Bipolar hemiarthroplasty in juvenile rheumatoid arthritis: long-term survivorship and outcomes

Because controversy surrounds the management of end-stage hip disease in juvenile rheumatoid arthritis (JRA), this study evaluated the long-term outcome of bipolar hemiarthroplasty as an alternative to conventional joint arthroplasty. A total of 24 JRA patients underwent 39 hemiarthroplasties; follow-up averaged 12 years (range, 3 to 15 years). There were 14 hips (36%) revised, and 25 hips (64%) maintained the original components. Mean Harris hip scores in surviving hips improved from 29 to 69 points (P<.001). Radiographs showed progressive bipolar superomedial migration (P<.01) despite attempted augmentation. Failure defined as revision to total hip arthroplasty or definite radiographic loosening occurred in 15 hips (38%). Ten-year Kaplan-Meier survivorship for all prostheses was 78%. Independent multivariate risk factors for failure included acetabular grafting (P =.006), prosthesis type (P<.001), and unilateral replacement (P<.001).     

Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old

BACKGROUND: Acetabular bone deficiency can present a challenge during total hip arthroplasty, especially in young patients. The purpose of the present study was to evaluate the long-term clinical and radiographic outcomes of primary and revision acetabular reconstruction with use of an impaction bone-grafting technique and a cemented polyethylene cup in young patients who had preexisting acetabular bone deficiency. METHODS: Forty-two consecutive acetabular reconstructions were performed in thirty-seven patients who were younger than fifty years old (average, 37.2 years old). The impaction bone-grafting technique was used for twenty-three primary and nineteen revision acetabular reconstructions. Twenty-eight patients (thirty-one hips) were available for review after a minimum duration of follow-up of fifteen years. Clinical and radiographic results were assessed, and survivorship analysis was performed with the Kaplan-Meier method. RESULTS: Eight hips were revised at a mean of twelve years (range, three to twenty-one years) after a primary reconstruction (four hips) or revision reconstruction (four hips). The revision was performed because of aseptic loosening of the acetabular component in four hips and because of culture-proven septic loosening in two. Two additional cups (both in hips that had had a revision reconstruction) were revised, during revision of the femoral stem, because of wear (one hip) or because of persistent intraoperative instability (one hip). Twenty-eight hips (in twenty-five patients) had retention of the acetabular component for a minimum of fifteen years. The mean Harris hip score for that group was 89 points. Twenty-six of these twenty-eight hips had no or slight pain. Kaplan-Meier analysis revealed a twenty-year survival rate of 80% (95% confidence interval, 67% to 94%) with acetabular revision for any reason as the end point and of 91% (95% confidence interval, 80% to 100%) with acetabular revision because of aseptic loosening as the end point. CONCLUSIONS: Acetabular reconstruction with use of impaction bone-grafting and a cemented polyethylene cup is a reliable and durable technique that is associated with good long-term results in young patients with acetabular bone-stock defects.     

双锥面螺旋臼固定治疗髋关节中心性脱位的中长期临床效果分析

目的 探讨使用双锥面螺旋臼假体固定髋关节中心性脱位病例的长期临床效果.方法 1998年5月至2006年9月北京大学人民医院关节病诊疗研究中心对31例髋关节中心性脱位患者的39侧髋关节行人工全髋关节置换术或翻修术,其中男性12例,女性19例.手术时平均年龄为57.6岁(30～82岁).引起髋关节中心性脱位的病因包括:类风湿关节炎3例6髋;股骨头坏死继发髋关节炎7例12髋,人工股骨头置换术后髋臼磨损11例11髋、髋臼假体松动10例10髋.术中髋臼部分均使用双锥面螺旋臼进行生物学固定.术前Harris评分平均为31.0分(14～61分).结果 所有病例均在术后6个月、1年时随访,2例3髋患者分别因肺癌、急性心肌梗死死亡.24例31髋获得随访,平均随访时间7.4年(5.0～11.5年).末次随访时Harris评分平均为84.7分(70～95分).1例股骨头坏死行双髋同时置换患者术后右髋出现感染,行关节取出骨水泥旷置术,但因内科疾病不稳定未再行翻修术.1例类风湿关节炎患者双髋关节分期手术,术后7年随访时左侧髋臼假体有内侧轻度移位,边缘有透亮线,但患者日常功能好,无疼痛.其余所有病例双锥面螺旋臼假体全部存留,患者日常生活功能良好,对手术效果满意.结论 髋关节中心性脱位使用双锥面螺旋臼的固定效果确切,平均超过7.4年的中长期随访结果显示效果良好.

