Minimum 5-year results of modular metal-on-metal total hip arthroplasty

This study reports minimum 5-year results of 95 hips implanted with a Pinnacle (DePuy, Warsaw, Ind) modular metal-on-metal acetabular prosthesis. Clinical scores such as the Harris Hip and Western Ontario and McMaster Universities Arthritis Index revealed excellent clinical outcomes at mean 6-year follow-up. With the use of large-diameter femoral heads, dislocation was rare, occurring in only 1 hip. Moreover, no acetabular and only 3 femoral osteolytic lesions were detected. Kaplan-Meier survivorship at 7 years after arthroplasty was 97.8% for the total hip arthroplasty construct and 100% for the acetabular shell. No unexplained pain or other complication attributable to wear debris or the metal-on-metal articulation was observed. These findings indicate that total hip arthroplasty with this specific modular metal-on-metal bearing performed well in a high-demand population at midterm follow-up.     

Midterm results of Metasul metal-on-metal total hip arthroplasty

We assessed 106 total hip arthroplasties performed with a new metal-on-metal hip system; the patients were monitored for at least 5 years. The average Harris Hip Score of the patients was 39.5 points before surgery and 87.8 points at final follow-up evaluation. Radiographically, the acetabular component was stable in 103 hips and possibly unstable in 3 hips. The femoral component was bone ingrown in 97 hips and stable and fibrous in 9. After surgery, 6 hips dislocated. The polyethylene liner dissociated in one patient. No patient exhibited clear signs of loosening, migration, or osteolysis. Distal femoral cortical hypertrophy was seen in 35.8% of the cases. Survival at the mean follow-up point (6.4 years) was 99.1%. There was no significant difference in serum chromium concentration between metal-on-metal bearings and polyethylene-on-metal bearings (control subjects). This study found that metal-on-metal total hip arthroplasty produces excellent midterm results.     

Alternative bearing surfaces in total hip arthroplasty: zirconia-alumina pairing. Contribution or caveat?

The aim of the present study was to evaluate the zirconia and alumina articulation in total hip arthroplasty in regard to clinical and radiological outcome. This is the first report concerning the clinical application of a hybrid ceramic articulation. Owing to ethical reasons, a limited number of patients was enrolled in the study. Ten consecutive patients with degenerative arthritis were randomly allocated after informed consent to hybrid total hip arthroplasty treatment using an alumina femoral head and an alumina acetabular liner (5 hips), or using a zirconia femoral head and an alumina acetabular liner (5 hips). The median age of patients at index operation was 57.8 years. Current criteria were used for clinical and radiological assessment. The mean follow-up was 5.1 years (5 to 5.3 years). No hip required revision, and no clinical and radiological differences were observed between the two groups of hips. The median preoperative Harris hip score was rated 55.3 points in the control group of hips with alumina head, and 55.6 in the group of hips with zirconia head. The median Harris hip score increased to 94.9 points at the time of follow-up in the control group, and 96 points in the zirconia group. No radiological signs of cup loosening or focal acetabular osteolysis were detected at follow-up. All stems showed stable fixation without radiolucent lines or focal osteolysis. Zirconia femoral heads and alumina acetabular liners have been successfully used in the present series of 5 total hip arthroplasties with a mean follow-up of 5.1 years. Nevertheless, the use of femoral heads made of zirconia in total hip arthroplasties remains an important clinical concern due to the potential genesis of wear microparticles which can lead to progressive osteolysis. Further in-vitro and in-vivo investigations are required to define the value of this alternative bearing surface.     

Cementless Acetabular Socket Revisions Using Metasul Metal-on-Metal Bearings

Thirty-four hips were treated with cementless acetabular socket revisions using a metal-on-metal bearing. The causes of revision were aseptic loosening in 33 hips and septic loosening in 1 hip. Revisions were performed for acetabular sockets in 28 hips and for acetabular sockets and femoral stems in 6 hips. Mean follow-up duration was 6.2 years (range, 4.0-9.1 years), and mean Harris Hip Scores improved from 56 to 92 points. No hip required further revision for aseptic loosening. Focal femoral osteolysis newly developed in zone I in 1 hip, which was treated by curettage and bone grafting. The authors suggest that second-generation metal-on-metal bearings in cementless acetabular socket revisions can achieve good medium-term clinical and radiographic results.     

