Minimum 30-Year Results of Bilaterally Implanted Cemented and Cementless Total Hip Arthroplasty in Patients Younger Than 50 Years

BackgroundThe rate of failure of cemented and cementless total hip arthroplasty (THA) in younger patients is higher than that in elderly patients. The purpose of this study is to document the long-term clinical results of THA with the so-called third-generation cementing and the results of second-generation cementless THA in patients <50 years of age.MethodsThis study included 106 patients who had had bilateral THA with a cemented stem in one hip and a cementless stem in the other. There were 78 men and 28 women. Their mean age was 47 years (range, 21-49). The average follow-up duration was 31 years (range, 30-32.5).ResultsThere were similar mean Harris Hip Scores (90 versus 91 points) between the groups at the final follow-up. Forty-six acetabular components (43%) in the cemented group and 48 acetabular components (45%) in the cementless group were revised. Five femoral components (5%) in the cemented group and 4 femoral components (4%) in the cementless group were revised. Survivorship of the acetabular component at 30.8 years was similar in both groups (57% in the cemented group versus 55% in the cementless group). Survivorship of the femoral component at 30.8 years was also similar in both groups (95% in the cemented group versus 96% in the cementless group).ConclusionLong-term fixation of the cemented or cementless femoral stem was outstanding. There was a high rate of the acetabular component revision due to conventional polyethylene wear and periacetabular osteolysis in both hybrid and fully cementless THA groups.     

Osteolysis in cemented versus cementless acetabular components

A prospective, randomized, double-blind, clinical trial comparing cemented with cementless total hip arthroplasty was performed to compare the prevalence and pattern of acetabular osteolysis. Both groups were similar before surgery. Acetabular components were metal-backed, titanium implants. Twenty-eight-millimeter modular femoral heads with titanium femoral stems were used. At a minimum 2-year and mean 4-year follow-up period (range, 2–6 years), 224 patients had clinical and radiographic data available. There was no significant difference in the prevalence of acetabular osteolysis between cemented (5%) and cementless (9%) fixation. With or without cement, the use of a titanium femoral head led to osteolysis within a relatively short period after surgery in almost all of the cases, although this was not significant. The pattern of acetabular osteolysis was different. Progressive osteolysis occurred predominantly in acetabular zone 1 in the cemented group and zone 2 in the cementless group. Cementless fixation of acetabular components has been advocated in an attempt to minimize osteolysis that may occur in cemented total hip arthroplasty. This study found no difference in the prevalence of acetabular osteolysis between the two groups.     

Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head: a concise follow-up, at an average of seventeen years, of a previous report

We previously evaluated ninety-eight consecutive patients (148 hips) at mean of 9.3 years after total hip arthroplasty; the mean age at the time of the index surgical procedure was 47.3 years. Fifty patients (100 hips) had simultaneous bilateral arthroplasty with a cemented stem in one hip and a cementless stem in the contralateral hip. Forty-eight patients (forty-eight hips) had unilateral hip arthroplasty with a cementless stem. All patients had a cementless acetabular component. In our first report, we found no difference in clinical results, as measured with the Harris hip score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), between the cementless and cemented stems. One hip (2%) in the hybrid group (a cementless cup and a cemented stem) had revision because of infection and two hips (2%) in the fully cementless group had revision of the femoral component because of a periprosthetic fracture. Between the time of follow-up in that study (at a mean of 9.3 years) and the time of follow-up in the present study (at a mean of 17.3 years), twenty-two revisions of acetabular components were performed, with eight in the hybrid group and fourteen in the fully cementless group. There was no difference in clinical results, as measured with the Harris hip score and the WOMAC, between the hybrid and fully cementless groups. At the time of the present review, forty (83%) of forty-eight acetabular components in the hybrid group and eighty (85%) of ninety-four acetabular components in the fully cementless group were intact. Most of the femoral components (98%) in both groups were intact. Wear and periacetabular osteolysis were the causes of failure in the hips requiring revision.     

