Staged bilateral total hip arthroplasty using rough and smooth surface femoral stems with similar design: 10-year survivorship of 48 cases

BACKGROUND: Various studies have reported good long-term results using femoral stems with either smooth or rough surfaces. In this retrospective cross-sectional survivorship study, we reviewed the 10-year results of 51 bilateral staged cemented total hip arthroplasties using the Harvard or the Charnley femoral stems-which have almost similar geometry but a different surface finish. METHODS: 51 patients were reviewed at median interval of 10 (Harvard group) and 11 years (Charnley group) after the primary operation. We evaluated cement mantle thickness, alignment of the components, presence of radiolucent lines, and aseptic loosening. Kaplan-Meier analysis was performed to calculate the survival rate using various endpoints. RESULTS: 8 hips in the Harvard group were revised for aseptic loosening of the femoral component at a median interval of 6.3 years after the primary procedure. 3 hips in the Charnley group were revised for aseptic loosening of the femoral and acetabular components between 10 and 11 years after the primary procedure. The 10-year survival rate for the femoral component using revision surgery for aseptic loosening as an endpoint was 80% (95% CI: 31-42) and 95% (95% CI: 44-47) in the Harvard and the Charnley group, respectively. Cox regression analysis did not reveal any statistically significant effect of various radiographical parameters on the survival rate (p < 0.05). INTERPRETATION: Our results demonstrate that in the group of patients studied, the femoral stem component with the matt surface finish had less satisfactory 10-year survival than the femoral stem of similar design which had a smooth surface finish.     

Staged bilateral total hip arthroplasty using rough and smooth surface femoral stems with similar design: 10-year survivorship of 48 cases

Background?Various studies have reported good long-term results using femoral stems with either smooth or rough surfaces. In this retrospective cross-sectional survivorship study, we reviewed the 10-year results of 51 bilateral staged cemented total hip arthroplasties using the Harvard or the Charnley femoral stems—which have almost similar geometry but a different surface finish.

Methods?51 patients were reviewed at median interval of 10 (Harvard group) and 11 years (Charnley group) after the primary operation. We evaluated cement mantle thickness, alignment of the components, presence of radiolucent lines, and aseptic loosening. Kaplan-Meier analysis was performed to calculate the survival rate using various endpoints.

Results?8 hips in the Harvard group were revised for aseptic loosening of thefemoral component at a median interval of 6.3 years after the primary procedure. 3 hips in the Charnley group were revised for aseptic loosening of the femoral and acetabular components between 10 and 11 years after the primary procedure. The 10-year survival rate for the femoral component using revision surgery for aseptic loosening as an endpoint was 80% (95% CI: 31–42) and 95% (95% CI: 44–47) in the Harvard and the Charnley group, respectively. Cox regression analysis did not reveal any statistically significant effect of various radiographical parameters on the survival rate (p < 0.05).

Interpretation?Our results demonstrate that in the group of patients studied, the femoral stem component with the matt surface finish had less satisfactory 10-year survival than the femoral stem of similar design which had a smooth surface finish.

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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.     

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

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

Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report

The purpose of the current study was to update the results of a prospective, single-surgeon series of primary Charnley total hip arthroplasties performed with cement. This investigation is one of the first studies in which hips treated with total hip arthroplasty with cement were followed for a minimum of thirty years. Twenty-seven patients (thirty-four [10.3%] of the hips in the initial study group) were alive at a minimum of thirty years postoperatively. These patients served as the focus of the present study. Revision because of aseptic loosening of the acetabular component was performed in 7.3% (twenty-three) of the hips from the original study group (excluding those revised because of infection or dislocation) and 26% (eight) of the hips in the living cohort. Revision because of aseptic loosening of the femoral component was performed in 3.2% (ten) of the hips from the original study group (excluding those revised because of infection or dislocation) and 10% (three) of the hips in the living patients. Since the twenty-five-year review, three hips were revised (one because of acetabular loosening, one because of femoral loosening, and one because of instability). This end-result study demonstrated the remarkable durability of cemented Charnley total hip replacements over a span of three decades, with 88% of the original prostheses intact at the time of the final follow-up or at the patient's death.     