Results of metal-on-metal hybrid hip resurfacing for Crowe type-I and II developmental dysplasia

BACKGROUND: Modern hip resurfacing implants may increase stability and preserve more bone than conventional total hip arthroplasty. The purpose of this retrospective study was to analyze the mid-term results in a consecutive series of middle-aged patients with developmental dysplasia of the hip treated with hybrid resurfacing joint arthroplasty. METHODS: Metal-on-metal hip resurfacing was performed in fifty-one patients (fifty-nine hips), forty-two of whom were female and nine of whom were male. The average age at the time of surgery was 43.7 years. Radiographic and clinical data were collected at six weeks, at three months, and at yearly follow-up visits. Seven hips had Crowe type-II developmental dysplasia of the hip and fifty-two had type-I. RESULTS: The follow-up period ranged from 4.2 to 9.5 years (average, 6.0 years). Initial stability was achieved in all but three hips. The clinical outcomes, as rated with the University of California at Los Angeles (UCLA) hip score, improved significantly compared with the preoperative ratings. On the average, the pain rating improved from 3.2 to 9.3 points; the score for walking, from 6.0 to 9.7 points; the score for function, from 5.7 to 9.6 points; and the score for activity, from 4.6 to 7.3 points (all p = 0.0001). The mean Short Form-12 (SF-12) mental score increased from 46.6 to 53.5 points, and the mean SF-12 physical score increased from 31.7 to 51.4 points (both p < 0.0001). The mean postoperative Harris hip score was 92.5 points. On the average, the range of flexion improved from 106 degrees to 129.6 degrees ; the abduction-adduction arc, from 41.9 degrees to 76.9 degrees ; and the rotation arc in extension, from 32.1 degrees to 84.8 degrees (all p = 0.0001). Four patients delivered a total of six healthy babies since the time of implantation of the prosthesis. Radiographic analysis showed a decrease in the mean body weight lever arm from 118.5 mm preoperatively to 103.9 mm postoperatively (p = 0.007). There were five femoral failures requiring conversion to a total hip arthroplasty. One hip showed a radiolucency around the metaphyseal femoral stem. There were no complete acetabular radiolucencies, and all sockets remained well fixed. CONCLUSIONS: The mid-term results of metal-on-metal resurfacing in patients with Crowe type-I or II developmental dysplasia of the hip were disappointing with respect to the durability of the femoral component. However, the fixation of the porous-coated acetabular components without adjuvant fixation was excellent despite incomplete lateral acetabular coverage of the socket. More rigorous patient selection and especially meticulous bone preparation are essential to minimize femoral neck fractures and loosening after this procedure.     

Treatment of femoro-acetabular impingement with surgical dislocation and débridement in young adults

BACKGROUND: Femoro-acetabular impingement has been associated with acetabular labral and/or articular cartilage damage that may ultimately result in osteoarthritis of the hip. Surgical treatment of femoro-acetabular impingement is directed at restoring a more normal femoral head-neck offset to alleviate femoral abutment against the acetabular rim and treating associated labral and articular cartilage damage. METHODS: Thirty hips with femoro-acetabular impingement (in twenty-nine patients) underwent débridement through a greater trochanteric flip osteotomy and anterior dislocation of the femoral head. There were sixteen male patients and thirteen female patients with a mean age of thirty-one years. Cam (femoral based) impingement was noted in fourteen hips; pincer (acetabular based) impingement, in one hip; and combined cam and pincer impingement, in fifteen hips. The mean duration of clinical and radiographic follow-up was thirty-two months. All patients were followed according to a prospective protocol, with Harris hip scores and plain radiographs obtained preoperatively and at six months, one year, and annually for a minimum of two years. RESULTS: The mean Harris hip score improved from 70 points preoperatively to 87 points at the time of final follow-up (p < 0.0001). Osteonecrosis did not develop in any hip, and there were no trochanteric nonunions. In eighteen hips, severe damage of the acetabular articular cartilage that had not been appreciated on preoperative plain radiographs or magnetic resonance arthrography was noted on arthrotomy. Eight of these eighteen hips subsequently had radiographic evidence of progression of the osteoarthritis, and four of the eight hips required or were expected to soon require conversion to a total hip arthroplasty to treat progressive pain. CONCLUSIONS: At the time of early follow-up, we found that surgical dislocation and débridement of the hip for the treatment of femoro-acetabular impingement in hips without substantial damage to the articular cartilage can reduce pain and improve function. This procedure has a low rate of complications. Radiographic signs of progression of osteoarthritis and clinical failure requiring conversion to a total hip arthroplasty were seen only in patients with severe damage to the acetabular articular cartilage, a finding that emphasizes the need for better imaging methods to assess the extent of damage to the acetabular articular cartilage in patients with this disorder.     