A comparison of cemented and cementless titanium femoral components used for primary total hip arthroplasty: a radiographic and survivorship study

Titanium has a low modulus of elasticity that makes it an attractive metal for femoral hip components. We directly compared 2 similar titanium stems, one cemented (n = 102 hips) and the other cementless (n = 78 hips), controlling for the most important surgical variables. The average radiographic follow-up was 6.7 and 7.0 years. Osteolysis below the joint line, zones 2 through 6, was 12.7% (13 of 102) in the cemented group and 0% in the cementless group (P<.001). There were 17 acetabular revisions in each study group. The cementless group had no femoral revisions, whereas 9 acetabular revisions in the cemented group had a simultaneous femoral revision (P=.005). Survivorship, defined as revision of the femur, was 84% for the cemented group and 100% for the cementless group at 10 years. Cementless titanium stems are more resistant to osteolysis and mechanical failure compared with similar cemented titanium stems.     

Outcome of primary total hip arthroplasty in Charnley Class C patients with juvenile idiopathic arthritis: a case series

The outcome and complications of 37 primary total hip arthroplasties by one surgeon in 24 patients with Charnley Class C juvenile idiopathic arthritis with up to 19.6 years follow-up are reported. Twenty-six femoral components were cementless; all acetabular components were cementless with screws. Age at operation averaged 22.6 years. Two patients (3 hips) have died. Twelve hips in 9 patients have failed. Six cementless acetabular components with conventional polyethylene were revised because of osteolysis after 5.5 to 14.5 years. All 3 cementless C2 femoral stems with minimal porous coating failed. One of eight cemented AML Bantam stems loosened at 3.5 years; 2 of 23 cementless AML Bantam stems loosened at 9.5 and 19.6 years. Pain relief and functional improvement are dramatic after total hip arthroplasty in juvenile idiopathic arthritis; however, the long-term outcome is guarded.     

Total hip arthroplasty with a cemented, polished, collared femoral stem and a cementless acetabular component. A follow-up study at a minimum of ten years

BACKGROUND: Recent studies have suggested that cemented femoral components with a polished surface may provide superior long-term fixation when compared with femoral components with a roughened surface. The purpose of this study was to evaluate the results of total hip arthroplasty with a cemented femoral component with a polished surface finish and compare them with the results of total hip arthroplasty performed with a similar design of cemented femoral component with a rougher surface finish. METHODS: We retrospectively reviewed a consecutive group of 132 patients (149 hips) in whom primary total hip arthroplasty had been performed by one surgeon using a cemented collared femoral component with a polished (0.1-microm Ra) surface finish and a cementless acetabular component. Ninety-eight patients (115 hips) were followed for a minimum of ten years. We compared the survivorship of this prosthesis with that of a femoral component of similar design but with rougher surfaces (matte or grit-blasted). RESULTS: No polished stems were revised because of aseptic loosening or demonstrated radiographic evidence of loosening; however, eight hips (5.4%) with a polished stem demonstrated osteolysis distal to the greater or lesser tro-chanter. In contrast, six stems (2.0%) with a matte surface finish of 0.8-microm Ra were revised because of aseptic loosening, and an additional five stems were seen to be loose radiographically. Eleven stems (9.2%) with a grit-blasted surface finish of 2.1-microm Ra were revised because of aseptic loosening, and an additional four stems were seen to be loose radiographically. The difference in the prevalence of revision due to aseptic loosening between the group with the 0.1-microm Ra surface and the group with the 2.1-microm Ra surface was significant (p = 0.001), as was the difference between the prevalence of revision due to aseptic loosening between the group with the 0.8-microm Ra surface and the group with the 2.1-microm Ra surface (p = 0.001). No cups were revised because of aseptic loosening, and one hip had radiographic signs of acetabular loosening. CONCLUSIONS: This study demonstrated excellent durability of a prosthesis consisting of a cemented, collared, polished femoral component and a cementless acetabular component. While no hips were revised because of aseptic loosening, distal femoral osteolysis was observed in eight hips (5.4%), a higher prevalence than has been reported by others after similar durations of follow-up of tapered, collarless, polished femoral components.     

