病灶清除颗粒骨植骨治疗全髋关节置换术后髋臼周围骨溶解

目的 探讨全髋关节置换（THA)术后髋臼周围骨溶解的治疗方法及疗效.方法 对24例(24髋)THA术后髋臼周围骨溶解行骨溶解病灶清除、同种异体颗粒骨植骨、更换高交联聚乙烯内衬和股骨头假体.14例（14髋）髋臼杯稳定保留金属臼杯;2例（2髋）髋臼杯稳定卡环损坏,被迫取出稳定臼杯,行非骨水泥型髋臼杯翻修术;8例（8髋）髋臼杯松动行髋臼翻修术.采用Harris评分评价髋关节功能.通过X线片观察假体是否松动和移植骨愈合情况.结果 23例获得随访,1例失访,平均随访16个月（10～45个月）.Harris评分由术前(58±23)分（17～86分）,提高到末次随访时(92±12)分（80～98分）,差异有统计学意义(P＜0.05).术后无感染、脱位、静脉血栓形成等.X线片显示髋臼假体无松动和异位骨化,可见移植骨-宿主骨交界处有连续性骨小梁通过.结论 保留髋臼杯积极进行骨溶解病灶清除,同种异体颗粒骨植骨,更换聚乙烯内衬和股骨头假体可阻断骨溶解的进展;髋臼翻修,同种异体颗粒骨植骨,短期随访示移植骨愈合、髋臼杯稳定,临床效果满意.     

全髋关节置换术治疗成人髋关节发育不良继发骨关节炎五年以上随访研究

目的 评价全髋关节置换术(total hip arthroplasty,THA)在成人髋关节发育不良(develop-mental dysplasia of the hip,DDH)继发骨关节炎患者中的疗效,回顾性分析该类患者THA术后5年以上的临床疗效及其影响因素.方法 对2000年2月至2002年7月在我院采用THA治疗DDH继发骨关节炎的患者55例(69髋)进行术后随访.临床评估以Harris评分为标准.影像学评估根据随访骨盆平片及患髋正、侧位X线片,观察髋臼、股骨假体位置及其周围骨质变化,测量内衬磨损率.假体生存率采用Kaplan-Meier方法进行分析,以任何原因的臼杯、股骨柄翻修或影像学假体明显松动为随访终点.结果 截至随访终点,共45例(57)髋获得5年以上随访,平均随访时间69个月,随访率为81.8%.Harris评分由术前的(46.19±18.01)分提高至末次随访时的(91.78±3.52)分,尚无假体翻修病例.聚乙烯内衬平均磨损率为(0.27±0.14)mm/年.5髋髋臼侧发生骨溶解,8髋股骨侧近端发生骨溶解.Kaplan-Meier分析假体总生存率为1.0(95%可信区间,0.98～1.00).结论 THA治疗DDH继发骨关节炎5年以上随访的影像学表现及临床效果尚可,但存在较高的聚乙烯磨损率及骨溶解发生率,对于年轻、活动量大的DDH患者,THA手术时应选择新型耐摩擦界面假体.DDH患者的定期随访尤为重要,可甲期发现骨溶解,及时给予相应的治疗.     

混合型初次全髋关节置换术中骨水泥柄10年以上的随访研究

目的回顾性分析混合型初次全髋关节置换术（THA）中骨水泥柄的临床和影像学疗效及其相关影响因素。方法对1999年1月至2001年12月期间接受混合型初次THA治疗髋部疾病的患者126例（135髋）进行至少10年的随访。观察Harris评分、股骨假体位置、骨水泥壳及其周围骨质变化。假体生存率采用Kaplan-Meier方法进行分析,以无菌性松动导致翻修及单纯骨溶解病灶清除植骨术为随访终点。结果共有79例（85髋）获得10年以上随访。Harris评分由术前（44.5±18.8）分提高至末次随访时（92.1±5.6）分。截至随访终点,在Gruen 1区观察到2髋发生骨溶解,7区4髋发生骨溶解现象。共有4例（4髋）接受翻修手术,其中1例男性患者因骨溶解致髋臼假体松动,同侧股骨近端骨溶解,同期行右髋臼侧翻修及股骨侧骨溶解病灶清除植骨术。另3例因髋臼假体松动行髋臼侧翻修术,影像学及术中见股骨假体稳定。以无菌性松动为随访终点,股骨假体生存率为100%;以无菌性松动翻修、单纯骨溶解病灶清除植骨术为随访终点,股骨假体生存率为98.8%（95%可信区间,12.23~12.32）。结论混合型初次THA术中骨水泥假体的远期生存率令人满意;采用第3代骨水泥技术固定的股骨柄取得与现代非骨水泥假体柄相近的远期生存率。     