Chiari pelvic osteotomy for advanced osteoarthritis in patients with hip dysplasia

BACKGROUND: It is not clear whether a Chiari pelvic osteotomy performed for the treatment of advanced osteoarthritis can delay the need for total hip arthroplasty. We present the mid-term results of the Chiari pelvic osteotomy performed for the treatment of T?nnis grade-3 osteoarthritis (large cysts, severe narrowing of the joint space, or severe deformity or necrosis of the head with extensive osteophyte formation), with a particular focus on whether this procedure can delay the need for total hip arthroplasty. METHODS: We followed thirty-two hips in thirty-one patients with T?nnis grade-3 osteoarthritis who had refused total hip arthroplasty and had been treated with a Chiari pelvic osteotomy. The mean age at the time of surgery was 35.2 years. The mean duration of follow-up was 11.2 years, at which time clinical evaluation with the Harris hip score and radiographic evaluation were performed. RESULTS: The average Harris hip score improved from 52 points preoperatively to 77 points at the time of follow-up; the average pain score improved from 20 to 31 points. Three hips with a hip score of <70 points required total hip arthroplasty. With a hip score of <70 points as the end point, the cumulative rate of survival at ten years was 72%. The clinical outcome was significantly influenced by the preoperative center-edge angle (p = 0.004), the preoperative acetabular head index (p = 0.039), achievement of the appropriate osteotomy level (p = 0.011), and superior migration (p = 0.009) and lateral migration (p = 0.026) of the femoral head. CONCLUSIONS: Although the clinical results were inferior to those of total hip arthroplasty, Chiari pelvic osteotomy may be an option for young patients with advanced osteoarthritis who prefer a joint-conserving procedure to total hip arthroplasty and accept a clinical outcome that is predicted to be less optimal than that of total hip arthroplasty. Moderate dysplasia and moderate subluxation without complete obliteration of the joint space and a preoperative center-edge angle of at least -10 degrees are desirable selection criteria.     

变异髋臼初次全髋人工关节置换术前设计及临床意义

目的:探讨变异髋臼初次全髋人工关节置换术中髋臼假体的正确放置位置及手术疗效。方法:对34例(38髋)接受全髋关节置换的髋臼变异的各类髋关节疾病进行术前设计,其中男20例,女14例,平均年龄56.1岁(29~75岁)。股骨头坏死继发骨性关节炎15例(19髋),髋臼发育不良继发骨性关节炎12例,创伤性骨关节炎5例,髋关节融合术后1例,髋关节人工股骨头置换术后1例。结果:术后患者均获得随访,平均随访11个月(5~38个月)。根据Harris髋关节功能评分评定,优(>90分)12髋,良(80~90分)23髋,尚可(70~79分)3髋,失败0髋(<70分)。评定结果:术前Harris评分平均47.9分,术后平均90.3分。结论:对于髋臼解剖结构异常的髋关节疾病患者行全髋人工关节置换时,通过术前对髋臼正确位置的设计,使髋关节中心置于正确的位置上,既可简化术中操作的难度,又可以使臼杯假体得到牢固固定及良好的骨覆盖,有利于人工全髋关节的长期疗效。     