Matched-pair analysis of cemented and cementless acetabular reconstruction in primary total hip arthroplasty

In a matched-pair study of primary total hip arthroplasty, 45 all-polyethylene cemented acetabular components were compared with 45 cementless, hemispheric, titanium acetabular components. At 9 to 12 years, 1 of the cemented acetabular components was revised for aseptic loosening, and 14 (31%) were radiographically loose. Nine (20%) cemented acetabular components had pelvic osteolysis. In the cementless acetabular component group, 2 well-fixed components were revised. No components were radiographically loose, and 3 (7%) had pelvic osteolysis. Thirty-eight (97%) of the patients in each group were satisfied with the surgery. The clinical results of the cemented and cementless components were excellent. The cementless components had less loosening (P <.001) than the cemented components.     

Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head

BACKGROUND: The rate of failure of primary total hip arthroplasty in patients with osteonecrosis of the femoral head is higher than that in patients with osteoarthritis. The purpose of this prospective study was to document the clinical and radiographic results of arthroplasty with so-called third-generation cementing and the results of second-generation cementless total hip arthroplasty in ninety-eight consecutive patients with osteonecrosis of the femoral head. METHODS: Fifty patients who had had simultaneous bilateral total hip arthroplasty with a cemented stem in one hip and a cementless stem in the other and forty-eight patients who had had a unilateral total hip arthroplasty with a cementless stem were included in the study. A cementless acetabular component was used in all hips. The presumed cause of the osteonecrosis was ethanol abuse in fifty-seven patients, unknown in twenty-seven, fracture of the femoral neck in nine, and steroid use in five. There were eighty men and eighteen women. The mean age at the time of the arthroplasty was 47.3 years (range, twenty-six to fifty-eight years). Clinical and radiographic evaluations were performed preoperatively; at six weeks; at three, six, and twelve months; and yearly thereafter. The average duration of follow-up was 9.3 years. RESULTS: The average Harris hip scores in the group treated with unilateral arthroplasty (97 points) and the group treated with bilateral arthroplasty (94 points) were similar at the time of final follow-up. They were also similar between the group treated with cement (mean, 96 points) and that treated without cement (95 points). No component had aseptic loosening in either group. In one hip, a cemented femoral stem (2%) and a cementless cup were revised because of infection. Two cementless stems (2%) were revised because of fracture of the proximal part of the femur with loosening of the stem. Annual wear of the polyethylene liner averaged 0.22 mm in the group treated with cement (a zirconia head) and 0.14 mm in the group treated without cement (a cobalt-chromium head). The prevalence of osteolysis in zones 1 and 7 of the femur was 16% in the group treated with cement and 24% in the group treated without cement. CONCLUSIONS: Advancements in surgical technique and better designs have greatly improved the long-term survival of cemented and cementless implants in young patients with osteonecrosis of the femoral head. Although there was no aseptic loosening of the components, a high rate of linear wear of the polyethylene liner and a high rate of osteolysis in these high-risk young patients remain challenging problems.     

Total hip arthroplasty in patients less than 40 years old with avascular necrosis of the femoral head. A 5 to 19-year follow-up study

We evaluated 34 total hip arthroplasties (THA) for avascular necrosis of the femoral head in 26 patients who were younger than 40 years at the time of the index operation. The average age at the time of THA was 283 (17-38) years. The mean follow-up was 10.9 (5-19) years. We used 6 cemented and 28 cementless acetabular components and a cemented polished tapered stem in all hips. The mean Charnley modified Merle d' Aubigné Postel score was 8.9 points preoperatively and 16.6 points at final follow-up. Two cemented metal-backed cups were revised because of aseptic loosening at 10 years, one cemented polyethylene cup failed at 12 years and 2 more all polyethylene cups had pending failure. The metal-backed cemented cups and the all polyethylene cups had a longer follow-up than the uncemented cups. Therefore and because of the proven unfavourable long-term outcome of the cemented metal-backed Exeter cup we are not able to draw any firm conclusions regarding the preferred choice between cemented and uncemented cups in this particular group of patients. On the femoral site none of the stems had to be revised. Our results show that a cemented polished tapered femoral component has an excellent survival in primary total hip replacement in young patients with avascular necrosis of the femoral head.     