氧化锆陶瓷头与金属头聚乙烯全髋关节的比较研究

目的讨氧化锆陶瓷头非骨水泥全髋关节的长期实际临床运用效果。方法在同一医院，由同一医生完成的钴铬金属头（CoCr）非骨水泥全髋的病例中，寻找26例（26髋）与氧化锆组进行配对研究。使配对病例的年龄、性别、体重指数、术前诊断、术后随访时间相匹配。通过Harris评分进行关节功能评价。研究术后一年和最后一次随访的X线片，对比两组病例假体松动发生率、假体周围骨溶解及透明带的形成、股骨矩吸收及聚乙烯髋臼的磨损率。结果氧化锆组26髋皆获随访，平均随访9年（6—13年）。术前和最后一次随访时平均Harris评分分别为46分和86分。钴铬金属头组26髋平均随访10年（5—14年），术前和最后随访时平均Harris评分分别为50分和88分。两组比较无明显差异。氧化锆组在随访期间共有10髋（38％）由于髋臼假体松动或广泛髋臼骨溶解而翻修，钴铬金属头组有4例（11．5％）。氧化锆组共发现有13髋（50％）有髋臼和股骨假体周围的骨溶解发生，钴铬金属头组有9髋（34．6％）。氧化锆组聚乙烯平均磨损率为0．118mm／年（0．064mm／年～0．175mm／年），金属头组为0．113mm／年（0．056mm／年～0．19mm／年）。两组比较无明显差异。结论在本组研究中，氧化锆陶瓷头组有较高的假体松动和翻修率，聚乙烯髋臼磨损率与钴铬金属头组相当。提示虽然氧化锆陶瓷头在体外研究中具有明显的抗磨损优势，但在实际临床运用中可能与体外实验有较大的差别。     

Zirconia陶瓷头-聚乙烯全髋关节的长期随访

目的: 通过对 28例 (30髋) zirconia-聚乙烯全髋关节的长期随访, 了解Zirconia陶瓷头的实际临床使用效果。方法: 用Harris评分分别评价术前和最后一次随访时髋关节功能。比较术后 1年及最后随访时的X线片, 记录假体松动、假体周围骨溶解、透亮线、及股骨矩吸收情况。根据Liv ermore的方法测量聚乙烯杯的磨损率。比较有骨溶解发生的髋关节与无骨溶解发生的髋关节的聚乙烯磨损率有无差别。结果: 共有 24例 (26髋) 获长期随访, 平均随访 9年 ( 6 ~13年 )。术前平均Harris评分 46分 ( 20 ~78分 ),最后随访时平均Harris评分 86分 (48~98分)。13髋 (50% ) 有假体周围的骨溶解发生。有 10髋 (38% ) 因髋臼假体的松动或髋臼周围骨溶解而接受翻修手术。平均聚乙烯髋臼磨损率为 0. 118mm/年。结论: 在本组研究病例中, 其髋臼磨损率并不比文献报道的传统的金属头低。而临床平均 9年翻修率更达 38%。其临床实际效果有待更深入的研究。     

