Total Hip Arthroplasty With an Uncemented Tapered Femoral Component in Patients Younger than 50 Years

The purpose of the present study was to evaluate the outcome of primary uncemented total hip arthroplasty in patients younger than 50 years using the Taperloc (Biomet, Warsaw, Ind) femoral component. We evaluated 94 hips in 79 patients at a mean follow-up of 16 years (range, 11-18.5 years). The average age of the patients at the time of surgery was 36 years (range, 20-49 years). Three femoral components had been revised, none for aseptic loosening. Complete clinical and radiographic follow-up was obtained on the 91 hips that had not undergone femoral component revision. The mean Harris hip score increased from 54 points (range, 20-72) before surgery to 93 points (range, 68-100) at the time of this review. Radiographically, 89 stems (98%) were determined to have fixation by bone ingrowth, 2 (2%) demonstrated stable fibrous ingrowth, and no femoral component was loose. Distal femoral osteolysis was identified in 1 hip (1%). These findings indicate that excellent clinical and radiographic results can be achieved in young patients with the Taperloc femoral component at a mean follow-up of 16 years.     

Cumulative Long-Term Incidence of Postoperative Periprosthetic Femoral Fractures Using an Uncemented Tapered Titanium Hip Stem: 26- to 32-Year Results

Background

Although falling is becoming a major problem in the elderly, little is known about the long-term incidence of postoperative periprosthetic femoral fractures (PFF) after total hip arthroplasty (THA) using uncemented stems with a minimum follow-up of 26 years postoperatively.

Preoperative Canal Bone Ratio is Related to High-Degree Stress Shielding: A Minimum 5-Year Follow-Up Study of a Proximally Hydroxyapatite-Coated Straight Tapered Titanium Femoral Component

Background

Few studies have reported risk factors for stress shielding. We sought to evaluate clinical and radiographic outcomes of a proximally hydroxyapatite-coated straight tapered titanium femoral component stem during a minimum 5-year follow-up and identify factors associated with high-degree stress shielding.

A Large-Scale Fifteen-Year Minimum Survivorship of a Cementless Triple Tapered Femoral Stem

BackgroundThis study reports the long-term outcomes of a metaphyseal fit-and-fill cementless femoral component in total hip arthroplasty (THA) with a follow-up of 15-19 years.MethodsWe conducted a retrospective review of 376 consecutive THAs (345 patients), using a triple tapered stem performed between 2000 and 2003 with a view to assessing survivorship and radiological and functional outcomes. Images were assessed for initial alignment, terminal osteolysis, or subsidence, while clinical outcomes were assessed using the St Michael’s Hip Score.ResultsForty-five (11.9%) hips were lost to follow-up, 20 (5.31%) had died before our 15-year cutoff follow-up, and 4 (1.06%) had declined follow-up early on, leaving 307 hips (81.64%, 276 patients) available for both clinical and radiological follow-up at a minimum of 15 years (range 15-19). The mean age at the time of operation was 49.6 years (range 19-71) and the cohort included 131 (42.67%) male and 145 (47.23%) female patients. Seven stems (2.28%) were revised: 4 due to periprosthetic fractures, 2 for periprosthetic joint infection, and 1 for adverse reaction to metal debris at the trunnion. The St Michael’s Hip Score improved from 14.2 (range 9-23) preoperatively to 22.3 (range 13 to 25) at the last documented follow-up (P = .000). Kaplan-Meier survivorship with stem revision for any reason as the end point was 97.70%. Worst-case scenario Kaplan-Meier survivorship, where all lost to follow-up are considered as failures, was 85.3%. No stem was revised for aseptic loosening.ConclusionThis triple tapered stem in THA shows excellent survivorship beyond a minimum of 15 years.     

Washing the Femoral Canal Results in More Predictable Seating of a Short,Tapered Femoral Stem

Background

It is critical that a femoral rasp be effective in preparing the proximal femur to accept the size and the geometry of the femoral implant at the time of total hip arthroplasty. Short, tapered femoral stems may be at greater risk because they require the preparation of a short femoral region without any reaming. We undertook a study to determine the effect on implant seating in femora that were prepared by rasping alone with those that were rasped and the canal was washed with saline at the time of cementless THA with a short, tapered femoral implant.