Changes in tibial bone mass after primary cementless and revision cementless total hip arthroplasty in canine models

The purpose of this study was to examine right-left differences in tibial bone mass after unilateral (left) cementless total hip arthroplasty (THA). Of 39 dogs with THAs, 9 had primary cementless porous-coated femoral stems for 6 months and 15 had similar stems for 2 years. Five dogs had aseptically failed cemented hips, and 10 had aseptically failed cemented hips that were revised with cementless porous-coated femoral stems (5 without bone graft and 5 with autogenous bone graft). These animals were sacrificed 6 months after the revision surgery. The primary cementless dogs showed no right-left difference in tibial bone mineral content (BMC) or cortical bone cross-sectional geometry after 6 months, but after 2 years there was a distal right-left difference in BMC of 6% caused by expansion of the medullary canal in the tibia of the operated limb. Tibial BMC was more than 20% lower in the operated limb of the failed cemented dogs, approximately 15% lower in the nongrafted group, and 7% lower in the grafted group. The right-left tibial difference in BMC in the 2-year primary cementless group is most probably because of subclinical disuse of the operated limb. Among the dogs with failed cemented stems, the lower right-left difference in the two revised groups compared with the non-revised group suggests that improved limb function after cementless revision THA may cause gain of previously lost bone.     

Cemented collarless (exeter-CPT) versus cementless collarless (PCA) femoral components: A 2- to 14-year follow-up evaluation

The purpose of this study was to compare the intermediate results of total hip arthroplasty with a cemented, collarless, femoral prosthesis design (Exeter, Howmedica, Middlesex, UK and CPT, Zimmer, Warsaw, IN) with those of a cementless, collarless, porous-coated femoral component (PCA, Howmedica). A total of 151 hips in 128 patients were reviewed. In the cemented group, 85 Exeter-CPT prostheses were used in 71 patients with an average follow-up period of 6.5 years. In the uncemented group, 66 PCA prostheses were placed in 57 patients with an average follow-up period of 7 years. Harrington hip scores improved from 50.1 to 80.7 for the PGA group and from 49.5 to 87.3 for the Exeter-CPT group. The patient satisfaction rates were 89 and 96%, respectively. Sixty-eight patients with Exeter or CPT prostheses had excellent function and no significant thigh pain after 2 years. One Exeter stem was revised 10 years after the primary surgery because of localized osteolysis due to cement defect. Two Exeter sockets were revised because of aseptic loosening. In the PCA group, the incidence of thigh pain that persisted beyond 2 years was 39.4%, and there were high incidences of distal cortical hypertrophy (66.6%) and bead loosening (45.5%). Sixteen hips were revised for aseptic stem loosening, uncontrollable thight pain, or stem fracture (1 hip), and seven were revised because of migration and aseptic loosening of the socket. The cementless ingrowth stems failed earlier (around 5 years), whereas the cemented stems continued to perform well past 14 years. In this study, the cemented, collarless, collarless, porous-coated anatomic design at an average follow-up period of 7 years (range, 2–14 years).     

Hybrid total hip arthroplasty

One hundred twenty-six primary total hip arthroplasties composed of a hybrid cemented femoral component and a cementless acetabular component were followed for a minimum of two years (mean, 42 months). The average patient age was 63 years. The most common diagnosis was osteoarthritis (85 hips), although 13 of the cases were severe or total congenital dislocations. Overall, the results were excellent. The mean Harris hip score was 93. Postoperative pain was rated as none or slight in 94% of the cases. No patient had moderate or severe pain. No femoral or acetabular components were revised. Roentgenographically no femoral component was definitely or probably loose. One acetabular reconstruction component had migrated. The authors conclude that the selective use of cemented and cementless fixation by anatomic site in this hybrid form of hip arthroplasty provided excellent results for five and one-half years.     