Abstract：

Objective To discuss long-term clinical results of using Zweymüller cup to treat protrusio acetabuli. Methods From May 1998 to September 2006, 31 patients with 39 hips diagnosed protrusio acetabuli were treated with Zweymtüller cup in total hip arthroplasties or revisions. There were 12 men and 19 women with average age of 57.6 years (from 30 to 82 years). The reasons causing protrusio acetabuli were as followed: rheumatoid arthritis 3 cases 6 hips, osteoarthritis followed femoral head necrosis 7 cases 12 hips, acetabular wear after hemi-arthroplasty 11 cases 11 hips and acetabular component Results All cases were followed up 6 months and one year after operations. Two patients with 3 hips were died for lung cancer and acute myocardial infarction respectively. Twenty-four cases with 31 hips got recent follow-up with average 7. 4 years (from 5.0 to 11.5 years). The average Harris score improved from 31.0 (from 14 to 61) preoperatively to 84. 7(from 70 to 95) postoperatively. There was one infection in right hip after bilateral hip arthroplasty treating by removel prosthesis and cement spacer insert. But until now this patient still did not get revision for her internal medicine. One rheumatoid arthritis patient with two-stage bilateral hip arthroplasty was found slight internal migration and loosening line of left acetabular component,but the patient had no pain with good hip function. All other cases had good hip functions and were very fixations and perfect medium and long-term clinical results for over 7.4 years.     

Mueller reinforcement rings in acetabular revision: outcome in 164 hips followed for 2-17 years

BACKGROUND: In revision hip arthroplasty, cages are commonly used for acetabular reconstruction in cases with loss of bone stock. It is important to follow this patient group closely, in order to better understand failure mechanisms and the chance of long-term success. PATIENTS AND METHODS: We followed our first 164 acetabular revisions with the Mueller reinforcement ring (ARR) in 164 patients, with an average follow-up period of 6 (2-17) years. Mean age at surgery was 69 (29-92) years. 39 patients died (39 hips) during follow-up, but only 3 patients (3 hips) were lost to follow-up. RESULTS: In the observation period, 13 of the hips had to undergo acetabular re-revision for aseptic and septic loosening. Overall survival at 5 years was 95% (CI: 89%-98%) and 90% (CI: 76%-95%) at 8 years using acetabular re-revision or implant removal for all reasons as endpoint. In addition, mechanical and clinical failure was seen in 2 cases. The mean Harris hip score was 70 points, whilst the Merle d'Aubigné score averaged 7 points. Radiolucent lines according to DeLee and Charnley were observed twice in zone I, 6 times in zone II and 14 times in zone III. INTERPRETATION: We found that mid- to long-term survival of the ARR is acceptable. However, failure of the implant due to allograft collapse/resorption or deep infection, and also poor clinical outcome, remain major concerns in acetabular revision arthroplasty. This should be recognized when advising patients.     

Long-term follow-up of cemented total hip arthroplasty in rheumatoid arthritis

Seventy-five primary cemented total hip arthroplasties (THAs) were performed in 53 patients with rheumatoid arthritis and juvenile rheumatoid arthritis. All patients were followed for an average of 7.4 years, unless their prosthetic hips failed before that time. Clinical evaluation was based on a 10-point maximum rating scale, and ratings for pain, walking, function, and activity improved from preoperative values to the most recent follow-up examination. Revision THA was performed for aseptic acetabular loosening in four hips, and femoral loosening in one hip. Sepsis occurred in another four hips. Complications of wound healing occurred in 14 hips. Roentgenographic evidence of loosening was seen in six acetabular components, in three femoral components, and in the femoral and acetabular component of one hip; none of these hips have as yet required revision THA. The Kaplan-Meier survivorship analysis revealed a 93% survival probability at seven years, which fell to 77% at 12 years in these patients. A trend was that younger, larger patients had increased failure and component loosening rates. Cemented primary THA has been a satisfactory operation in the rheumatoid patient. The relatively high rate of wound healing problems and sepsis may be due to the systemic immune nature of rheumatoid arthritis; however, 25% of these prosthetic hips either failed or are at risk for future failure. Thus, improved techniques are still necessary to increase the long-term success of THA in the rheumatoid patient.     

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.     