Minimum 5-Year Results in 96 Consecutive Hips Treated With a Tapered Titanium Stem System

We performed total hip arthroplasty with single titanium stem in 96 consecutive, nonselected hips. All patients, regardless of bone type and shape, neck shaft angulation, or age, received the same implant. Patients were followed for a minimum of 5 years, and an independent radiographer evaluated the hips for ingrowth, subsidence, leg-length discrepancy, and remodeling. The average Harris Hip score was 96 points (range, 73-100 points) at final follow-up. Radiographically, all stems were ingrown. No stem had more than 3 mm of subsidence, and there were no leg-length discrepancies more than 5 mm. We concluded that this titanium stem is a versatile option for total hip arthroplasty in patients with a wide variety of demographic and femur characteristics.     

Fifteen-Year to Twenty-Year Results of Cementless Harris-Galante Porous Femoral and Harris-Galante Porous I and II Acetabular Components

This study examined long-term survivorship of primary total hip arthroplasty (THA) using cementless Harris-Galante porous femoral and Harris-Galante porous I or II acetabular components. Of 113 hips (101 patients) studied, 60 hips (53 patients) were available for follow-up at a mean of 17.2 years after surgery. A total of 10 hips had documented revision, and 2 hips had failed radiographically. The average Harris hip score was 82. Radiographically, 12 hips demonstrated eccentric wear, 8 had osteolysis, and 1 had a broken tine. The overall survival rate was 87.7%; the mean volumetric wear rate was 74.96 mm³; and the mean polyethylene linear penetration rate was 0.153 mm/y, similar to that of well-cemented THA in other series. This long-term outcome for an early-generation cementless THA is promising and provides a standard by which to judge the newer generation of cementless implants.     

Results of a Tapered Proximally-Coated Primary Cementless Stem for Revision Hip Surgery

Nineteen patients (nineteen hips) who had undergone revision total hip arthroplasties using a proximally-coated primary cementless stem were evaluated to determine if a subset of revision arthroplasty patients could be identified where the use of this stem would be appropriate. Of these 19 revisions, 15 were performed for the second stage treatment of infection. The femoral bone deficiency was classified as Paprosky Type I in 6 hips and Type II in 13 hips. At a mean follow-up of 49 months, aseptic stem survivorship was 95% with one revision due to aseptic stem failure. The mean Harris hip scores had improved from a mean of 44 points pre-operatively to 89 points post-operatively. Intra-operatively, there was one complication which included a peri-prosthetic fracture distal to the stem which was treated with an allograft strut with cerclage wires. The authors believe that in type I or II femoral defects, the use of this specific cementless stem may be beneficial in the setting of a revision total hip arthroplasty.     

Long-Term Results of Alumina Ceramic-On-Ceramic Bearings in Cementless Total Hip Arthroplasty: A 20-Year Minimum Follow-Up

BackgroundAlumina ceramic-on-ceramic bearings are used in total hip arthroplasty (THA) because of their wear-resistant and inert properties. In this study, we assessed the clinical and radiographic outcomes of patients undergoing primary cementless ceramic-on-ceramic THA at a minimum follow-up of 20 years.MethodsA series of 301 consecutive primary THAs in 283 patients were assessed. Clinically, patients were assessed with the modified Harris Hip Score (HHS) and pain questionnaires. Anteroposterior radiographs of the pelvis and lateral radiographs of the hip were used to radiologically assess the implant. Patients were classified as lost to follow-up if they could not be contacted on multiple occasions or did not wish to participate further in this study.ResultsAt twenty years after operation, 60 patients had died of a cause unrelated to surgery, 16 had experienced complications requiring reoperation, and 100 hips had both clinical assessments and radiographs at a minimum of 20 years of follow-up. The average HHS improved from 56.1 (range: 17-89) before THA to 92.5 (range: 63-100) at the latest follow-up. The classification of the HHS was good or excellent in 96.4% of patients. Only 1.8% of patients still had moderate residual pain at the thigh or groin. Radiographically, all patients demonstrated bony ingrowth but no clinical symptoms of loosening. The overall survival rate of the implants was 94.2% at 20 years with revision for any reason as the end point.ConclusionLong-Term follow-up in our series showed excellent implant survival, excellent functional outcomes, and minimal late complications. There was no significant radiographic evidence of failure at a minimum of 20 years after THA.Level of evidenceTherapeutic Level IV.     