初次骨水泥型人工全髋关节置换术的中远期疗效分析

目的回顾性分析初次骨水泥型全髋关节置换术（THA）的中远期临床及影像学疗效、假体的生存率及其相关影响因素。方法对1991年7月至2006年6月间接受初次骨水泥型THA的患者187例（201髋）进行随访。观察并发症情况、影像学表现,并对Harris评分和骨密度结果值进行统计学分析,以假体翻修为随访终点,计算假体的生存率。结果共117例（126髋）获得完整随访,平均随访时间为13.5年。Harris评分由术前的（32.8±22.5）分提高至末次随访时的（90.3±7.3）分,差异有统计学意义（t=-27.91,P〈0.01）。假体周围界面有不同表现的患者的骨密度结果比较无统计学差异（F=0.289,P〉0.05）。晚期感染1髋,脱位3髋,下肢深静脉血栓4髋,下肢不等长4髋,假体周围骨折2髋,异位骨化6髋,无菌性松动5髋。共有7髋接受髋关节翻修手术,平均翻修手术时间为初次置换术后11.3年,假体的生存率为94.4%。结论骨水泥型THA在治疗高龄骨质疏松患者髋关节疾病方面可以取得良好的临床效果,骨水泥假体的远期生存率令人满意。     

金属对聚乙烯假体全髋关节置换术后磨损的中期随访研究

【摘要】〓目的〓对金属-聚乙烯(MOP)全髋关节置换术(THA)后患者的界面磨损进行回顾性研究,探讨不同年龄段患者金属-聚乙烯全髋关节置换术的临床疗效。 方法〓收集2003年5月到2008年11月期间于常熟市第一人民医院行THA患者资料研究,共获得完整病例资料84例(88髋),按年龄及活动量分为两组:年龄<50岁和活动量大病例组(A组)和年龄≥50岁和活动量小病例组(B组)。全髋假体为钻铬钼合金-高分子聚乙烯全髋假体,临床疗效应用Harris评分标准进行临床随访和对比研究,影像学进行内衬磨损率及骨溶解测量分析。 结果〓所有病例均取的至少5年的完整随访资料,其中A组有3例3髋(7.7%)因假体松动而最终行翻修手术,而B组资料中无任何翻修病例。所有病例均未发生骨折、感染、深静脉血栓(DVT)等常见并发症。A组Harris评分由术前34.13±6.28改善至手术后91.35±2.68,B组35.51±5.32改善至90.05±2.47;影像学观察,A组内衬磨损率为每年0.19±0.24 mm,B组为每年0.09±0.13 mm,两组中MOP内衬磨损差异具有统计学意义(P<0.05);A组MOP全部发生不同程度的骨溶解,B组MOP骨溶解的发生率为63.16%,两组比较,P<0.05)。结论〓对于小于50岁和活动量大的患者,MOP假体的内衬磨损、骨溶解及影像学松动率均明显高于年龄≥50岁和活动量小的病例组,因此,对于年轻患者使用MOP假体应慎重,而对于老年病人和低活动需求的病人行THA时中期疗效较好。     

非骨水泥全髋关节置换术治疗股骨头缺血性坏死的中期疗效评估

目的对使用非骨水泥型假体行全髋关节置换术(totalhiparthroplasty,THA)治疗的股骨头缺血性坏死患者进行术后中期的影像学及临床评估,回顾性研究非骨水泥型假体的疗效及其影响因素。方法对1998年1月至2001年3月,采用非骨水泥型假体行THA治疗的股骨头缺血性坏死患者71例(80髋)进行至少5年的随访。临床评估以Harris评分为标准。影像学评估根据术后随访时骨盆正位与髋关节正、侧位X线片,观察髋臼、股骨假体的位置及其周围骨质的改变,并测量臼杯内衬的磨损速度、磨损方向。假体的生存率采用Kaplan-Meier分析,分别以髋臼、股骨假体的无菌性松动和任何原因所致的翻修为终点。结果共54例(62髋)患者获得至少5年的随访,术前Harris评分平均为(44.0±8.4)分(21～50分),终末随访时平均为(92.4±5.7)分(78～100分)。截至末次随访时无一例翻修或表现为影像学无菌性松动。1髋出现骨盆局灶性骨溶解,12髋出现股骨局灶性骨溶解。聚乙烯内衬平均线性磨损率为(0.125±0.074)mm/年。Kaplan-Meier分析假体生存率为1.0(95%可信区间,0.98～1.00)。结论多孔涂层非骨水泥型假体可为晚期股骨头缺血性坏死患者提供良好的中期固定及临床效果。然而,因为聚乙烯髋臼的磨损不可避免及假体周围骨溶解等潜在因素的存在,长期效果仍须进一步随访。     

