Hybrid revision total hip arthroplasty: a 7-year follow-up study

The hybrid method for fixation of total hip arthroplasty (THA) has shown excellent results during the first decade in primary operations. To investigate its role in revision surgery, data on 48 revision THAs in 45 patients that met the inclusion criteria were gathered prospectively, using HGP cementless acetabular components and precoated cemented femoral components inserted with so-called second generation femoral cementing technique in each case. For the 48 hips during an average follow-up period of 7.4 years, no acetabular components was loose or had pelvic lysis. One acetabular component was revised for recurrent dislocation; 1 of 48 femoral components was revised for aseptic loosening and 1 for periprosthetic fracture. Three additional femoral stems (6%) were loose. In this small series, the hybrid concept for revision of failed nonseptic THAs has shown excellent results.     

The Harris-Galante total hip arthroplasty: a minimum 8-year follow-up study

A total of 93 Harris-Galante Porous I (HGP- I) prostheses were analyzed with a mean follow-up of 10.2 years. Thigh pain (28 hips) correlated with unstable fixation (P<.005), female gender (P<.045), young age (P<.05), poor distal femoral fill (P<.002), subsidence (P<.0001), and osteolysis (P<.05). Thirteen stems and 6 metallic shell cups were revised. Kaplan-Meier analysis showed 13-year survival rates of 92.5% +/- 5.8% for the metallic shell cup, 79.7% +/- 13% for the HGP-I cup, and 76.3% +/- 14.0% for the stem. Five polyethylene liners were changed because of wear >1 mm. Radiographic loosening occurred in 8 cups. Radiographic bone ingrowth was present in 54 stems, stable fibrous fixation was present in 24 stems, and unstable fixation was present in 15 stems. The mean polyethylene wear was 0.17 mm/y. Eleven hips (11.8%) had acetabular osteolysis, and 24 (25.8%) had femoral osteolysis, the latter being more frequent in unstable stems (P<.007). The HGP-I metallic cup shows better clinical and radiographic results than the stem, which frequently is associated with pain, unstable fixation, and osteolysis. Excessive polyethylene wear is frequent.     

Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study.

BACKGROUND: The purpose of this retrospective study was to report the results, after a minimum of 18.5 years of follow-up, in a consecutive series of total hip arthroplasties performed with an alumina-on-alumina combination. METHODS: One hundred and eighteen consecutive total hip arthroplasties were performed in 106 patients between 1979 and 1980. The prostheses combined a 32-mm alumina head and an all-alumina socket. Both components were cemented in eighty-five hips, both components were implanted without cement in twenty-nine, and only the stem was cemented in four. The mean age of the patients at the time of the index arthroplasty was 62.2 years (range, thirty-two to eighty-nine years). RESULTS: At the 18.5 to 20.5-year follow-up evaluation, forty-five patients (fifty-one hips) were alive and had not had a revision, twenty-five patients (twenty-five hips) had undergone revision of one or both components, twenty-seven patients (thirty hips) had died, and nine patients (twelve hips) had been lost to follow-up. The mean Merle d'Aubigné hip score (and standard deviation) was 16.2 +/- 1.8 points at the latest follow-up evaluation. The rate of survival at twenty years, with revision for any reason as the end-point, was 85.6% for the cementless cups compared with 61.2% for the cemented cups and 84.9% for the cementless stems compared with 87.3% for the cemented stems. Wear of the prosthetic components was undetectable on plain radiographs. Periprosthetic cystic or scalloped lesions requiring the use of allograft bone during revision were present in three of the twenty-five revised hips. In addition, seven hips had moderate acetabular osteolysis treated with a 4-mm-larger cup. No fracture of the alumina socket or head was recorded. The mean acetabular wear rate in this series was <0.025 mm/yr. CONCLUSION: With the alumina-on-alumina total hip arthroplasty, minimal wear rates and limited osteolysis can be expected up to twenty years after the operation, provided that sound acetabular component fixation is obtained.     

Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation

A group of 42 primary total hip arthroplasties performed through an abridged surgical incision (group 1) was prospectively compared to a cohort of 42 primary total hip arthroplasties performed through a standard surgical incision (group 2). The length of the incision was 8.8 +/- 1.5 cm for group 1 and 23.0 +/- 2.1 cm for group 2. The groups were not significantly different with respect to age, height, preoperative Harris Hip scores (HHS), estimated blood loss, or length of hospital stay (P>.05). Group 1 patients had a lower body mass index than group 2 patients (P<.01). Length of surgery was slightly less for group I (P =.02). A 0% incidence was found of infection, nerve palsy, component malposition, and aseptic loosening in both groups. No dislocations occurred in group 1, and one dislocation occurred in group 2. Patients in group 1 have expressed considerable enthusiasm regarding the cosmetic appearance of the surgical incisions, and their postoperative HHS are slightly higher than those of group 2 (P =.042). Total hip arthroplasty can be performed safely and effectively through an abridged surgical incision, but this investigation confirms no dramatic clinical benefit other than cosmetic appeal.     

Activity level in young patients with primary total hip arthroplasty: a 5-year minimum follow-up

Increased activity level after total hip arthroplasty (THA) is considered a risk factor for early prosthetic failure in young patients. Forty-one primary total hip arthroplasties in 34 patients were evaluated. Walking activity was measured using a pedometer to record gait cycles. Patients completed a University of California, Los Angeles (UCLA) activity questionnaire. Linear wear rates were measured. Mean ages at surgery and final follow-up were 42 and 50.3 years, respectively (mean gait cycles per year, 1.2 million; mean UCLA score, 6; mean linear wear, 0.16 mm/y). Increased body mass index and age correlated with decreased gait cycles per year. Patients with systemic disease were less active than patients with localized hip conditions. Femoral head diameter was a predictor of linear wear. The average gait cycles per year and wear rate for this population do not appear accelerated relative to average values reported in older populations.     

Simultaneous bilateral total hip arthroplasty with hydroxyapatite-coated implants: a 20-year follow-up

Bilateral hip arthroplasty has been reported to be a safe and effective way to treat bilateral hip arthritis in a selective group of patients. We report a follow-up of 30 patients who underwent simultaneous bilateral total hip arthroplasty with hydroxyapatite implants and were followed for an average of 19.4 years. Patients had an average Harris Hip Score of 90 at the latest follow-up (range, 78-99). The average Western Ontario and McMaster Universities Arthritis Index questionnaire index score was 12 (range, 0-41), with high functional results on the 12-Item Short Form Health Survey (SF-12) and Oxford 12 questioners. Using the Kaplan-Meier survivorship analysis, with revision for any reason as an end point, survivorship was 94% at 12 years, 88% at 15 years, 74% at 18 years, and 61% at 23 years. All revisions were for the acetabular component, and the survivorship for the femoral component was 100% throughout the 23-year period. We conclude that bilateral uncemented total hip arthroplasty can provide satisfactory long-term clinical, radiological, and functional outcomes in patients even with older-generation polyethylene liners and stem designs.     

Uncemented total hip arthroplasty in Paget's disease of the hip: a report of 5 cases with 5-year follow-up.

Five patients with Paget's disease localized to the acetabulum received cementless acetabular components during total hip replacement. Three were primary surgeries, and 2 were revisions of a failed cemented acetabular component. At an average of 5.8 years (range, 4.8-8.8 years) after the operation, all acetabular components were well fixed radiographically with no migration or loosening. No patients complained of clinical symptoms referable to the acetabular component. No revisions had been performed. The ability of this inherently abnormal bone to proceed through the reparative and remodeling phases of porous ingrowth adds support to the use of uncemented components for acetabular reconstruction in Paget's disease of the hip.     