大直径股骨头金属对金属全髋关节置换术的近期临床疗效

目的 评价大直径股骨头(大头)金属对金属全髋关节置换术治疗晚期髋关节疾病的近期疗效,回顾性分析影响该类全髋关节置换术临床疗效的因素.方法 对2007年10月至12月,采用大头金属对金属全髋关节置换术治疗晚期髋关节疾病患者41例(49髋)进行术后随访.临床评估以Harris评分为标准,记录患髋的活动范围及并发症发生情况.影像学评估根据随访骨盆X线片及患髋正、侧位X线片,测量髋臼外展角、前倾角,记录髋臼和股骨假体周围透亮线和骨溶解情况.结果 截至随访终点,共39例(47髋)获得2年以上随访,平均随访25个月,随访率为95.1%.Harris评分由术前的(43.8±13.1)分提高到末次随访时的(92.0±5.4)分.患髋活动度较术前明显改善,术后3个月屈髋由79.8°增加至110.2°,外展由20.9°增加至38.3°,外旋由12.0°增加至26.0°;术后2年屈髋平均可达113.2°,外展可达40.2°,外旋可达30.8°.术后患者轻度跛行3例,大腿不适2例,所有患者均无感染、假体周围骨折、术后假体松动或脱位、术后异位骨化发生.X线片显示:关节假体位置正常,髋臼假体外展角为39.5°±4.9°,前倾角为14.5°±2.1°,髋臼未见松动、移位.术后均未发现透亮线和假体周围骨溶解.结论 大头金属对金属全髋关节置换术治疗髋关节疾病具有良好的近期疗效,特别适用于活动量大、预期寿命较长的年轻患者.

Abstract：

Objective To evaluate clinical and radiographic outcomes associated with total hip arthroplasty (THA) using metal-on-metal prosthesis with large diameter femoral head.Methods From October 2007 to December 2007,41 patients (49 hips) underwent large diameter femoral head metal-on-metal THA in our hospital were involved in this study.Clinical outcomes measures were Harris score,hip range of motion and incidence of complications.Abduction angle and anteversion angle of cup were measured on radiological films.The radiolucent line and osteolysis around the prosthesis were also recorded.Results Thirty-nine patients (47 hips) were followed up at least 2 years.The average Harris hip score had improved from (43.8±13.1) points preoperatively to (92.0±5.4) points at final follow-up.All the patients had attained satisfactory results.No late complication happened.For the rang of motion at final follow-up:flexion of the hip had improved from 79.8° to 113.2°,abduction had improved from 20.9° to 40.2°,external rotation had improved from 12.0° to 30.8°.Radiological measurement showed the mean abduction angle of cup was 39.5°±4.9°,the mean anteversion angle of cup was 14.5°±2.1°.No radiolucent line and osteolysis were found after THA.Conclusion The short-term effects of THA using metal-on-metal prosthesis with large diameter femoral head is encouraging,especially for young patients.     

应用S-ROM全髋关节置换术治疗Crowe Ⅳ型髋臼发育不良

目的总结采用粗隆下截骨和生物固定型带股骨柄模块的人工关节假体治疗CroweⅣ型髋臼发育不良伴骨关节炎的效果及经验。方法回顾从2004年2月到2009年4月对12例21髋CroweⅣ型髋臼发育不良伴骨关节炎患者治疗的详细过程及疗效,记录所有的并发症。全部采用粗隆下截骨和S-ROM生物固定型人工关节假体置换术进行治疗。髋臼杯假体均植入真臼位置,7例13髋采用自体股骨头于髋臼外上方作结构性植骨,均作了粗隆下缩短截骨术,平均截骨长度为39.4 mm(35~50 mm)。结果平均随访30.8个月(6~62个月)。髋关节Harris评分明显改善(t=24.862,P0.01),从术前的平均(38.2±6.4)分(28~48分)到术后平均(82.1±8.6)分(62~94分)。术后肢体均得到不同程度的延长(t=12.099,P0.01),平均(33.5±12.7)mm(11~65 mm)。术前所有患者均有明显跛行,术后4例有轻度跛行,2例仍需扶双拐行走。19髋股骨截骨处愈合良好,2髋截骨处延迟愈合。在最后一次回访时显示髋臼假体和股骨柄假体位置均良好,无松动、下沉、断钉、骨溶解及异位骨化出现。髋关节中心平均下移了73.0 mm(46~105 mm)。结论利用S-ROM带股骨柄模块的生物固定型人工关节假体的高度适配性,加上在真臼位置加深髋臼,适当植骨,以及精确的粗隆下截骨,是治疗CroweⅣ型髋臼发育不良伴骨关节炎的良好选择。     

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.     

Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities

BACKGROUND: Acetabular dysplasia associated with deformity of the proximal part of the femur can result in hip dysfunction and degenerative arthritis in young adults. The optimal method of surgical correction for these challenging combined deformities remains controversial. METHODS: We retrospectively analyzed twenty-four hips in twenty patients who underwent a Bernese periacetabular osteotomy, which was done with a proximal femoral valgus-producing osteotomy in thirteen hips, for the treatment of acetabular dysplasia associated with proximal femoral structural abnormalities. The average age of the patients at the time of surgery was 22.7 years, and the average duration of clinical follow-up was 4.5 years. The Harris hip score and overall patient satisfaction with surgery were used to assess hip function and clinical results. Plain radiographs were used to assess the correction of the deformity, healing of the osteotomy, and progression of degenerative arthritis. RESULTS: The mean Harris hip score increased from 68.8 points preoperatively to 91.3 points at the time of the most recent follow-up (p<0.0001). Sixteen patients (nineteen hips) had an excellent clinical result, and one patient (one hip) had a good result. Two patients (two hips) had a fair result, and one patient (two hips) had a poor result. Twenty-two of the twenty-four hips improved clinically. There was an average improvement of 27.6 degrees in the lateral center-edge angle of Wiberg (p<0.0001), an average improvement of 33.1 degrees in the anterior center-edge angle of Lequesne and de Seze (p<0.0001), and an average improvement of 16.5 degrees in the acetabular roof obliquity (p<0.0001). The hip center was translated medially an average of 6.3 mm (p=0.0003). The T?nnis osteoarthritis grade was unchanged in twenty hips, progressed one grade in three hips, and progressed two grades in one hip. There were three major technical complications. At the time of the most recent follow-up, none of the hips had required total hip arthroplasty. CONCLUSIONS: The combination of acetabular dysplasia and proximal femoral deformities presents a complex reconstructive problem. The range of motion and radiographic assessment of the hip are major factors in the selection of patients for surgery. In selected patients, the periacetabular osteotomy combined with concurrent femoral procedures, when indicated, can provide comprehensive deformity correction and improved hip function.     

Clinical experience with a proximally porous-coated second-generation cementless total hip prosthesis: minimum 5-year follow-up

This study reports the minimum 5-year follow-up of our experience with the Porous-Coated Anatomic E (PCA-E) series femoral stem and the modular acetabular cup. A total of 115 consecutive total hip replacements using PCA-E series (Howmedica, Rutherford, NJ) were performed in 108 patients. Six patients whose hips were performing well clinically died before 5-year follow-up and were excluded from the final evaluation. The remaining 109 hips (102 patients) were assessed at a mean follow-up of 72 months (range, 60-84 months). The hip diagnoses were osteoarthritis in 73, osteonecrosis in 31, rheumatoid arthritis in 2, and hip dysplasia in 3. The mean age was 56 years (range, 24-83 years). Three hips were revised: 1 because of late hematogenous infection, 1 because of aseptic loosening of the femoral component, and 1 because of postoperative loosening of an acetabular component. The Harris hip scores improved from a mean of 50 points (range, 20-66 points) preoperatively to a mean of 92 points (range, 64-100 points) at final follow-up. The score differed in each Charnley functional class, with a mean of 93 points (range, 72-100 points) in 57 hips of class A (no other joint involvement); 90 points (range, 58-100 points) in 26 hips of class B (opposite hip involvement); and 85 points (range, 37-100 points) in 26 hips of class C (multiple joint involvement or severe systemic disease). Out of 106 hips that had a full radiographic evaluation performed, 103 femoral components revealed stable bony ingrowth, 2 revealed stable fibrous ingrowth, and 1 showed migration with progressive loosening. This patient with radiographic loosening has minimal symptoms and has not required or been offered further surgery (Harris hip score of 86 points). The low aseptic loosening rate (2%) at minimum 5-year follow-up compares favorably with any cemented or cementless series. The osteolysis that was seen was focal and localized. The short follow-up does not allow determination of progression. There were no cases of distal osteolysis. We attribute the improved results from reported first-generation experience to multiple factors, including increased number of sizes (9 vs 6), increased proportional metaphyseal size, improved polyethylene manufacture (ram extruded vs machined), improved acetabular locking mechanism, and change to 26-mm from 32-mm femoral heads.     