Seven-year Results of a Tapered, Titanium, Hydroxyapatite-Coated Cementless Femoral Stem in Primary Total Hip Arthroplasty

Background

Aseptic loosening of cemented hip prostheses is recognized as a long-term problem, and especially in males and younger patients. Much energy has been focused on developing new prostheses that are designed for cementless fixation. We evaluated the performance of and periprosthetic bone response to a tapered, titanium, hydroxyapatite (HA)-coated femoral hip prosthesis at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty.

Methods

Seventy-eight patients and 86 hips were included in the study. There were 35 men and 43 women; the mean age at the time of the operation was 59 years (range, 41 to 81 years). We used a tapered, titanium (Ti6Al4V), HA-coated femoral implant. We evaluated the patients at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. Clinical evaluation was performed using the scoring system and the hip scores were assigned according to the level of pain, the functional status and the range of motion. The patients who refused to return, but who did forward X-rays for review after being contacted were questioned by phone about the functional status of their hip. Radiographic follow-up was performed at six weeks, at three, six and twelve months and yearly thereafter. All the available radiographs were collected and assessed for implant stability, subsidence, osseointegration, osteolysis, stress shielding and evidence of periprosthetic lucency.

Results

Eighty-six hips (78 patients) were available for review at follow-up of greater than 7 years. In 11 of the 86 cases, acetabular failure required revision of the acetabular component, but the femoral stem survived and it was available for long-term evaluation. The radiographs were obtained at 7-year follow-up for another 20 hips, but the patients would not come in for the 7-year clinical evaluation. Therefore, a phone interview was conducted to assess any change in the functional status at a minimum of 7 years.

Conclusions

The mechanical fixation of a tapered, titanium, HA-coated femoral implant was excellent in this study. This femoral design provided reliable osseointegration that was durable at a mean of 7 years follow-up.     

Revision Total Hip Arthroplasty With a Modular Cementless Femoral Stem

We retrospectively reviewed 123 patients who underwent cementless THA with modular femoral stem designs for revision THA or conversion of failed ORIF and found 75 patients available for analysis. The Harris Hip Score (HHS) improved from 52 ± 14 to 86 ± 11 (P < 0.001). The femoral stem was re-revised in eight patients (11%). The mean time to re-revision was 1.1 years (0.13–2.54). Reasons for re-revision included infection (n = 5, 7%), aseptic loosening (n = 2, 3%) and significant pain (n = 1, 1%). There were no failures of the modular junctions. PC stems had an increased rate of intraoperative fractures (PC 28% vs. STS 9%, P = 0.04). Modular cementless femoral stems provide acceptable mid-term results in revision THA.     

Survival and Clinical Outcomes at 30 to 35 Years Following Primary Total Hip Arthroplasty With a Cementless Femoral Stem Fully Coated With Hydroxyapatite