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.     

Sequential changes in periprosthetic bone mineral density following total hip arthroplasty: a 3-year follow-up

 We sequentially measured the periprosthetic bone mineral density (BMD) of the femur after cementless total hip arthroplasty, using dual-energy X-ray absorptiometry, over a 3-year period. The periprosthetic bone was divided into three regions (proximo-medial, middle, and distal to the prosthetic stem). After the insertion of a fully porous coated stem in 21 patients, the BMD was measured within 3 weeks, and 6, 12, 24, and 36 months after surgery. At 6 months, all zones showed a decrease in BMD relative to the BMD within 3 weeks, but subsequently the BMD was unchanged. The lower the BMD within 3 weeks of surgery, or the lower the body weight, the higher the percent loss of BMD at 6 months. Received: September 9, 2002 / Accepted: December 12, 2002 RID="*" ID="*" Offprint requests to: H. Ohta     

Denham total knee arthroplasty: a 10-year follow-up study

We reviewed 72 patients with 89 Denham total knee arthroplasties (Biomet, Warsaw, IN) (TKAs) 10 to 15 years after the operation. Of 8 TKAs that were considered as failures, 5 had been revised at the time of review for pain and aseptic loosening, and 3 others were considered to have failed because of breakage of the polyethylene tibial plateau, dislocation, and infection. Survival analysis suggested a 10-year survival rate of 92.7%. There were 36 patients with 45 TKAs alive at the time of follow-up. We reviewed 32 of the patients with 40 Denham TKAs that had not failed. Their average age was 81 years (range, 58-93 years). They were reviewed at an average of 11.8 years after TKA. Nine knees (6 patients) had some anterior knee pain from the unresurfaced patella. Restriction of function was mainly due to medical conditions and old age. Survival analysis performed with the living patients found the 10-year survival to be 91.1%. Long-term survival shows that the Denham knee prosthesis is effective despite its simplicity.     

Charnley total hip arthroplasty. A ten- to 14-year follow-up study

The long-term results of 325 consecutive Charnley total hip arthroplasties (THAs) were assessed at an average of 62 and 140 months (five-year and ten-year follow-up examinations) postoperatively. Cases developing deep infection during the first five years were not included. Pain, walking ability, and mobility were rated as advocated by Charnley. The results were then graded as excellent, good, fair (clinically successful), and failure. At the five-year follow-up evaluation, 77 hips were excluded; 92% (228/248) of the results were successful. At the ten-year follow-up examination, interest was focused on the 228 hips graded as successful after five years. Sixty-six were excluded, one that had not been included at the five-year evaluation was traced, and 92% (150/163) were again clinically successful. The failure rate owing to mechanical causes during the first five years and between the five-year and ten-year follow-up examinations was 6.9% and 6.7%, respectively. The clinical results were considered highly satisfactory because only 50% of the hips judged successful at the ten-year examination had roentgenographically intact components. There is good reason to have great confidence in the Charnley THA.     

Improved clinical outcomes after high-flexion total knee arthroplasty: a 5-year follow-up study

The purpose of this study was to determine if high-flexion total knee arthroplasty resulted in improved outcomes compared with conventional total knee arthroplasty. This was a prospective, double-blind, randomized controlled trial involving 76 patients over 5 years. We compared the postoperative flexion range, Knee Society scores, Oxford knee scores, and SF-36 scores between 2 groups. The high-flexion group was able to achieve a significant sustainable increase in postoperative knee flexion angle; and this correlated to a significant improvement in the General Health, Vitality, and Physical Functioning scales of SF-36 at 5 years postoperatively. Our results signify that high-flexion total knee arthroplasty has additional benefits to the quality of life in patients who require higher degrees of knee flexion in their activities of daily living.     

