No increased stem subsidence after arthroplasty in young patients with femoral head osteonecrosis:41 patients followed for 1–9 years

Background?Poor bone stock in patients with osteonecrosis of the femoral head may be a reason for poor outcome after hip replacement. One way of studying bone quality is to measure implant migration. We thus investigated the clinical and radiographic results of cementless THR in younger patients with femoral head osteonecrosis.

Patients and methods?We studied hips in 41 patients (mean age 48 (25–63) years) with a cementless hip arthroplasty after late stage osteonecrosis. Clinical evaluation was by the Harris hip score, the WOMAC score and the SF-36 score. Stem subsidence was measured with the Ein Bild Roentgen Analyse femoral component analysis (EBRA-FCA) at 3, 12, 24, 60, and 72 months after operation. The average duration of follow-up was 7(1–9) years, with less than 2 years for 2 patients.

Results?There was no revision of any hip. No radiographic or clinical stem loosening was seen. After 60 months, the cementless stems showed a median subsidence of –0.7?mm (95% CI: –0.9 to –0.2). No femoral osteolysis occurred. Femoral radiolucent lines, all < 1?mm, were seen in 10 hips. At the latest follow-up the Harris hip score was 83 (23–100) points.

Interpretation?Our findings for porous-coated stems in patients with femoral osteonecrosis indicate no greater risk of stem subsidence and rate of osteolysis after an average of 7 years follow-up. Thus, we continue to use uncemented stems in younger patients with femoral osteonecrosis. However, continued follow-up will be necessary to evaluate the long-term outcome.     

Third-generation ceramic-on-ceramic total hip arthroplasty in patients younger than 30 years with osteonecrosis of femoral head

The purpose of this study was to evaluate the functional and radiographic results of patients younger than 30 years who underwent cementless third-generation ceramic-on-ceramic total hip arthroplasty for osteonecrosis of the femoral head. Forty-one patients (56 hips) with a minimum follow-up of 6 years were included. In all cases, third-generation ceramic-on-ceramic articulation was used. Average Harris Hip Scores improved from 52.9 preoperatively to 98.2, and Western Ontario and McMaster Universities Osteoarthritis Index score, from 95.2 to 25.2. Thirty-nine patients returned to their normal occupations. No aseptic loosening or osteolysis was observed. Total hip arthroplasty performed using third-generation ceramic-on-ceramic bearings for osteonecrosis of femoral head was found to provide satisfactory clinical and radiologic results, especially in active, young patients.     

Cementless total hip arthroplasty in Chinese patients with osteonecrosis of the femoral head

This study was designed to evaluate the midterm (> or = 5 years) clinical and radiographic outcomes of the cementless total hip arthroplasty in 64 Chinese patients (72 hips), which revealed that the mean Harris hip score increased from an average of 44.0 points before operation to 92.4 points at the last follow-up. Excellent results were achieved in 60 hips (83%). No loosening of the components was observed radiographically. No revision of the femoral components was required. Only one focal area of pelvic osteolysis in 1 hip (1%), which requires a revision, and some small focal areas of femoral osteolysis in 12 hips (17%) were observed. The mean linear wear rate was 0.125 mm/y. The survival rate of the acetabular and femoral components for radiographic loosening was 100% (95% confidence interval, 0.93-1.0) and for revision was 98.61% (95% confidence interval, 0.95-1.0). This study indicated that the cementless total hip arthroplasty in patients with osteonecrosis of the femoral head has a satisfactory midterm clinical and radiographic outcomes, but the long-term effect should be further studied.     

