently loose and awaiting revision. We observed unacceptably high rates of complication and failure in our group of patients and cannot recommend this implant or technique.     

Clinical and radiological results of the collarless polished tapered stem at 15 years follow-up

We prospectively followed 191 consecutive collarless polished tapered (CPT) femoral stems, implanted in 175 patients who had a mean age at operation of 64.5 years (21 to 85). At a mean follow-up of 15.9 years (14 to 17.5), 86 patients (95 hips) were still alive. The fate of all original stems is known. The 16-year survivorship with re-operation for any reason was 80.7% (95% confidence interval 72 to 89.4). There was no loss to follow-up, with clinical data available on all 95 hips and radiological assessment performed on 90 hips (95%). At latest follow-up, the mean Harris hip score was 78 (28 to 100) and the mean Oxford hip score was 36 (15 to 48). Stems subsided within the cement mantle, with a mean subsidence of 2.1 mm (0.4 to 19.2). Among the original cohort, only one stem (0.5%) has been revised due to aseptic loosening. In total seven stems were revised for any cause, of which four revisions were required for infection following revision of the acetabular component. A total of 21?patients (11%) required some sort of revision procedure; all except three of these resulted from failure of the acetabular component. Cemented acetabular components had a significantly lower revision burden (three hips, 2.7%) than Harris Galante uncemented components (17 hips, 21.8%) (p < 0.001). The CPT stem continues to provide excellent radiological and clinical outcomes at 15?years following implantation. Its results are consistent with other polished tapered stem designs.     

Long-term survivorship of cemented all-polyethylene acetabular components in patients > 75 years of age

Between 1974 and 1982, 132 consecutive hips in 112 patients >75 years of age were treated with primary total hip arthroplasty for osteoarthritis using a cemented all-polyethylene T28 socket and cemented T28 or TR28 stem with a 28-mm head size. At the time of review, 94 patients (110 hips [83%]) had died and 18 patients (22 hips [17%]) were still living (mean age at follow-up, 93 years). Five hips (5 patients) were lost to follow-up. Clinical follow-up averaged 8.9 years for the entire group and 14.6 years for patients still living. Only 2 acetabular components have been revised (1 for recurrent dislocation, 1 for infection). No acetabular component has required revision for aseptic loosening. Survivorship free of acetabular revision for aseptic loosening at 10 years was 100%; free of symptomatic acetabular loosening, 97.4% (95% confidence interval, 91.8-100%); and free of acetabular loosening, 95.9% (95% confidence interval, 89.7-100%). The commonest complication was postoperative hip dislocation, which occurred in 11 hips (8.7%) and which required reoperation in 2 hips. Cemented acetabular components implanted in patients >75 years of age with a diagnosis of osteoarthritis showed a high rate of survivorship free of revision and free of symptomatic aseptic loosening.     

Long-term results of HA coated threaded versus HA coated hemispheric press fit cups: 287 hips followed for 11 to 16 years

Introduction There are many studies on the short and medium term results of hydroxyapatite (HA) coated acetabular components, but information on survival in the longer run is sparse. In this paper, we report 11 to 16 years follow up results of HA coated threaded versus HA coated hemispherical press fit cups.Patients and methods During the years 1988–1993, we performed 323 primary total hip replacements in 276 patients with an HA coated acetabular component. In 128 cases we used a HA coated threaded cup, and in 195 cases a HA coated hemispherical press fit cup was inserted. There were 189 women and 87 men aged 15–79 (mean 48) years. During follow-up, 14 patients died and 21 patients would not come for the follow-up examination as they were doing quite well with their prostheses. These patients were censored at their last control examination. This left 241 patients (287 hips) followed for 11 to 16 (mean 13) years after the operation.Results During the follow-up period 48 press fit cups and 9 threaded cups were revised, none because of infection. Survival analyses indicated a cumulative survival of the threaded HA coated cup of 0.91 (95% CI: 0.86–0.97) at 16 years with one patient at risk. The cumulative survival of the HA coated press fit cup was 0.74 (0.69–0.80) at 15 years with no patient at risk. The difference is significant (P = 0.0002). Wear and age was significantly associated with revision (P < 0.0001 and 0.0002, respectively), and wear was significantly (P < 0.0001) associated with osteolysis.Conclusion These results indicate that HA coated threaded cups provide satisfactory bony interlock to resist force loads in the long run whereas the HA coated hemispherical press fit cups do not.     