Bipolar hemiarthroplasty in juvenile rheumatoid arthritis

Because controversy surrounds the management of end-stage hip disease in juvenile rheumatoid arthritis (JRA), this study evaluated the long-term outcome of bipolar hemiarthroplasty as an alternative to conventional joint arthroplasty. A total of 24 JRA patients underwent 39 hemiarthroplasties; follow-up averaged 12 years (range, 3 to 15 years). There were 14 hips (36%) revised, and 25 hips (64%) maintained the original components. Mean Harris hip scores in surviving hips improved from 29 to 69 points (P<.001). Radiographs showed progressive bipolar superomedial migration (P<.01) despite attempted augmentation. Failure defined as revision to total hip arthroplasty or definite radiographic loosening occurred in 15 hips (38%). Ten-year Kaplan-Meier survivorship for all prostheses was 78%. Independent multivariate risk factors for failure included acetabular grafting (P = .006), prosthesis type (P<.001), and unilateral replacement (P<.001).     

Mueller reinforcement rings in acetabular revision Outcome in 164 hips followed for 2–17 years

Background?In revision hip arthroplasty, cages are commonly used for acetabular reconstruction in cases with loss of bone stock. It is important to follow this patient group closely, in order to better understand failure mechanisms and the chance of long-term success.

Patients and methods?We followed our first 164 acetabular revisions with the Mueller reinforcement ring (ARR) in 164 patients, with an average follow-up period of 6 (2–17) years. Mean age at surgery was 69 (29–92) years. 39 patients died (39 hips) during follow-up, but only 3 patients (3 hips) were lost to follow-up.

Results?In the observation period, 13 of the hips had to undergo acetabular re-revision for aseptic and septic loosening. Overall survival at 5 years was 95% (CI: 89%–98%) and 90% (CI: 76%–95%) at 8 years using acetabular re-revision or implant removal for all reasons as endpoint. In addition, mechanical and clinical failure was seen in 2 cases. The mean Harris hip score was 70 points, whilst the Merle d'Aubigné score averaged 7 points. Radiolucent lines according to DeLee and Charnley were observed twice in zone I, 6 times in zone II and 14 times in zone III.

Interpretation?We found that mid- to long-term survival of the ARR is acceptable. However, failure of the implant due to allograft collapse/resorption or deep infection, and also poor clinical outcome, remain major concerns in acetabular revision arthroplasty. This should be recognized when advising patients.     

Cementless Total Hip Arthroplasty in Patients with Osteonecrosis After Kidney Transplantation

This study was to determine the mid- to long-term survivorship of cementless metal-on-metal THA in 52 patients (74 hips) who underwent THA for osteonecrosis of the femoral head with a cementless THA. The mean follow-up was 10.2 years. The mean age at operation was 42.1 years (range, 25–62 years). The survivorship analysis with revision as the end point estimated a 96.6% chance of THA survival during 16.4 years. The average Harris hip score at last follow-up was 89.2 points (range, 74–100). Two patients (two hips) required revision surgery for extensive acetabular osteolysis at 9 years and acetabular liner dissociation at 2 years. The survival rates of cementless THA in these patients are encouraging. However, the possibility of metallic wear related complications are raising concern.     

Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with rheumatoid arthritis: three to fourteen-year follow-up

BACKGROUND: Acetabular revision in patients with rheumatoid arthritis is often difficult because of the poor quality and quantity of the acetabular bone stock. The purpose of this study was to evaluate the midterm clinical and radiographic outcomes of acetabular revision with use of an impaction bone-grafting technique and a cemented polyethylene cup. METHODS: Thirty-five consecutive acetabular revisions were performed with impaction bone-grafting and use of a cemented cup in twenty-eight patients with rheumatoid arthritis. The average age at the revision was fifty-seven years. The minimum duration of follow-up of all reconstructions that were still functioning or that were followed until the time of death was three years (mean, 7.5 years; range, three to fourteen years). No patient was lost to follow-up, but five patients (six hips) died before the time of the review. The acetabular bone defects were classified as cavitary in twelve hips and as combined segmental-cavitary in twenty-three. RESULTS: The five patients (six hips) who died had been doing well at the time of their latest follow-up. Of the remaining patients, six (six hips) had a repeat revision. The average Harris hip score of the living patients with a surviving implant at the time of follow-up was 82 points, and there was no or only mild pain in twenty-one of the twenty-three hips. Radiographic analysis of all twenty-nine hips that had not been revised showed loosening in one hip and a nonprogressive radiolucent line in one zone in two others. Kaplan-Meier analysis demonstrated a prosthetic survival rate, with aseptic loosening as the end point, of 90% at eight years. CONCLUSION: Acetabular revision with impaction bone-grafting and a cemented cup in patients with rheumatoid arthritis had acceptable results at an average of 7.5 years postoperatively.     