Total hip arthroplasty performed without cement in patients with femoral head osteonecrosis who are less than 50 years old

Seventy-two cementless total hip arthroplasties were performed by a single surgeon in 58 patients with the diagnosis of femoral head osteonecrosis. All patients were less than 50 years old (mean, 37 years). The mean follow-up was 84 months with a minimum of 48 months. Good-to-excellent results were maintained at final follow-up in 94% of the hips. Revision rate was 1.5% each for the cups and the stems. Mechanical failure rate was 7.6% for the cups, and 6% for the stems. If the results were analyzed excluding the data from the group of patients who received the Mittelmeier prostheses, the mechanical failure rates for the cups was 0% and for the stems was 4.2%. The probability of survival for the entire series using revision as the endpoint was 96.9% at 11 years. Survival probability decreased to 88.5% if radiographic failures were included. Excluding the Mittelmeier prostheses, survival probability was estimated to be 100% for the cups using both revision and radiographic failures as endpoints; for the stems, the survival probability was 98.0% using revision as the endpoint and 95.8% including radiographic failures. Femoral osteolysis was observed in 1.5% of the hips. No hip had acetabular osteolysis. No measurements of polyethylene wear were attempted in this study. These results appeared superior to total hip arthroplasties done with early cementing techniques in this population of young patients with femoral head osteonecrosis.     

Comparison of hydroxyapatite-coated and non-hydroxyapatite-coated noncemented total hip arthroplasty in same patients

The comparison between standard blasted and hydroxyapatite (HA)-coated cementless femoral stems (CLS stem) was made in the same patients who have bilateral late-stage osteonecrosis. Clinical and radiographic evaluations were performed in 20 patients (among 29 patients) with the minimum follow-up of 10 years (range, 123-168 months). Endosteal bone formation was found in all patients of both stems, and no radiolucent line was observed. The mean of initial stem subsidence was 1.27 +/- 0.95 mm with the standard stem and 0.59 +/- 0.56 mm with the HA-coated stem. Other results, such as hip score, endosteal bone formation, cortical hypertrophy, osteolysis, and heterotopic ossification showed no statistical differences. These have suggested that the fixation obtained by the cementless stem with a corundum-blasted surface is stable enough to get excellent clinical and radiographic results without the HA coating.     

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 with a cementless acetabular component and a cemented femoral component in the treatment of Chinese patients with femoral head necrosis

The purpose of this study was to evaluate midterm clinical and radiographic outcomes associated with hybrid total hip arthroplasty in a consecutive series of 86 Chinese patients (93 hips) with osteonecrosis of the femoral head, which revealed that the mean Harris hip score increased from 39 +/- 6.0 points before operation to 90.4 +/- 4.6 points at the latest follow-up. There was pelvic osteolysis in one hip (1%), which required revision, and some small focal areas of femoral osteolysis in 12 hips (13%) were observed. The mean linear wear rate was 0.143 +/- 0.05 mm/y (0.02-0.45 mm/y). No loosening of the components was observed radiographically. The survival rate of the acetabular and femoral components for revision was 98% (95% confidence interval, 0.96-1.0) and 100% (95% confidence interval, 0.95-1.0). Hybrid total hip arthroplasty in patients with osteonecrosis of the femoral head had a satisfactory clinical and radiographic outcome at a minimum 5 years of follow-up. Because polyethylene wear and osteolysis cannot be avoided, the long-term effect should be further studied.     

Second-generation cementless total hip arthroplasty in patients with osteonecrosis of the femoral head

The results of cementless total hip arthroplasties in patients with osteonecrosis have been inferior to those in patients with other diagnoses. Fifty-eight primary total hip arthroplasties with insertion of a femoral stem with a circumferentially proximal porous coating and a cementless acetabular component were followed for a mean of 11.1 years. Fifty-seven (98%) of 58 stems were biologically stable, and one stem was loose. There were acetabular revisions in 18 hips (31%) because of polyethylene wear and osteolysis. One hip (1.7%) underwent revision of both acetabular and femoral components. Osteolysis around the acetabular component was seen on radiographs in 22 hips (37.9%). Femoral osteolysis was seen in 9 hips (15.5%), and there was no osteolysis below the lesser trochanter in any hip. Second-generation femoral prostheses provide excellent fixation in patients with osteonecrosis of the femoral head. However, a high rate of polyethylene wear and osteolysis in these high-risk patients remains a challenging problem.     

Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis

Despite improvements in the quality of alumina ceramics, osteolysis has been reported anecdotally after total hip arthroplasty (THA) with use of a contemporary alumina-on-alumina ceramic bearing. The purpose of this study was to evaluate the clinical and radiographic outcomes of THA using alumina-on-alumina ceramic bearing and to determine osteolysis using radiographs and computed tomographic (CT) scans in young patients. Consecutive primary cementless THA using alumina-on-alumina ceramic bearing were performed in 64 patients (93 hips) who were younger than 45 years of age with femoral-head osteonecrosis. There were 55 men (84 hips) and nine women (nine hips). Average age was 38.2 (range 24–45) years. Average follow-up was 11.1 (range 10–13) years. Preoperative Harris Hip Score was 52.9 (range 22–58) points, which improved to 96 (range 85−100) points at the final follow-up examination. Two of 93 hips (2%) had clicking or squeaking sound. No hip had revision or aseptic loosening. Radiographs and CT scans demonstrated that no acetabular or femoral osteolysis was detected in any hip at the latest follow-up. Contemporary cementless acetabular and femoral components with alumina-on-alumina ceramic bearing couples function well with no osteolysis at a ten year minimum and average of 11.1-year follow-up in this series of young patients with femoral-head osteonecrosis.     

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.     

Total hip replacement with a cementless acetabular component and a cemented femoral component in patients younger than fifty years of age

BACKGROUND: We have been using hybrid total hip arthroplasty (a cementless acetabular component and a cemented stem) in young patients. The purpose of this study was to determine the prevalence of aseptic loosening, polyethylene wear, and osteolysis after the use of this technique. METHODS: We studied a prospective consecutive series of sixty-four primary hybrid total hip replacements in fifty-five patients younger than fifty years old. There were forty-three men and twelve women; the average age at the time of the index operation was 43.4 years. The average duration of follow-up was 9.4 years. We used a cementless acetabular component without screw-holes and a cemented femoral component with a 22-mm head in all hips. Clinical follow-up with use of Harris hip ratings and radiographic follow-up were performed at six weeks; at three, six, and twelve months; and yearly thereafter. The sequential annual linear and volumetric wear rates were measured, and bone-remodeling and osteolysis were assessed. RESULTS: The mean preoperative Harris hip score was 44 points, which increased to 95 points at the time of final follow-up. No hip had aseptic loosening. One hip (2%) was revised because of late infection. The average linear wear (and standard deviation) was 0.96 +/- 0.066 mm, with an average annual rate of 0.096 +/- 0.013 mm. The average volumetric wear was 364.7 +/- 25.2 mm (3), with an average annual rate of 43.4 +/- 3.5 mm (3). Six hips (9%) had an osteolytic lesion of <1 cm in diameter in the calcar femorale (zone 7). CONCLUSIONS: Our results show that a hybrid arthroplasty with a cementless acetabular component and a smooth cemented femoral component (Ra, 0.6 mm) is effective for primary total hip replacement in young patients. Although there was no aseptic loosening and a low prevalence of osteolysis at the latest follow-up evaluation, the high rates of linear and volumetric wear of the polyethylene liner in these young patients remain a concern.     