BackgroundThe purpose of the present study was to update and report clinical outcomes and survival of primary total hip arthroplasty using a cementless double-tapered titanium fully hydroxyapatite-coated stem at a follow-up > 30 years.MethodsThe outcomes of this series of 347 primary total hip arthroplasties were already published at a follow-up > 25 years, during which only 12 stems were revised. Since then, there were two additional stem revisions, bringing the total to 14 stem revisions (all of which also required cup revision). Patients still living with the original stem were assessed using the modified Harris Hip Score and patient satisfaction (very satisfied, satisfied, dissatisfied, and very dissatisfied). Revision incidence was calculated using the Kaplan-Meier (KM) method and Cumulative Incidence Function (CIF) at 35 years.ResultsAt a mean follow-up of 33 years (range, 31 to 35 years), 32 patients (34 hips) were still living with the original stem. Their mean modified Harris Hip Score was 86 points (range, 46 to 100) and all patients (100%) were very satisfied or satisfied with surgery. The revision incidence at 35 years considering (a) stem revision for any reason was 9.5% using KM and 4.5% using CIF; (b) stem revision for aseptic loosening was 3.1% using KM and 2.1% using CIF; and (c) reoperation or revision of any component for any reason was 45.3% using KM and 26.3% using CIF.ConclusionThe present study has demonstrated excellent survival at 35 years for a cementless double-tapered titanium fully hydroxyapatite-coated stem.Level of EvidenceLevel IV, Retrospective cohort study.     

Limited Slot Femorotomy for Removal of Proximally Coated Cementless Stems. A 10-Year Follow-Up of An Unreported Surgical Technique

We present a technique of single posterior longitudinal slot femorotomy. This technique allows the expansion of the metaphyseal–diaphyseal region of the proximal femur facilitating extraction of proximally coated uncemented femoral components while leaving the metaphysis and diaphysis intact. Since 1996 we have performed this technique in 18 revision total hip arthroplasties in 15 patients who had x-ray appearance of bony in-growth/on-growth and where found to have solidly ingrown stems at revision surgery. All were revised to a metaphyseally fitting uncemented stem. At mean follow-up of 122.4 months, there were significant improvements in both pain and function. All revised stems achieved stable boney fixation. There were no complications due to this technique. No patient developed a limp or thigh pain postoperatively. There have been no re-revisions of the stem. With appropriate patient selection, this is a simple, reliable, and extensile technique is useful to assist in the extraction of uncemented proximally coated femoral components whether hydroxyapatite-coated or not.     

Clinical Performance,Patient Reported Outcome,and Radiological Results of a Short,Tapered, Porous,Proximally Coated Cementless Femoral Stem: Results up to Seven Years of Follow-Up

Background

The primary aim of our study was to assess clinical performance, patient reported outcome and radiological results of cementless primary total hip arthroplasty using Tri-Lock Bone Preservation Stem.

Results of Isolated Femoral Component Revision With Well-Fixed Acetabular Implant Retention

The present study was undertaken to evaluate the clinical and radiological results of isolated femoral revisions conducted while retaining well-fixed cementless acetabular sockets. Thirty-nine patients that underwent isolated femoral stem revisions were reviewed. Mean age at time of surgery was 60.5 years, and mean follow-up duration was 4.2 years. Decisions to retain acetabular sockets were based on clinical and radiographic findings and intraoperative stabilities. During revisions, polyethylene liners were exchanged for metal-inlay polyethylene liners to have a metal-on-metal bearing surface in 23 cases. Mean Harris hip score improved from 58 points preoperatively to 85 points at final follow-up (P < .001). With the exception of one patient, no increases in acetabular radiolucent line numbers or thicknesses were observed during follow-up visits. Isolated femoral stem revisions with acetabular socket retention were found to provide excellent clinical and radiographic results.     

Revision Total Hip Arthroplasty Using an Extensively Porous Coated Femoral Stem

Background

To determine the benefit of an extensively porous coated femoral stem in patients receiving revision total hip arthroplasty.

Methods

This study reviewed the results of 35 patients who received a revision total hip arthroplasty with extensively porous coated femoral stem between August, 1996, and December, 2002. The mean follow-up period was 77.5 months. The clinical and radiological results were evaluated by the Harris hip score and serial roentgenographic findings.

Results

The preoperative and postoperative Harris hip score was 68.3 and 92.5, respectively. Radiographically, none of the acetabular components showed any evidence of migration, tilt, rotation, or shedding of metal particles. In addition, none of the femoral components showed evidence of subsidence, pedestal, or shedding of metal particles. Twenty-two hips had a mild stress shield and 2 hips had a moderate stress shield. The perioperative complications encountered were deep vein thrombosis (1 case), mild heterotopic ossification (4 cases), intraoperative periprosthetic fractures (1 case), and nonunion of the trochanteric osteotomy site (2 cases).