Radiological factors influencing femoral and acetabular failure in cemented Charnley total hip arthroplasties

We have made a retrospective review of 185 cemented Charnley total hip arthroplasties performed between 1970 and 1974 to determine the relationships between radiological variables and failure of the femoral and acetabular components. We measured the acetabular wear, the orientation of the cup, the thickness and consistency of acetabular and femoral cement mantles, radiolucency and femoral alignment. The mean follow-up was for 11.7 years. Femoral loosening was demonstrable radiologically in 15 hips (8.1%), ten (5.4%) of which were revised during the period of follow-up. Only when the first postoperative radiograph showed a thin cement mantle in Gruen zone 5 was there a significant association with failure of the femoral component. There were 12 loose acetabular components (6.5%), nine (4.8%) of which were revised. When the initial radiograph after operation showed radiolucency in DeLee and Charnley zone 1, the incidence of acetabular loosening was 28.21%. If such radiolucency was not present, the incidence of acetabular loosening was only 0.69%. Our findings emphasise the importance of careful cementing.     

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.     

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

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

Hybrid total hip arthroplasty with a precoated offset stem. Four to nine-year results

BACKGROUND: Use of modern cementing techniques for fixation of femoral components in total hip arthroplasty has had excellent clinical and radiographic results in most patients. However, several authors have described early loosening of femoral components with roughened and precoated finishes. The purpose of this study was to examine the performance of the precoated Iowa stem, which has increased offset, and to compare the results with those of another cemented precoated femoral component with standard offset used at our institution. METHODS: We carried out a prospective analysis of 102 primary hybrid total hip arthroplasties (a cementless acetabular component and a cemented femoral component) performed with use of the Iowa femoral component in ninety-five patients at our institution. The Iowa stem was used in hips that required greater offset than is available with standard stems as determined by preoperative templating. The average age of the patients at the time of the index procedure was sixty-nine years. Sixteen patients (seventeen hips) died before the forty-eight-month minimum follow-up period had elapsed. Two patients were lost to follow-up, and radiographic follow-up was incomplete for one. The mean duration of clinical and radiographic follow-up of the remaining eighty-two hips in the seventy-six surviving patients was sixty-five months (range, forty-eight to 104 months). RESULTS: The average preoperative Harris hip score of 47 points (range, 16 to 69 points) improved to an average of 87 points (range, 24 to 100 points) at the time of the review. Two hips underwent femoral component revision. Four femoral stems were radiographically loose at an average of thirty-four months. Femoral osteolysis was seen in five hips (6 percent) at an average of fifty-four months postoperatively. No acetabular component was revised because of aseptic loosening. According to Kaplan-Meier analysis, the seven-year survival rate, with an end point of femoral revision, osteolysis, or stem debonding, was 90.6 percent (95 percent confidence interval, 0.87 to 0.94). CONCLUSIONS: The prevalence of revision, osteolysis, and loosening after total hip arthroplasty with the Iowa femoral component at our institution was higher than that seen in our series of Harris Precoat stems, which had a survival rate of 98.4 percent (95 percent confidence interval, 0.97 to 1.00) at ten years with the same end points. The design of the Iowa stem may make it difficult to achieve a good cement mantle, and, in combination with the geometry and increased offset of the stem, may compromise the long-term survival of this cemented femoral component.     

Primary total hip arthroplasty with a flanged, cemented all-polyethylene acetabular component: evaluation at a minimum of 20 years

One hundred twenty-three consecutive primary total hip arthroplasties in 107 patients were performed with the insertion of a cemented, all polyethylene, flanged acetabular component. At a minimum of 20 years, 66 patients had died (75 hips) and 8 patients (8 hips) were lost to follow-up evaluation, leaving 40 hips in 33 patients. At a mean of 21.1 years, 2 cups had been revised for aseptic loosening, one well-fixed cup was revised at the time of femoral component revision, and 4 additional cups had definite evidence of radiographic loosening. Survivorship analysis revealed a 77.3% survivorship for the component at 21 years, with revision or definite loosening as an endpoint (95% confidence interval, 67.8%-86.8%).     

The fate of stable femoral components retained during isolated acetabular revision: a six-to-twelve-year follow-up study