保留髋臼杯更换聚乙烯衬垫在全髋关节翻修术中的应用

目的 探讨保留髋臼杯更换聚乙烯衬垫在全髋关节翻修术中的作用.方法 1995年4月至2007年12月,80例(93髋)接受保留髋臼杯更换聚乙烯衬垫手术.男41例,女39例;年龄27～82岁,平均53.3岁.初次置换与更换衬垫手术间隔0.3～18.4年,平均10.9年.翻修原因:聚乙烯磨损及骨溶解78髋,聚乙烯接近完全磨损但无骨溶解5髋,聚乙烯磨损及股骨柄假体松动4髋,复发性关节脱位3髋,感染1髋,假体周围骨折1髋,衬垫脱位1髋.翻修衬垫采用高交联聚乙烯60髋、普通聚乙烯33髋,以骨水泥固定47髋、原锁定机制固定46髋.结果 随访5～15年,平均7年.术前Harris髋关节评分(86.0±16.9)分,终末随访时(89.4±11.6)分.并发症包括脱位10髋,感染2髋,假体周围骨折1髋,衬垫脱落1髋.10髋再次翻修:髋臼杯翻修5髋,普通聚乙烯磨损2髋,感染2髋,衬垫脱落1髋.普通聚乙烯组新发骨溶解12髋.以假体松动为终点,十年生存率骨水泥固定组100％、原锁定机制固定组84.8％;以再次翻修为终点,十年生存率分别为90.4％和65.0％.结论 以骨水泥或原锁定机制固定翻修衬垫均安全有效.高交联聚乙烯耐磨性较好,能降低骨溶解风险,假体存活率更高.     

高交联聚乙烯内衬在中国年轻全髋关节置换患者中应用的6年随访结果

目的回顾性分析50岁或以下的中国年轻全髋关节置换术（THA）患者中应用高交联聚乙烯内衬的临床效果和线性磨损率。方法对本中心应用Marathon高交联聚乙烯内衬和Duraloc非骨水泥臼杯的38髋,29例THA患者的治疗结果进行了回顾性分析。通过Harris髋关节评分对临床效果进行评估。在随访期间,测量每一年的X线片,对比分析臼杯内衬的线性磨损和周围的骨溶解情况。结果患者手术时的平均年龄为（41.0±6.86）岁（29~50岁）。所有股骨假体的球头直径为28 mm。26髋应用了非骨水泥假体柄,12髋应用了骨水泥假体柄。平均随访时间（7.2±1.3）年（6~9.6年）。平均Harris髋关节评分由术前的（45.3±18.0）分（12~73分）显著提高到术后的（93.26±9.9）分（64~100分）。末次随访X线片上未见髋臼周围骨溶解改变。高交联聚乙烯内衬的第一年蠕变量为：（0.26±0.21）mm（0.01~0.91 mm）,聚乙烯内衬在术后2年的平均累积线性磨损量为：（0.31±0.19）mm（0.04~0.76 mm）,术后3年的平均累积线性磨损量为：（0.31±0.21）mm（0.07~0.93 mm）,术后4年的平均累积线性磨损量为：（0.34±0.31）mm（0.07~1.68 mm）,术后5年和6年的平均累积线性磨损量分别为：（0.38±0.22）mm（0.07~0.97 mm）和（0.38±0.25）mm（0.08~1.26 mm）。手术2年后的聚乙烯平均线性磨损率为：0.025 mm年/。结论应用于中国年青患者THA术中的高交联聚乙烯内衬具有低的线性磨损率,从而可以降低磨损和由此而引起的骨溶解的发生。Marathon高交联聚乙烯内衬材料具有满意的临床应用效果。     