双极人工股骨头与全髋关节置换术在老年患者股骨头缺血性坏死FicatⅢ期的中远期随访比较

目的比较生物型双极人工股骨头置换与全髋置换术治疗老年FicatⅢ期股骨头缺血性坏死患者的中远期疗效。方法对获得随访的61例（64髋）FicatⅢ期股骨头缺血性坏死患者,其中23例（24髋）行生物型双极人工股骨头置换、38例（40髋）行全髋关节置换术对其行回顾分析比较,观察手术前后Harris评分和术后髋部疼痛、影像学变化等情况。结果术后随访5～13年（平均8年）,末次随访Harris评分全髋置换组（88.5±8.9）分,较股骨头置换组（73.5±8.3）分高,差异有统计学意义（t=6.69,P〈0.05）。在疼痛发生率及翻修率上股骨头置换组分别为37.5%（9/24）、29.2%（7/24）,均较全髋置换组10%（4/40）、7.5%（2/40）高,差异有统计学意义（2=5.41、2=5.39,P均〈0.05）。随访X线检查假体位置,股骨头置换组9例出现髋臼磨损,发生率为37.5%;全髋置换组髋臼松动率为2.5%（1/40）,假体柄松动率为5%（2/40）;股骨头置换组5例出现股骨柄松动,发生率为20.8%（5/24）,两组在股骨柄松动发生率上差异无统计学意义（2=2.41,P〉0.05）;在股骨侧骨溶解发生率上股骨头置换组20.8%（5/24）与全髋关节置换组22.5%（9/40）间的差异无统计学意义（2=2.44,P〉0.05）。结论治疗老年FicatⅢ期股骨头缺血性坏死选择双极股骨头置换术应慎重,对于大多数患者,应积极选用生物型全髋置换术。     

Cementless alumina-on-alumina total hip arthroplasty in patients younger than 50 years: a 5-year minimum follow-up study

Sixty-seven patients (78 hips) who were younger than 50 years underwent cementless total hip arthroplasty using a porous-coated acetabular cup, an alumina liner, a 28-mm alumina head, and a proximally porous-coated femoral stem. One patient (1 hip) died and 2 patients (3 hips) were lost to follow-up. The remaining 64 patients (74 hips) were followed for 5 to 6 years. Their mean age at the index operation was 37 years. The mean Harris hip score was 94 points at the time of final follow-up. Four patients (4 hips) had mild thigh pain. All acetabular and femoral components were bone-ingrown, and neither pelvic nor femoral osteolysis was identified. No fracture of the ceramic liner or head was identified. Wear of the ceramic components was undetectable in 27 hips in which measurement was possible.     

Cementless Modular Total Hip Arthroplasty in Patients Younger than Fifty with Femoral Head Osteonecrosis: Minimum Fifteen-Year Follow-Up

This study aimed to report the outcome of total hip arthroplasty (THA) with a modular femoral component in patients younger than fifty years with osteonecrosis of femoral head. Sixty-four osteonecrotic hips in fifty-five patients were available for clinical and radiographic analyses at minimum follow-up of fifteen-years. The mean Harris hip score improved from 36 points preoperatively to 92.7 points at final follow-up. Sixty-two (95.3%) hips demonstrated stable bone ingrowth. No hips showed loosening or required revision for aseptic loosening. Survivorship with an end point of stem revision for any reason was 93.8% and for aseptic loosening was 100% at 16.8 years. We believe that cementless THA with a modular stem is a promising procedure for young and active patients with osteonecrosis of the femoral head.     

Cementless Metasul metal-on-metal total hip arthroplasty in patients less than fifty years old

BACKGROUND: Durable results of total hip arthroplasty have been difficult to achieve in young patients. We reviewed the intermediate-term clinical and radiographic results in a series of active, higher-demand patients who were less than fifty years old when they underwent cementless total hip arthroplasty with the use of the Metasul metal-on-metal articulation. METHODS: Seventy total hip arthroplasties were performed in sixty-two patients who were younger than fifty years of age (average age, thirty-seven years). Two patients (two hips) had had a resection arthroplasty because of deep infection less than five years postoperatively and were excluded. Sixty patients (sixty-eight hips) were available for complete clinical and radiographic analysis after a mean duration of follow-up of seven years. RESULTS: The mean preoperative Harris hip score of 49 points improved to 95 points at the time of final follow-up; fifty-six patients (93%) had an excellent result. No component was seen to be loose radiographically at the time of final follow-up. Only one focal area of pelvic osteolysis in one patient and two small focal areas of femoral osteolysis in another patient were identified. The hip with focal pelvic osteolysis underwent revision surgery with a liner change and bone-grafting of the osteolytic lesion around a stable component. CONCLUSIONS: At a mean of seven years after arthroplasties with a Metasul metal-on-metal articulation, there was a low rate of osteolysis and aseptic loosening in this group of young patients. However, additional follow-up is necessary to determine any possible long-term deleterious effects associated with this metal-on-metal articulation.     