Use of constrained acetabular components for hip instability: an average 10-year follow-up study

The short-term efficacy of using constrained acetabular components for hip instability in the total hip arthroplasty construct has been documented. However, long-term concerns including late dislocation, loosening of components, and osteolysis have not been addressed. The authors evaluated, at an average 10.3-year follow-up, 101 tripolar constrained components (Stryker Howmedica Osteonics) used in the total hip arthroplasty construct. At final follow-up, 6 hips had dislocated or had failure of the constrained component, 5 of which were revised. In addition, 4 hips were revised for aseptic loosening of the acetabular component, 4 hips were revised for aseptic femoral loosening, and 1 hip was revised for acetabular osteolysis. Considering the complexity of the cases, this component has provided durable fixation and hip stability at this intermediate-term follow-up.     

Hybrid total hip arthroplasty in patients under the age of fifty: A five- to ten-year follow-up

In 37 patients, 45 total hip replacements were performed using contemporary cementing techniques, an uncemented Harris-Galante I acetabular component and a cemented precoated Iowa femoral component in patients under the age of 50 at the time of their surgery; 36 patients with 43 hybrid hips were living, 1 patient with 2 hybrid hips was decreased. No patients were lost to follow-up. At 5- to 10-year follow-up, eight hips were revised for aseptic loosening. No acetabular components, and eight femoral components (18%) were revised for aseptic loosening. When looking at radiographic results, including revision as well as those components that were probably or definitely loose on radiographs, 0 acetabular components and 11 femoral components (24%) were radiographically loose. These results demonstrate the excellent durability of the uncemented Harris-Galante acetabular component in the younger patient. However, the Iowa grit-blasted methyl methacrylate precoated femoral component had a magnitude increase in the prevalence of revision for aseptic femoral loosening when compared to the senior author's long-term Charnley results in this age group. The authors attribute the failure to the rough surface finish applied to the femoral component. However, the polymethyl methacrylate proximal precoating and the femoral component design may also contribute to the femoral failures.     

High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis

This study reports the mid-term results of a large-bearing hybrid metal-on-metal total hip replacement in 199 hips (185 patients) with a mean follow-up of 62 months (32 to 83). Two patients died of unrelated causes and 13 were lost to follow-up. In all, 17 hips (8.5%) have undergone revision, and a further 14 are awaiting surgery. All revisions were symptomatic. Of the revision cases, 14 hips showed evidence of adverse reactions to metal debris. The patients revised or awaiting revision had significantly higher whole blood cobalt ion levels (p = 0.001), but no significant difference in acetabular component size or position compared with the unrevised patients. Wear analysis (n = 5) showed increased wear at the trunnion-head interface, normal levels of wear at the articulating surfaces and evidence of corrosion on the surface of the stem. The cumulative survival rate, with revision for any reason, was 92.4% (95% confidence interval 87.4 to 95.4) at five years. Including those awaiting surgery, the revision rate would be 15.1% with a cumulative survival at five years of 89.6% (95% confidence interval 83.9 to 93.4). This hybrid metal-on-metal total hip replacement series has shown an unacceptably high rate of failure, with evidence of high wear at the trunnion-head interface and passive corrosion of the stem surface. This raises concerns about the use of large heads on conventional 12/14 tapers.     

High placement of noncemented acetabular components in revision total hip arthroplasty. A concise follow-up, at a minimum of fifteen years, of a previous report

We previously reported the average ten-year results associated with the use of porous-coated noncemented acetabular shells that were placed at a high hip center at the time of revision total hip arthroplasty in thirty-four patients (thirty-six hips) with severe acetabular bone loss. We now report the average 16.8-year results for twenty-one patients (twenty-three hips). Of the original cohort of forty-four patients (forty-six hips), thirty-nine patients (forty-one hips; 89%) retained the shell. Two shells (4.3%) were revised because of aseptic loosening, and three (6.5%) were revised because of infection. Six femoral components were revised because of femoral osteolysis, and seven were revised because of aseptic loosening without osteolysis. On the basis of our results after an average duration of follow-up of 16.8 years, we believe that the placement of an uncemented acetabular component at a high hip center continues to be an excellent technique for revision total hip arthroplasty in selected patients with severe acetabular bone loss.     

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%).