The fate of revised uncemented acetabular components in patients with rheumatoid arthritis

The results of patients with rheumatoid arthritis who had revision hip arthroplasty have been studied infrequently. The purpose of this study was to review the authors' clinical and radiographic experiences and outcomes with revision hip arthroplasty. Revision total hip arthroplasties were done on 28 patients (30 hips). All hips had morselized bone grafting and four hips had bulk allografts for segmental defects. The mean age of the patients at the time of surgery was 50 years (range, 20-74 years). Patients were followed up for 4 to 15 years (mean, 7 years). At the latest followup, 14 hips (13 patients) of the 30 hips (47%) had good and excellent Harris hip score ratings. Mechanical failures included six hips (five patients) that had revision arthroplasty and two hips (two patients) that had resection arthroplasty. Six other hips (five patients) had poor Harris hip score ratings. The Kaplan-Meier survivorship curve for failure of the acetabular component revealed an 89% chance of survivorship curve for failure of the acetabular component revealed an 89% chance of survival at 60 months and a 44% chance of survival at 108 months. Based on the results of this study, revision hip arthroplasty for acetabular loosening with a cementless acetabular prosthesis has a low rate of success in patients with rheumatoid arthritis.     

Total hip replacement arthroplasty with Mallory-Head system—minimum ten-year follow-up results

Purpose

The purpose of this study was to assess the clinical and radiographic results of a total hip arthroplasty with the double tapered Mallory-Head system.

Methods

The clinical and radiographic results of a consecutive series of 81 total hip replacements in 75 patients were reviewed 10–15?years (average 11.4?years) postoperatively. The patients’ underlying conditions were avascular necrosis in 46 hips (57?%), osteoarthritis in 12 hips (15?%), RA in nine hips (11?%), and others. Clinical results were evaluated based on the modified Harris hip score and modified Merle d’Aubigné-Postel score. A radiographic analysis was performed.

Results

The average modified Harris hip score improved from a preoperative score of 56 points to a postoperative 92 points. The average modified Merle d’Aubigné-Postel score was 15 points at the latest follow up, and 55 hips (68?%) were classified as the clinical grades of excellent or good results. One acetabular component was revised because of loosening, and one was revised for recurrent dislocation.

Conclusion

The clinical and radiological evaluations of the total hip replacements using the Mallory-Head system showed good results.     

Bipolar hemiarthroplasty for osteonecrosis of the femoral head. A 7- to 18-year followup

This study evaluated clinical and radiographic results of bipolar hemiarthroplasties for the treatment of osteonecrosis of the femoral head. Forty-eight hips in 35 patients with a mean age of 37 years who underwent primary bipolar hemiarthroplasties were observed for an average of 11.4 years. Osteonecrosis was associated with corticosteroid use (21 patients), alcohol (six patients), idiopathic (four patients), and other conditions (four patients). The average Harris hip score was 46 before surgery and 86 at the time of the final followup. Twenty (42%) hips were radiographic failures, and 12 (25%) hips were revised. Groin symptoms were present in 20 (42%) hips. Radiographic proximal migration greater than 4 mm and osteoarthritic signs of the acetabulum indicated a high risk of groin symptoms. The results were inferior to those previously reported for total hip arthroplasty. Thus, for the treatment of osteonecrosis of the femoral head in which necrotic lesions are wide, the authors no longer use this system and currently use total hip arthroplasty.     

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.     

Hip Osteonecrosis: Does Prior Hip Surgery Alter Outcomes Compared to an Initial Primary Total Hip Arthroplasty?