Minimum ten-year results of primary bipolar hip arthroplasty for degenerative arthritis of the hip

BACKGROUND: Bipolar hip arthroplasty has been advocated by some as an alternative to total hip arthroplasty for the treatment of degenerative arthritis of the hip. We sought to assess the results of this procedure at our institution after a minimum duration of follow-up of ten years. METHODS: We retrospectively reviewed a consecutive series of 152 patients (173 hips) who underwent primary bipolar hemiarthroplasty for the treatment of symptomatic degenerative arthritis of the hip with a cementless femoral component between 1983 and 1987. Of the original cohort of 152 patients, ninety-two patients (104 hips) were available for clinical and radiographic review at a mean of 12.2 years postoperatively. At the time of the latest follow-up, self-administered Harris hip questionnaires were used to assess pain, mobility, activity level, and overall satisfaction with the procedure. Biplanar hip radiographs were made to evaluate bipolar shell migration, osteolysis, and femoral stem fixation. RESULTS: At the time of the latest follow-up, nineteen patients (nineteen hips) had undergone revision to total hip arthroplasty because of mechanical failure, and three patients (three hips) were awaiting revision because of symptomatic radiographic mechanical failure. Twelve acetabular revisions were performed or scheduled for the treatment of pelvic osteolysis or protrusio acetabuli secondary to component migration. Acetabular reconstruction required bone-grafting, an oversized shell, and/or a pelvic reconstruction ring. The overall rate of mechanical failure was 21.2% (twenty-two of 104 hips), with 91% (twenty) of the twenty-two failures involving the acetabular component. Reaming of the acetabulum at the time of the index arthroplasty was associated with a 6.4-fold greater risk of revision. The rate of implant survival, with revision because of mechanical failure as the end point, was 94.2% for femoral components and 80.8% for acetabular components at a mean of 12.2 years. Of the remaining sixty-nine patients (eighty-one hips) in whom the original prosthesis was retained, seventeen patients (24.6%) rated the pain as moderate to severe. Nearly 30% of patients with an intact prosthesis required analgesics on a regular basis. Radiographs were available for fifty-eight hips (including all of the hips with moderate to severe pain) after a minimum duration of follow-up of ten years; twenty-eight of these fifty-eight hips had radiographic evidence of acetabular component migration. CONCLUSIONS: This bipolar cup, when used for hemiarthroplasty in patients with symptomatic arthritis of the hip, was associated with unacceptably high rates of pain, migration, osteolysis, and the need for revision to total hip arthroplasty, especially when the acetabulum had been reamed. To the extent that these findings can be generalized to similar implant designs with conventional polyethylene, we do not recommend bipolar hemiarthroplasty as the primary operative treatment for degenerative arthritis of the hip.     

Cementless hemispheric acetabular component for acetabular revision arthroplasty: a 5- to 19-year follow-up study

This study evaluated the 5- to 19-year clinical and radiographic results of cementless acetabular revision. Between 1986 and 1998, 130 hips (125 patients) underwent cementless acetabular revisions. Ten patients were lost to follow-up; 6 patients died. One hundred nine patients (114 hips) were reviewed at a mean follow-up of 8.8 years. The mean Harris hip score improved from 62.1 to 90.7 at final follow-up. Two hips underwent repeat revision. Twenty-two hips developed cavitary osteolysis. Kaplan-Meier survivorship at 121 months was 98.2% with repeat revision for any reason as the end point and 89.5% with repeat revision or radiographic loosening as the end point. Cementless acetabular revision provides favorable clinical and radiographic results, and the initial disease and age may adversely affect the outcomes.     

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.     

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.     

Porous-coated total hip arthroplasty in rheumatoid arthritis

Thirty-five porous-coated total hip arthroplasties were implanted in 25 patients with juvenile-onset or adult-onset rheumatoid arthritis and prospectively followed for a mean of 4.5 years (range, 3–6.5 years). Using the Harris hip rating, the mean hip score at the final follow-up evaluation was 91, and 86% of the hips had a good or excellent result. Thirty-one hips had no hip or thigh pain, while four had occasional slight pain. After surgery, 10 patients were employed and the remainder were ambulatory. There were no early or late deep infections. There was one reoperation for recurrent dislocation of the hip, but the components were not removed. Radiographic evaluation of the acetabular component showed that only one component had a complete radiolucent line in all three zones. Three femoral components had nonprogressive subsidence. At this intermediate-term follow-up period, porous-coated total hip arthroplasty is a promising technique that is likely to be successful in young patients with rheumatoid arthritis.     