Early radiographic results comparing cemented and cementless total hip arthroplasty

In a randomized clinical trial of cemented and cementless total hip arthroplasty, 147 patients (76 cemented, 71 cementless) have had a minimum 4-year clinical and radiographic follow-up evaluation. No revisions have been done in either group. Two cemented acetabular components were considered definitely loose and 18 were probably loose; 7 cemented stems were possibly loose at last follow-up examination. One cementless socket was considered unstable. Although cementless femoral component subsidence occurred in 10 cases, the sinkage always stabilized within 6 months, and no stem was considered unstable at last follow-up examination. Significant femoral bone resorption was rare, and so-called “spot welds” were uncommon using this titanium stem. Distal cortical hypertrophy was common, but the cause is uncertain. Osteolysis was seen around 10 cementless and 6 cemented sockets. A small area of lysis occurred in the proximal medial femoral neck in 15 cemented stems and 1 cementless stem. No cases of distal femoral lysis were seen in either group. Despite excellent clinical results with no difference between groups, the high rate of early radiographic failure of this metal-backed acetabulum should preclude its use. Osteolysis will continue to be a problem in both groups, and its prevention should remain the focus of future studies.     

Acetabular revision after failed total hip arthroplasty in patients with congenital hip dislocation and dysplasia. Results after a mean of 8.6 years

BACKGROUND: Revision of a total hip arthroplasty in a patient who has had congenital hip dysplasia or dislocation is often more difficult than a standard revision operation. The purpose of this study was to assess the efficacy and complications of use of a cementless hemispherical acetabular component for revision of an acetabular component of a failed total hip replacement in patients whose initial problem was arthritis secondary to congenital dislocation or dysplasia. The mean duration of follow-up was approximately eight years. METHODS: We reviewed a consecutive series of sixty-one hips in fifty-three patients who underwent a cementless acetabular revision with use of a hemispherical acetabular component, with or without concurrent femoral revision. Data were collected prospectively. The mean age of the patients at the time of the index operation was fifty-six years. A mean of 1.9 ipsilateral hip operations had been performed previously. Thirty-nine hips (64 percent) had a so-called high hip center prior to the index revision. With one exception, the uncemented acetabular component was fixed with screws. Fifty-one acetabular components were placed with so-called line-to-line fit, and ten were oversized by one to three millimeters. In thirty-eight hips, the femoral component was revised as well. Twenty-nine femora were reconstructed with use of a cemented device, and nine were revised with an uncemented patch-porous-coated femoral stem (a stem on which the porous coating appears in patches). RESULTS: Four patients (five hips) died prior to the five-year minimum follow-up interval. With the exception of one hip treated with resection arthroplasty because of deep infection, none of the hips in these deceased patients had been revised or had a loose component. One living patient (one hip) had a resection arthroplasty, and one additional patient (two hips) had both stable acetabular components rerevised at the time of femoral rerevision at another institution because of loosening and osteolysis. One patient refused to return for follow-up, but the components had not been revised. The remaining fifty-two hips in forty-six patients were followed for a mean of 8.6 years (range, 5.0 to 12.7 years). The mean Harris hip score was 80 points (range, 56 to 100 points) at the time of the latest follow-up. No acetabular component had been revised, although two had migrated. No other acetabular component was loose according to our radiographic criteria. Thus, the mechanical failure rate on the acetabular side was 3 percent (two of sixty-one) for the entire series and 4 percent (two of fifty-two) for the patients who had been followed for a mean of 8.6 years. On the femoral side, the mechanical failure rate was 3 percent (one of twenty-nine) for the cemented stems and six of nine for the uncemented patch-porous-coated stems. CONCLUSIONS: Of the approaches used in this difficult series of patients requiring revision, the hybrid arthroplasty (a cementless acetabular component and a cemented femoral component) yielded overall good results after an intermediate duration of follow-up.     