初次全髋关节置换术后5年以上随访结果与分析

目的评估初次全髋关节置换术（THA）后5年以上患者的临床疗效、并发症及其影响因素。方法对中山大学附属第一医院关节外科2006年6月前行THA的273例患者（305髋）进行随访,截至末次随访时,191例（206髋）患者获得随访,随访时间平均为9.3年（5-21年）,临床随访内容包括SF-36量表、术前、术后Harris评分及各种并发症。影像学评估包括骨盆正位、患髋正侧位片,判断人工假体位置、假体周围骨质以及并发症情况。结果随访率为69.96%,SF3-6体能方面总分由术前的（30.92±3.90）分（24~39分）提高至（53.69±3.97）分（44~62分）,在精神方面的总分则由术前的（45.91±5.63）分（37~56分）提高至（57.06±7.26）分（43~72分）。术前Harris评分为（46.71±10.76）分（5~68分）,末次随访时为（92.83±4.88）分（56~100分）。假体的5年生存率为98.06%,10年生存率为94.17%,15年生存率为85.92%,20年生存率为81.55%。混合型假体、非骨水泥型假体的翻修率分别为2.4%、5.6%。术后并发症包括跛行（17例）、脱位（3例3髋）、深静脉血栓（1例1髋）、假体周围骨折（1例1髋）、无菌性松动（9例9髋）、异位骨化（6髋）和感染（0例）等。结论本组病例整体疗效满意、假体生存期长,但随访率偏低,病例数偏少,需进一步完善随访机制,提高随访率。     

The stanmore total hip arthroplasty: A 15- to 20-year follow-up study

An ongoing study was made of 804 primary Stanmore total hip prostheses implanted in 839 patients between 1973 and 1991. The earliest surviving implants were brought back for radiologic and clinical review in 1995 at an average of 17 years after surgery. The remainder of the patients still living were sent a questionnaire to assess their current status. Survivorship was 95% at 10 years, 85% at 15 years, and 73% at 20 years. The average Merle d'Aubigné—Postel score was excellent up until 14 years. Patient satisfaction remained high until 22 years. Overall, 10% of the prostheses had failed. The results of this study suggest that the Stanmore prosthesis is capable of producing satisfactory long-term results that compare favorably with those of other cemented prostheses.     

DEXA evaluation of total hip arthroplasty with neck-preserving technique: 4-year follow-up

Abstract Periprosthetic bone remodeling, and its evaluation, are the keys of long-term survival of cementless total hip arthroplasty. Dual energy X-ray absorptiometry (DEXA) is the most accurate method to measure bone mineral density, evaluating the effects of bone-prosthesis interactions. We studied, 4 years after implantation, 10 patients who underwent total hip arthroplasty with the CFP prosthetic stem and TOP acetabular cup (Waldemar Link, Hamburg, Germany). Our results demonstrate minimal periprosthetic bone loss compared to that normally observed with conventional stems. A few cases exhibited an increase in BMD. We believe that primary stability, prosthetic design, preservation of natural neck anteversion and off-set, better function related to muscle lever arm, and physiological bone loading with natural stress distribution are the keys of this succesful mini-invasive total hip replacement system.     

Total hip arthroplasty for failed treatment of acetabular fractures: a 5-year follow-up study

Total hip arthroplasty (THA) remains an available surgical option for failed treatment of acetabular fractures. We retrospectively analyzed 53 patients who underwent THA because of failed treatment of acetabular fractures. The mean duration of follow-up monitoring was 64 months (range, 32-123 months) in 49 patients. The average Harris hip score increased from 49.5 before surgery to 90.1 at the latest follow-up examination. Postoperative complications included 1 dislocation, 3 sciatic nerve injuries, and 3 class III instances of heterotopic ossification. There was only 1 revision due to aseptic loosening of the acetabular and femoral component. Despite the technically demanding nature of the procedure, the results of acetabular reconstruction are encouraging in these patients; complication rates are low, and patient satisfaction level is high.     