Primary bipolar total hip arthroplasty

A retrospective clinical and radiographic review of 140 primary total hip arthroplasties using a bipolar acetabular component and an uncemented AML femoral component (Depuy, Warsaw, IN) was done. The length of follow-up was from 2 to 5 years with a mean of 44.2 months. A mean postoperative Harris hip score of 84.3 points and a mean postoperative Harris pain score of 38.8 points were identified. Five hips required revision surgery, three for recurrent dislocations and two for infection. Nine percent of acetabular components were noted to have migrated within the bony pelvis by 2 mm or more. However, the presence of migration was not statistically associated with low pain or function scores. Ninety-eight percent of patients with surviving implants felt satisfied with the results of their surgery. Total hip arthroplasty using a bipolar acetabular component appears to be a successful method of hip replacement.     

Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center

BACKGROUND: Most reports on the results of the Bernese periacetabular osteotomy for the treatment of developmental dysplasia of the hip have been by the originators of the procedure. In 1997, we began to use this osteotomy without direct training from the originators of the procedure. METHODS: Seventy-three patients (eighty-three hips) underwent a Bernese periacetabular osteotomy between 1997 and 2003 and were followed prospectively with use of the Harris hip score to assess clinical results and with use of anteroposterior pelvic and false-profile lateral plain radiographs to assess radiographic results. The three-dimensional position of the acetabulum was recorded preoperatively and postoperatively. The mean duration of follow-up was forty-six months. RESULTS: The average Harris hip score improved from 54 to 87 points (p < 0.001). Three hips (three patients) had a conversion to total hip arthroplasty at two, three, and four years after the periacetabular osteotomy. Preoperatively, fifty-four of the eighty-three acetabula were anteverted, and twenty-nine were either retroverted or had neutral wall relationships. Postoperatively, sixty-five hips (78%) were anteverted. Radiographically, in preoperatively anteverted hips, the average center-edge angle improved from 3 degrees to 29 degrees (p < 0.0001), the average anterior center-edge angle improved from 5 degrees to 31 degrees (p < 0.0001), and the acetabular index improved from 25 degrees to 5 degrees (p < 0.0001). In preoperatively retroverted or neutral hips, the average center-edge angle improved from 13 degrees to 33 degrees (p < 0.0001), the average anterior center-edge angle improved from 15 degrees to 36 degrees (p < 0.0001), and the acetabular index improved from 19 degrees to 2 degrees (p < 0.0001). Complications included four hematomas, three transient femoral nerve palsies, two deep wound infections, and one transient sciatic nerve palsy. Nine of the ten major complications and all four of the failed osteotomies occurred in the first thirty hips in which the index procedure was performed. CONCLUSIONS: In our experience, the early results of the Bernese periacetabular osteotomy have been encouraging, with a 92% survival rate at thirty-six months. The occurrence of complications demonstrates a substantial learning curve. Recognition of the true preoperative acetabular version and reorientation of the acetabulum into an appropriately anteverted position have become important factors in surgical decision-making. LEVEL OF EVIDENCE: Therapeutic Level IV.     

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.     

Influence of acetabular coverage on hip survival after free vascularized fibular grafting for femoral head osteonecrosis

BACKGROUND: Osteonecrosis of the femoral head frequently results in collapse of the head and subsequent arthrosis of the joint. Surgical treatment has been based entirely on the evaluation of the femoral side of the hip joint, with little consideration given to the possible influence on outcome of the orientation of the acetabulum. METHODS: We retrospectively reviewed a consecutive series of 200 hips in 160 patients with osteonecrosis of the femoral head who had undergone free vascularized fibular grafting between 1997 and 1998. The mean duration of clinical follow-up was 7.5 years. Ninety-one hips in seventy-one patients were evaluated radiographically for evidence of progression of femoral head collapse at a minimum of two years, and a mean of three years, postoperatively. We defined conversion to a total hip arthroplasty and progression of femoral head collapse as the failure end points, and we analyzed the association of the acetabular center-edge angle of Wiberg, the area and laterality of the lesion, the amount of preoperative collapse of the femoral head, and the etiology of the osteonecrosis with the likelihood of failure. RESULTS: Forty-eight (24%) of the 200 hips had undergone conversion to a total hip arthroplasty at the time of the final clinical follow-up. In addition, 15% (fourteen) of the ninety-one hips with sufficient radiographic follow-up demonstrated progression of femoral head collapse at the time of the final radiographic examination. Of the hips with a center-edge angle of 30 degrees , 10% had progressive collapse (p = 0.002) and 6% were converted to a total hip arthroplasty (p < 0.001). Neither the etiology nor the size of the lesion was significantly correlated with progression of collapse or conversion to a total hip arthroplasty. CONCLUSIONS: Patients with osteonecrosis of the femoral head and a suboptimal center-edge angle of the hip are at substantial risk for progression of femoral head collapse and conversion to a total hip arthroplasty following free vascularized fibular grafting. An estimation of the degree of hip dysplasia should be included in the preoperative assessment of patients with osteonecrosis of the femoral head for prognostic and possibly surgical planning purposes.     