Résultats de la série GECO

301 hip prostheses were implanted in patients under the age of 50 years. All patients were followed for a minimal period of 3 years or until revision. The young age is due to the etiologies: femoral head necrosis, congenital hip dislocation, post-traumatic arthrosis. The implanted prostheses were of different types: both components were usually cementless; most bearing surfaces were alumina-polyethylene, with a head diameter of 32 or 28 mm. Patients were followed for 3 to 18 years after implantation (mean: 7 years). At the last follow-up, 59 prostheses (20%) had been exchanged; 232 cases had a good functional result according to Merle d’Aubigné (77% of the whole series and 96% of the surviving prostheses). The non revised patients mostly had an excellent result with regard to pain, range of motion and gait, and 85% returned to work.The final X-ray examinations of surviving prostheses showed 22% acetabular and 25% femoral radiolucent lines without loosening, 7% severe acetabular polyethylene wear. 3% of acetabular and 9% of femoral prostheses had migrated, mostly during the first months after cementless implantation with subsequent stabilisation.Revisions were performed after 6 months to 16 years. Main reasons were primary instability of a cementless implant (14 cases), secondary instability of a cementless implant (18 cases) and loosening of a cemented implant (18 cases). The global survival rate is 67% after 10 years, and 47% after 14 years. The survival rate of cemented cups was higher than screwed uncemented cups after 12 years (73% vs 59% - p<0,05), and there was no difference with uncemented press-fit cups after 7 years (95% vs 90%). The survival rate of cemented cups was higher than uncoated uncemented cups after 13 years(67% vs 53% -p<0,05), and there was no difference with hydroxyapatite-coated uncemented cups after 5 years (97% vs 93%). There was no difference between survival rates of cemented or cementless femoral prosthesis after 12 years (63% vs 54%) with respect to the presence or absence of hydroxyapatite. There was no difference between the survival rates of all bearing surfaces after 5 and 11 years, but none of the zirconia-polyethylene bearings had been revised after 5 years. There was no difference between survival rates of 28 mm and 32 mm heads after 8 years (86% vs 78%).Cemented prostheses are clearly indicated for patients under 50. Screwed uncemented cups are no longer indicated. Uncemented prostheses showed no better survival than cemented ones. Zirconia-polyethylene bearings could lead to a better survival rate than alumina-polyethylene or steel-polyethylene bearings.     

半髋柄固定方式对高龄股骨颈骨折疗效的影响

目的探讨半髋置换股骨柄在股骨近端髓腔不同形态固定方式对高龄股骨颈骨折疗效的影响。 方法回顾分析2007年1月至2017年2月在东莞市人民医院关节外科分别连续收治的75岁以上高龄股骨颈骨折患者100例,纳入标准：Garden Ⅲ、Ⅳ型、骨折前尚能独立行走;排除标准：股骨颈病理性骨折、同侧髋骨关节炎、严重内科疾病不能耐受手术。分为骨水泥组和生物组。骨水泥组行骨水泥股骨柄双动头置换术,生物组行生物双动头置换术,对比骨水泥组与生物组术中并发症,术后假体周围骨折情况,股骨近端髓腔Noble分型,股骨假体的初始位置,假体松动情况及其末次随访时的髋关节功能Harris评分差异,计量资料对比采用t检验,计数资料比较采用卡方检验。 结果100例患者均获得随访平均(15 ± 3)个月。骨水泥组术中出现明显骨水泥反应2例,未出现死亡病例,术后有2例出现假体周围骨折(Vancouver分型VB2型和VC型)。生物组术中出现股骨距骨折6例(Vancouver分型VAL型),术后假体周围骨折2例(Vancouver分型均为B2型),术后3个月内出现髋关节后脱位1例。术后3个月内死亡2例,均为肾功能衰竭患者。股骨柄的位置安放在内或外翻位>3°为异常时,100例中仅生物组1例烟囱型髓腔出现内翻位置达4°,异常率仅为1%。骨水泥型股骨柄容易出现外翻位放置,生物型股骨柄容易出现内翻位放置。术后末次随访髋关节功能Harris评分骨水泥组和生物组优良率分别为89%和83%,两组差异无统计学意义(χ²＝0.44,P>0.05)。 结论生物无领矩形股骨柄(LCU股骨柄)与有领骨水泥股骨柄(Classic股骨柄)双动头置换治疗高龄股骨颈骨折患者在股骨近端不同类型的髓腔中均能获得良好的治疗效果。     