BACKGROUND: The decision as to whether to revise a well-fixed femoral component in hips requiring isolated acetabular revision is challenging. The purpose of the present study was to determine the long-term results of, and the complications associated with, retention of a stable and well-fixed femoral component during isolated acetabular revision. METHODS: We retrospectively reviewed the clinical and radiographic results for thirty-one patients (thirty-two hips) who underwent isolated revision acetabuloplasty without removal of a well-fixed femoral component. The reason for acetabular revision was aseptic loosening in thirty-one hips and malposition in one hip. Of the thirty-two femoral components, twenty-one were cemented and eleven were cementless. The average duration of follow-up from the time of the index revision was 8.1 years (range, 6.4 to 12.5 years), and the average duration of total service of the femoral component was seventeen years (range, seven to twenty-five years) from time of the initial implantation. The average age of the patients at the time of the index revision was sixty-six years (range, twenty-nine to eighty-seven years). RESULTS: Thirty-one (97%) of the primary femoral components were judged to be stable and well fixed at the latest follow-up evaluation. One femoral component (3%) was revised because of aseptic loosening, eight years after the index acetabular revision and seventeen years after the initial total hip arthroplasty. Radiographic evaluation of the thirty-one femoral components that were not revised demonstrated no evidence of loosening or subsidence. There were no dislocations, nerve palsies, or intraoperative fractures associated with retention of the femoral component. Twenty-seven (84%) of the acetabular components were judged to be stable at the latest follow-up evaluation. CONCLUSION: In hips treated with isolated acetabular revision, a well-fixed femoral component can be retained successfully without adversely affecting the acetabular exposure; the placement, position, or stability of the acetabular component; or the ability to restore bone stock. The data from the present study support the decision to retain a well-fixed femoral component when the acetabular component needs to be revised.     

Long-term outcome of cemented total hip arthroplasty with the Charnley-type femoral stem made of titanium alloy

BackgroundTotal hip arthroplasty is a successful treatment for hip diseases including osteoarthritis, osteonecrosis of the femoral head, and rheumatoid arthritis. Various designs of cemented femoral stems made of stainless steel and titanium alloy have been used. Among them, Charnley-type femoral stems made of stainless steel have often been reported to have good long-term outcome. However, the long-term outcome of the Charnley-type femoral stem made of Ti alloy is yet to be reported. We conducted a retrospective study to assess the long-term outcome of cemented primary total hip arthroplasty with the Charnley-type femoral stem made of Ti alloy.MethodsBetween October 1988 and February 1997, 341 cemented primary total hip arthroplasties with the Charnley-type femoral stem made of Ti alloy were consecutively performed in our hospital. Among these, 164 patients (211 hips) who underwent this procedure were followed up for more than 12 years, and the surgical hips were analysed clinically and radiologically. The mean follow-up period was 20.6 years. Kaplan–Meier survival analyses were performed to assess femoral component survival. Factors affecting stem revision for aseptic loosening were also investigated using log-rank tests.ResultsIn the functional assessment, the preoperative Japanese Orthopaedic Association score significantly improved from 47.2 points preoperatively to 79.0 points at the final follow-up. Eventually, 33 femoral stems were revised, of which 12 were revised for aseptic loosening. In the Kaplan–Meier survival analysis, the 20-year survival rates with stem revision for aseptic loosening and radiological stem loosening at the end points were 95.9% and 97.1%, respectively. Original diagnosis (non-osteoarthritis) was the only significant factor for aseptic loosening of the femoral stem.ConclusionsCemented primary total hip arthroplasty with the Charnley-type femoral stem made of Ti alloy showed excellent outcomes for more than 20 years.     

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.     

Polyethylene wear in prosthetic hips with loose components

We measured in vivo polyethylene wear of acetabular cups in 74 patients (83 hips) with Charnley total hip arthroplasties (THA), revised because of aseptic loosening of either the acetabular or femoral component. We analyzed conventional pelvic radiographs of 42 THAs before revision due to loose acetabular components alone and 41 THAs before revision due to loose femoral components alone. The THAs were revised after 10 to 26 years. The mean wear-rate in hips with a loose acetabular components was 0.3 mm/y, whereas in hips with a loose femoral components, it was 0.1 mm/y (P=.0001). The mean total linear wear, as measured on the last available radiographs before revision, was 3.4 mm and 1.5 mm, respectively (P=.0001). A significant difference in linear wear between hips with loose cups and loose stems was seen 1 year after surgery: 0.4 mm/y versus 0.3 mm/y, respectively (P=.05).     

Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review.

To assess the effect of improved methods of femoral cementing on the loosening rates in young patients, we reviewed 50 'second-generation' cemented hip arthroplasties in 44 patients aged 50 years or less. The femoral stems were all collared and rectangular in cross-section with rounded corners. The cement was delivered by a gun into a medullary canal occluded distally with a cement plug. A clinical and radiographic review was undertaken at an average of 12 years (10 to 14.8) and no patient was lost to follow-up. No femoral component was revised for aseptic loosening, and only one stem was definitely loose by radiographic criteria. By contrast, 11 patients had undergone revision for symptomatic aseptic loosening of the acetabular component and 11 more had radiographic signs of acetabular loosening.     