Second-generation cementless total hip arthroplasty. Eight to eleven-year results.

BACKGROUND: Second-generation cementless femoral components were designed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces. We examined the eight to eleven-year results of total hip arthroplasty with a cementless, anatomically designed femoral component and a cementless hemispheric acetabular component. METHODS: Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating (Anatomic Hip) and a cementless hemispheric porous-coated acetabular component (Harris-Galante II) were performed in eighty-five patients. These patients were prospectively followed clinically and radiographically. Six patients (seven hips) died and five patients (seven hips) were lost to follow-up, leaving seventy-four patients (seventy-eight hips) who had been followed for a mean of ten years (range, eight to eleven years). The mean age at the time of the arthroplasty was fifty-two years. RESULTS: The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up; 86% of the hips had a good or excellent result. Thigh pain was reported as mild to severe after seven hip arthroplasties. No femoral component was revised for any reason, and none were loose radiographically at the time of the last follow-up. Two hips underwent acetabular revision (one because of dislocation and one because of loosening). Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point. The ten-year survival rate was 96.4% +/- 2.1% for the total hip prosthesis, 100% for the femoral component, and 96.4% +/- 2.1% for the acetabular component. Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight (93%) of the -seventy-three hips with complete radiographic follow-up. Femoral osteolysis proximal to the lesser trochanter was noted in four hips (5%). No osteolysis was identified distal to the lesser trochanter. Periacetabular osteolysis was identified in twelve hips (16%). Five patients underwent exchange of the acetabular liner because of polyethylene wear. CONCLUSIONS: This second-generation cementless, anatomically designed femoral component provided excellent clinical and radiographic results with a 100% survival rate at ten years. The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty.     

Bone-grafting in total hip arthroplasty for protrusio acetabuli. A follow-up note

The results of total hip arthroplasty with the use of medial and superior bone-graft augmentation in thirty-nine hips (thirty-two patients) that had protrusio acetabuli were previously reported after two to eight years (mean, 4.7 years) of follow-up. We followed the surviving patients for 10.9 to 17.4 years (mean, 12.8 years). The average Harris hip-rating was 72 points--an average drop of 17 points since the previous report. The average was 64 points for patients who had rheumatoid arthritis and 83 points for those who had another diagnosis. Radiographic evaluation demonstrated definite, probable, and possible loosening in about 20, 10, and 60 per cent of the hips, respectively. Of the six hips that had definite loosening, four (10 per cent of the total series) had progression of the protrusion (acetabular migration); operative revision was performed on two of those four hips and on two other hips, in which progression had ceased. Hips that had progressive protrusion demonstrated superior migration more often than medial migration. The rates of loosening and revision were similar to those in hips that did not have protrusio acetabuli. We concluded that augmentation of total hip arthroplasty with bone-grafting is effective in arresting the progression of protrusio acetabuli in most hips (90 per cent in our series).     

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.     

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.     

Primary total hip arthroplasty with the AML total hip prosthesis

Primary total hip arthroplasty using an uncemented AML total hip prosthesis (trispiked cup and a 4/5 porous coated stem) was performed in 50 patients (52 hips). The average age of the patients at the time of surgery was 47.6 years (range, 19-68 years), and the diagnosis was osteonecrosis of the femoral head in 18 hips, osteoarthritis in 16, fracture of the femoral neck in 14, osteoarthrosis secondary to childhood pyogenic arthritis in two, childhood tuberculous arthritis in one, and traumatic arthritis in one. The average followup was 11.3 years (range, 11-12 years). The average preoperative Harris Hip Score was 59 points, which improved to 90 points. Twenty-five (48%) hips had excellent results, 14 (27%) had good results, three (6%) had fair results, and 10 (19%) had poor results. The overall rate of revision was 15% (eight hips). The rate of revision of the femoral component was 2% (one hip), and the rate of revision of the acetabular component was 15% (eight hips). Twenty (38%) hips had acetabular and femoral osteolysis. Nine (17%) hips had femoral osteolysis only. Thirty-four (65%) hips had an average of 3.3 mm (range, 2-12 mm) of wear in the polyethylene liner. The average wear rate was 0.29 mm (range, 0.17 to 1.04 mm) per year.