Total hip arthroplasty in adult patients who had childhood infection of the hip

BACKGROUND: Adult patients with a history of infection of the hip in childhood present a challenge as candidates for total hip arthroplasty because of abnormal bone development, soft-tissue contractures, the possibility of reinfection, and their relative youth. The purpose of this study was to analyze the mid-term results of primary total hip arthroplasty in adult patients who had had infection of the hip in childhood. METHODS: We retrospectively analyzed 170 total hip arthroplasties that had been performed between 1983 and 1996 in patients who had had infection of the hip during childhood. Forty-seven hips had cemented or hybrid total hip replacements, and 123 hips had cementless total hip replacements. The age of the patients at the time that the infection was contracted was an average of 7.3 years (range, one to eleven years). The average age of the patients at the time of the index total hip arthroplasty was 41.9 years in the cemented or hybrid group and 42.7 years in the cementless group. The interval between active infection and arthroplasty was 34.9 years in the cemented or hybrid group and 31.9 years in the cementless group. All but two hips (one patient) had a quiescent period of infection of more than ten years. The average duration of follow-up was 9.8 years (range, seven to seventeen years) in the cemented or hybrid group and 10.8 years (range, seven to seventeen years) in the cementless group. RESULTS: All hips with a quiescent period of more than ten years had no recurrence of infection. The remaining two hips in one patient with a quiescent period of seven years had recurrence of the infection. The mean Harris hip scores improved from 50 points preoperatively to 85 points at the latest follow-up examination in the cemented or hybrid group and from 50 points preoperatively to 89 points at the latest follow-up examination in the cementless group. Eight (17%) of forty-seven hips with cemented or hybrid fixation and eighteen (15%) of 123 hips with cementless fixation had revision of both components because of aseptic loosening and/or osteolysis. The mean rate of linear wear of the polyethylene was 0.25 mm per year in the cemented or hybrid group and 0.29 mm per year in the cementless group. The prevalence of osteolysis was 53% (twenty-five of forty-seven hips) in the cemented or hybrid group and 59% (seventy-two of 123 hips) in the cementless group. CONCLUSIONS: There was no recurrence of infection after total hip arthroplasty in the patients with a quiescent period of infection of more than ten years. These young, active patients with technically difficult arthroplasties were at considerable risk for aseptic loosening. The prevalence of polyethylene wear and osteolysis was attributable to the less than optimal prosthetic designs and materials used during the time-period of this study.     

Cementless acetabular fixation in patients 50 years and younger at 10 to 18 years of follow-up

The purpose of the study was to evaluate the 10- to 18-year follow-up of cementless acetabular fixation in patients 50 years and younger. We retrospectively reviewed a consecutive group of 118 patients (144 hips) in whom primary total hip arthroplasty had been performed by 2 surgeons using a cementless acetabular component. Two (1.4%) cementless acetabular components were revised because of aseptic loosening. Twenty-four hips (16.7%) were revised for any mechanical failure of the acetabular component mostly related to acetabular liner wear and osteolysis. The average linear wear rate was 0.19 mm per year, which was higher than our previous reports with cemented acetabular fixation. The fiber mesh ingrowth surface of the cementless acetabular component in this study was superior to cemented acetabular components in terms of fixation. However, the high rates of wear and osteolysis have led to poor overall acetabular component construct survivorship.     

Revision total hip arthroplasty in juvenile chronic arthritis: 17 revisions in 11 patients followed for 4-12 years

BACKGROUND: Revision total hip arthroplasty (THA) in patients with juvenile chronic arthritis (JCA) is complicated by the young age of the patient, poor bone stock and small physical proportions. We report the complications and outcome of a prospective series of 17 revision THAs in Charnley class C JCA patients. METHODS: 15 acetabular components and 10 femoral components were revised. 13 cementless cups, 2 reconstruction/roof rings and cemented cups, and 4 cemented and 6 cementless femoral stems were implanted. 2 proximal femoral allografts and 1 strut allograft were used. Age at revision was 32 (21-53) years. Follow-up averaged 7 (4-12) years. RESULTS: 2 patients with cemented femoral stems developed loosening, osteolysis and fracture. Both were successfully revised to long-stem cementless implants with strut/proximal femoral allografts. 1 loose, worn cementless cup with osteolysis was revised. 1 patient with a peri-operative infection and late acetabular fracture had a loose, non-revised cementless cup. 1 case of sciatic nerve palsy occurred after revision using a reconstruction ring. 1 late infection necessitated resection arthroplasty. Harris hip scores improved from 53 (34-85) to 76 (47-96). INTERPRETATION: Revision THA in JCA has a substantial complication rate, even in experienced hands. The problem of obtaining long-term stable fixation, osteolysis, and replenishment of lost bone stock are major difficulties.     

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.