类风湿性关节炎继发严重髋臼内陷的全髋关节置换

目的探讨类风湿性关节炎继发严重髋臼内陷患者行全髋关节置换术治疗的临床疗效。 方法2011年1月至2014年11月,对解放军兰州总医院收治18例(20髋)类风湿性关节炎的严重髋臼内陷患者进行随访观察,其中男6例,女12例;年龄37～68岁,平均(46±8)岁。纳入病例均类风湿性关节炎继发严重髋臼内陷,髋臼内陷依Sotello-Garza和Charnley分型：Ⅰ型(内陷1～5 mm)0例,Ⅱ型(内陷6～15 mm)15例(17髋),Ⅲ型(内陷>15 mm)3例(3髋)。排除标准为先天性、创伤性或髋关节骨关节炎所继发的髋臼内陷。手术采用后外侧入路,股骨颈截骨后股骨头逆行取出,取自体松质颗粒骨打压植骨重建髋臼,采用压配方式植入生物型多孔髋臼假体。随访时采用Harris髋关节评分评估髋关节功能,X线平片观察假体是否有松动和再次内陷以及植骨愈合情况。对手术前、后髋关节功能、股骨头中心到Kohler线的距离等计量资料采用t检验分析。 结果手术时间为55～131 min,平均(89±8)min。失血量为165～480 ml,平均(295±11)ml。术中未发生血管、神经损伤以及髋臼和股骨劈裂骨折。随访时间2.5～6年,平均(4.5±1.7)年。术后X线片示4.5个月自体移植骨均与髋臼融合。末次随访的Harris髋关节评分由术前(55±9)分(40～65分)提高至(92±13)分(89～95分),差异有统计学意义(t ＝22.81,P <0.01)。股骨头中心到Kohler线的距离由置换前的(20± 4)mm增加到置换后的(21±3)mm,差异有统计学意义(t ＝2.312,P <0.01);随访期间均无髋臼假体松动发生。 结论类风湿性关节炎继发严重髋臼内陷的髋臼骨质菲薄且局部骨质疏松严重,髋臼形态不规则。采用自体股骨头颗粒骨移植填充髋臼结合生物型钽金属骨小梁髋臼杯假体,可恢复髋关节旋转中心并获得满意的近中期临床效果。     

金属对金属髋关节表面置换术治疗重度股骨头无菌性坏死的短期临床效果

目的探讨新一代的金属对金属髋关节表面置换术治疗重度股骨头无菌性坏死（FicatⅢ、Ⅳ）的短期临床效果。方法对28例（33髋）诊断为股骨头无菌性坏死的患者行金属对金属髋关节表面置换手术。股骨头无菌性坏死程度按照Ficat分期：Ⅲ期24例（27髋），Ⅳ期4例（6髋），手术时的平均年龄是48岁（21-77岁），其中男患者17例（60.7%），女患者11例（39.3%）。术后随访内容包括所有患者的临床及影像学资料。结果平均随访时间为24个月（11-35个月），在随访期内未发生髋关节脱位、深静脉栓塞、感染、股骨颈骨折等并发症。临床结果显示，Harris髋关节评分较术前显著提高，术后平均Harris评分为92.6分，术前平均Harris评分为48.5分。影像学资料显示所有假体在位，未观察到放射性透亮带。所有患者疼痛解除，髋关节活动度也明显改善，术后早期活动无任何受限。结论金属对金属髋关节表面置换术治疗重度股骨头坏死的早期临床效果满意，其远期效果仍有待于观察。