Straight tapered titanium stem with alumina bearing in cementless primary total hip arthroplasty: a minimum 5-year follow-up

The aim of this study was to assess the midterm results of primary cementless total hip arthroplasty using a tapered stem and alumina bearing couple in active patients. After a minimum of 5 years of follow-up, 78 arthroplasties in 72 patients were reviewed retrospectively. The mean Harris hip score was 94 points, and 2 hips had thigh pain. All components radiographically demonstrated stable fixation by bone ingrowth and mild stress shielding of the proximal femur were noted in 14% of hips. There was no significant osteolysis or aseptic loosening. There was a ceramic head fracture in 1 hip and audible sounds in 2 hips. The results of total hip arthroplasty with a straight, tapered, proximally porous-coated stem and alumina-on-alumina bearing were encouraging for active patients.     

Metal-on-metal total hip arthroplasty - five- to 11-year follow-up

Metal-on-metal (MoM) total hip arthroplasty (THA) has been introduced in an attempt to reduce the wear rate and the consequent osteolysis around implants. The aim of this study was to present the intermediate to long-term clinical and radiological outcomes and to investigate the metal ion levels in the blood of patients who had undergone primary uncemented MoM THA in our institution. Between July 1997 and November 2003, 166 patients (193 hips), with a mean age of 50 years (range, 18-65 years), underwent primary MoM THA. Clinical data, radiographs, and blood samples were obtained at regular follow-up visits. Cobalt (Co), chromium (Cr), and molybdenum (Mo) ions were measured by inductively coupled plasma-mass spectrometry (ICP-MS) from the patient's whole blood. All patients were prospectively followed for a minimum of 5 years (mean, 7 years; range, 5-11 years). The mean Harris hip score (HHS) and the University of California at Los Angeles (UCLA) activity score at the latest follow-up was 88 ± 11 and 7 ± 1.8 points, respectively. Thirteen hips have been revised. Ten acetabular components had early failure, due to factory manufacturing problems. All other implants have been found stable, with no signs of aseptic loosening. The probability of survival at 11 years, if the hips that were revised due to manufacturing problems were excluded, was 98.4%. The Co and Cr metal ion levels, after increasing significantly during the first 4 to 5 years post-surgery, remained stable, with a tendency to decrease thereafter, but not significantly. During the same follow-up period, Mo ion levels remained stable. In this 5-to-11 year follow-up study of MoM THA patients, excellent survivorship, with low complications rates, was found. Results of longer follow-up studies are necessary to clarify the possible long-term effects of metal ion release.     

67例全髋关节置换术后13年的随访结果

目的探讨全髋关节置换术后的远期疗效。方法对1994年6月至1995年7月施行全髋关节置换术的88例患者进行随访调查，其中67例（76髋）获访，21例失访，随访期平均13年。67例患者中男51例（59髋），女16例（17髋）；年龄34～85岁，平均64．8岁。67例中患髋骨关节炎11例（11髋），年龄49．5～69岁；股骨头缺血性坏死27例（29髋），年龄35～59岁；股骨颈骨折（头下型）16例（16髋），年龄54～85岁；髋关节发育不良10例（15髋），年龄35～53岁；强直性脊柱炎髋强直3例（5髋），年龄36～44岁。右髋41例（46髋），左髋26例（30髋）。采用国产假体17髋，DePuy假体28髋，Zimmer假体31髋；其中生物固定27髋，混合固定26髋，骨水泥固定23髋。结果采用Harris评价标准，同时由患者自我满意度调查。结果优（85～100分）41例（49髋），良（75～84分）15例（17髋），可（60～74分）5例（5髋），失败（〈60分）5例（5髋），优良率为86．8％（髋）和83．6％（例）。共收到65份满意度调查表，很满意27例，满意22例，基本满意11例，不满意6例，满意率为75．4％。结论稳定且优化的手术团队采用品质优良的假体，可以提高全髋关节置换术的远期疗效。