Metal-on-Metal Hip Arthroplasty Does Equally Well in Osteonecrosis and Osteoarthritis

Many previous reports suggest total hip arthroplasty performs suboptimally in young patients with osteonecrosis. We retrospectively compared the performance of metal-on-metal articulation in a select group of 107 patients with 112 hips (98 uncemented and 14 cemented stems) 60 years of age or younger with either osteonecrosis (27 patients, 30 hips) or primary osteoarthritis (80 patients, 82 hips). We evaluated all patients with patient-generated Harris hip score forms and serial radiographs. Five mechanical complications were caused by impingement, two with pain, two dislocations, and one liner dissociation. At a minimum followup of 2.2 years (mean, 5.5 years; range, 2.2-11.7 years), we observed no osteolysis or aseptic loosening in the osteonecrosis group, whereas one osteoarthritic hip had cup revision for loosening (none showed evidence of osteolysis). None of the stems were loose. Patients with osteonecrosis or primary osteoarthritis were similar in clinical and radiographic performance. The patients with metal-on-metal hip arthroplasty for osteonecrosis had no revisions for aseptic loosening, but did have one liner change in a cup for painful impingement.     

Uncemented total hip arthroplasty in patients 50 years of age or younger

The results of a consecutive series of uncemented total hip arthroplasties in patients 50 years or younger are reviewed. There were 41 total hip arthroplasties in 36 patients at an average follow-up period of 5.3 years. Average patient age was 42 years at the time of implantation. Preoperative Harris hip score (HHS) averaged ; the final HHS averaged 93. Radiographic evaluation revealed that the femoral stems were all solid, with no progressive subsidence, reactive lines, or osteolysis. Twenty of the hips (49%) demonstrated evidence of polyethylene wear. There was significant acetabular osteolysis in 12 of these 20 hips. Five of the acetabular cups were definitely loose; 1 was possibly loose. Three of the patients underwent revision surgery for acetabular loosening and/or osteolysis. It is concluded from this study that the femoral stem is excellent but that the original acetabular component and polyethylene locking mechanism are poor and made even worse with the use of a titanium femoral head.     

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.     

Does an Ultra-Short Anatomic Cementless Femoral Stem Improve Long-Term (Up to 17 Years) Results in Patients Younger Than 30 Years?

BackgroundThe purpose of this long-term (up to 17 years) follow-up study was to determine: (1) clinical results and evidence of clicking or squeaking sounds; (2) radiographic results, including rates of osseointegration, bone remodeling, and osteolysis; (3) rates of complications including thigh pain, periprosthetic fracture, and ceramic fracture; (4) rates of revision; and (5) survival rates of implants in patients younger than 30 years.MethodsWe analyzed the results of 240 consecutive primary total hip arthroplasty in 180 patients (118 men and 62 women who had a mean age of 27 years (range, 21 to 30 years)). The mean follow-up was 16 years (range, 14 to 17 years).ResultsMean Harris hip score, Western Ontario and McMaster Universities score, and University of California, Los Angeles activity score were 93 points, 18 points, and 7 points, respectively, at final follow-up. Radiographically, all of the acetabular components and all but two femoral components were well-fixed at the final follow-up. No hip had osteolysis or exhibited Grade 3 stress shielding. All but two patients had no groin or thigh pain. No hip had a periprosthetic or ceramic fracture. Eight hips (3%) exhibited squeaking sounds. Two acetabular components and two femoral stems were revised. The survival of the acetabular and femoral component was 99.2% (95% confidence interval, 94 to 100%).ConclusionThe results of the present long-term study of ultra-short anatomic cementless femoral stems suggest excellent clinical and radiographic results in patients younger than 30 years.