Total hip arthroplasty with a modified cementing technique using hydroxyapatite granules

Results of total hip arthroplasties with a modified cementing technique using hydroxyapatite were evaluated. Femoral and acetabular components were inserted with cement after hydroxyapatite granules (phi = 100-300 microm). The study group comprised 268 hips in 232 patients. The diagnosis was osteoarthritis in 197 patients. After a mean follow-up of 10.3 years, 5 patients died and 30 patients were lost to follow-up, leaving 218 hips (197 patients; mean age, 58.2 years) for evaluation. Three hips were revised because aseptic (1) and septic (2) loosening of acetabular components. Six other sockets were defined as radiologically loose, and no femoral component was loose. Osteolysis was identified in 2 femora and 0 acetabula. The overall loosening rate was 3.2% for acetabular components and 0% for femoral components. These results show that the loosening rate of cemented total hip arthroplasty components, especially the acetabulum, is reduced markedly with this modified cementing technique.     

Results of isolated acetabular revisions: The fate of the unrevised femoral component

Controversy exists over whether to remove a well-fixed femoral component at the time of revision of a failed acetabular component, and it has been suggested that the femoral component be removed and recemented. The hypothesis presented in this article is that only the acetabular component should be revised in these situations. Thirty-eight isolated, uncemented acetabular revisions were performed by 1 surgeon and prospectively followed for a mean of 4 years (range, 2–10 years). The femoral component was well fixed at the time of revision and left in situ. There were 30 cemented and 8 uncemented femoral components, which had been in place for a mean of 10.7 years. The hips were evaluated clinically using the Harris hip score rating system. Radiographic evaluation of both components was performed using well-established criteria. Morselized cancellous allograft was used to fill acetabular defects in 30 hips, and a bulk allograft was used in 1 hip. There was a good or excellent clinical result in 32 hips (84%). Two cemented femoral components required revision for aseptic loosening at 2.5 and 4 years. No acetabular component migrated or was revised, and no revisions of either component are pending. Thirty-six (95%) of the unrevised femoral components remain well fixed at the most recent follow-up examination. Compared with a similar population of hips in which both the acetabular and femoral components were revised, the mean blood loss for these revisions was 52% less and the mean surgical time was 35% shorter. Revision of only the acetabular component is recommended for isolated acetabular aseptic loosening. Because the femoral component is not removed, surgical time and blood loss are decreased and serious potential complications related to removing a well-fixed femoral component can be avoided.     

Cementless acetabular fixation at fifteen years. A comparison with the same surgeon's results following acetabular fixation with cement

BACKGROUND: Loosening of the acetabular component is the major long-term problem associated with total hip arthroplasty with cement. The purpose of the present study was to evaluate the minimum thirteen-year results associated with cementless acetabular components that had been inserted by a single surgeon and to compare them with the results associated with cemented acetabular components that had been inserted by the same surgeon. METHODS: One hundred and twenty consecutive, nonselected primary total hip replacements were performed in 108 patients with use of a Harris-Galante-I cementless acetabular component and a cemented femoral component with a 28-mm head. The patients were evaluated clinically with use of a standard terminology questionnaire, and they were evaluated radiographically for loosening, component migration, wear, and osteolysis. The rates of revision for aseptic loosening and radiographic evidence of loosening for this cohort were compared with the rates for four previously reviewed consecutive series of hips in which the acetabular component had been inserted with cement. All patients were managed by the same surgeon, were followed for thirteen to fifteen years, and were evaluated with use of the same two criteria (revision and loosening) as the end points for Kaplan-Meier analysis. RESULTS: Sixty-six patients (seventy-two hips) were living and forty-two patients (forty-eight hips) had died after thirteen to fifteen years of follow-up. No acetabular component had been revised because of aseptic loosening, and no acetabular component had migrated. With revision of the acetabular component for any reason as the end point, the survival rate was 81% +/- 8% at fifteen years. With revision of the acetabular component for clinical failure (osteolysis, wear, loosening, or dislocation) as the end point, the survival rate was 94% +/- 8% at fifteen years. Among the seventy hips with at least thirteen years of radiographic follow-up, five had pelvic osteolysis and three had had revision of a well-fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm/yr (0.12 mm/yr when one outlier was excluded). CONCLUSIONS: In terms of fixation, Harris-Galante-I cementless acetabular components performed better than did cemented 22-mm-inner-diameter Charnley acetabular components as well as 28-mm-inner-diameter all-polyethylene and metal-backed acetabular components that had been inserted by the same surgeon. However, the rate of wear was greater in association with the Harris-Galante-I cementless components than it was in association with the Charnley cemented all-polyethylene components.