Conclusions

Extensively porous coated femoral stems and acetabular components produce excellent clinical and radiological results in revision total hip arthroplasty.     

Minimum 10-Year Results of Cementless Ceramic-On-Ceramic Total Hip Arthroplasty Performed With Transverse Subtrochanteric Osteotomy in Crowe Type IV Hips

BackgroundTotal hip arthroplasty (THA) performed for developmental dysplasia of the hip is a technically difficult procedure with a high complication rate, especially in the presence of completely dislocated hips. This study aimed to evaluate at least 10 years of follow-up results of cementless, ceramic-on-ceramic (CoC) THA performed with transverse subtrochanteric osteotomy in Crowe type IV hips.MethodsWe retrospectively reviewed 50 patients’ 67 hips that underwent CoC, cementless THA with transverse subtrochanteric osteotomy between 2008 and 2011. Clinical and radiological data of the hips were examined. Clinical results were evaluated using the Harris Hip Score and the Western Ontario and McMaster Universities Osteoarthritis Index.ResultsThe mean Harris Hip Score improved from 22.9 ± 9.9 preoperatively to 94.1 ± 8.1 at the final follow-up (P < 0.001). The median Western Ontario and McMaster Universities Osteoarthritis Index score improved from 72 (interquartile range: 17) preoperatively to 2 (interquartile range: 17) postoperatively (P < 0.001). The preoperative mean leg length discrepancy was improved from 4.9 ± 1 cm to 1.5 ± 1 cm in unilateral cases at the last follow-up (P < 0.001). Revision surgery was required because of nonunion in two patients, prosthetic infection in one patient, and aseptic femoral loosening in the other patient. The overall ten-year survival rate was 94% for femoral stems and 98.5% for acetabular components as per Kaplan-Meier survival analysis.ConclusionTransverse subtrochanteric shortening osteotomy combined with using cementless acetabular and femoral components with a CoC bearing surface promises successful clinical results and high prosthesis survival in the treatment of Crowe IV hips at long-term follow-up.     

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.     

Long-Term Results Using the Straight Tapered Femoral Cementless Hip Stem in Total Hip Arthroplasty: A Minimum of Twenty-Year Follow-Up

We report the first long-term results of a prospective cohort study after total hip arthroplasty using the cementless Bicontact hip stem. Between 1987 and 1990, 250 total hip arthroplasties in 236 patients were performed using the cementless Bicontact hip stem. The average follow-up was 22.8 years (20.4–24.8) and average age at index surgery was 58.1 years. Eighty-one patients died and 9 were lost to follow-up. We noted 11 stem revisions revealing an overall Kaplan Meier survival rate of 95.0% (CI 95%: 91.1–97.2%). The average Harris Hip Score revealed 81 points (range 24–93). The Bicontact hip stem demonstrated high survival rates despite high ages and osteopenic changes, which are equivalent to other long-term reports of cementless stem fixation.     

Revision Total Hip Arthroplasty Using a Modular Tapered Stem With Distal Fixation : Good Short-Term Results in 125 Revisions

After 2 to 7 years we reviewed 125 prosthetic hip arthroplasty stem revisions using a modular tapered stem with distal fixation. Median age of these patients was 68 (33-92) years. Baseline and follow-up data were registered prospectively according to the Danish Hip Arthroplasty Registry. Survival, free of any rerevision, was 94%. Harris Hip Score improved from average 44 to 85. Bony regeneration was an early and significant finding in most cases. Complications included 4 (3%) fractures intraoperatively and 8 (6%) dislocations, 4 (3%) deep infections, and 1 (1%) stem fracture. This modular taper system is very versatile, can be used in most femoral revision cases, and allows rapid bone remodeling. We did not find an increased number of complications compared to the literature. Further long-term follow-up, however, is essential.