The purpose of this study was to assess the clinical and radiographic outcomes of total hip arthroplasty (THA) in patients who had osteonecrosis to see if prior hip preserving surgery affected outcomes. Implant survivorship, Harris hip scores, and radiographic outcomes were compared between 87 patients (92 hips) who had undergone prior hip preserving procedures and 105 patients (121 hips) who had only undergone THA. Patients were also sub-stratified into low- and high-risk groups for osteonecrosis. At a mean follow-up of 75 months, there were no significant differences in survivorship, clinical, and radiographic outcomes among the cohorts. Higher revision rates were associated with patients who were in the high-risk group. The authors believe that hip joint preserving procedures may not adversely affect the outcomes of later THA in patients with osteonecrosis.     

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.     

Poor outcome of the PCA and Harris-Galante hip prostheses. Randomized study of 171 arthroplasties with 9-year follow-up.

155 patients (171 hips) with a mean age of 50 years (24-64) were randomized to uncemented PCA (84 hips) or Harris-Galante type I (87 hips) total hip arthroplasty. Clinical and radiographic evaluations were done regularly. The improvements in the Harris hip and pain scores did not differ. Osteolysis developed in 5 PCA and 17 Harris-Galante hips. 13 hips in the PCA and 16 in the Harris-Galante (HG) group were revised because of mechanical failures and 1 hip (HG) because of infection after a mean follow-up of 9 years. Decreased 10-year survival rate, based on revision as end-point, was noted for the PCA (85%), compared with the Harris-Galante cup (99%). The corresponding survival rate of the PCA stem (96%) was higher than that observed for the Harris-Galante design (86%). When radiographic failures were included, the survival rates of the 4 different components dropped to between 73% and 94%. These findings indicate that further revisions will be necessary and continuous radiographic follow-up is indicated to enable revision before severe bone destruction has occurred. Although the PCA and the Harris-Galante designs differed as regards the survival of the individual components, the overall clinical and radiographic survival rates of these cementless total hip arthroplasties were poor.     

Total hip arthroplasty with a collarless, tapered, fiber metal proximally coated femoral stem: minimum 5-year follow-up

The purpose of this study was to evaluate the midterm results, osteointegration potential, and implant-related complications of a cementless, collarless, proximally coated, distally tapered femoral hip prosthesis. The clinical and radiographic results for 129 hips in 116 patients after total hip arthroplasty with a Fiber Metal Taper (Zimmer, Inc ,Warsaw, Ind) femoral stem are reported. One hundred twenty-two (95%) hips were available for the minimum of 5 years clinical and radiographic follow-up. The mean duration of follow-up was 81 months (range, 60-104 months). The mean Harris hip score improved from 44 to 92 at the most recent follow-up. All femoral components were clinically stable with radiographic evidence of bone ingrowth. There has been no evidence of subsidence greater than 2 mm, no significant thigh pain, and no femoral revisions for any reason. Total hip arthroplasty with the Fiber Metal Taper stem demonstrates good clinical and radiographic results at midterm follow-up.     

Poor outcome of the PCA and Harris-Galante hip prostheses: Randomized study of 171 arthroplasties with 9-year follow-up

155 patients (171 hips) with a mean age of 50 years (24-64) were randomized to uncemented PCA (84 hips) or Harris-Galante type I (87 hips) total hip arthroplasty. Clinical and radiographic evaluations were done regularly. The improvements in the Harris hip and pain scores did not differ. Osteolysis developed in 5 PCA and 17 Harris-Galante hips. 13 hips in the PCA and 16 in the Harris-Galante (HG) group were revised because of mechanical failures and 1 hip (HG) because of infection after a mean follow-up of 9 years. Decreased 10-year survival rate, based on revision as end-point, was noted for the PCA (85%), compared with the Harris-Galante cup (99%). The corresponding survival rate of the PCA stem (96%) was higher than that observed for the Harris-Galante design (86%). When radiographic failures were included, the survival rates of the 4 different components dropped to between 73% and 94%. These findings indicate that further revisions will be necessary and continuous radiographic follow-up is indicated to enable revision before severe bone destruction has occurred. Although the PCA and the Harris-Galante designs differed as regards the survival of the individual components, the overall clinical and radiographic survival rates of these cement-less total hip arthroplasties were poor.     

Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial

BACKGROUND: Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial. METHODS: In the present prospectively randomized study, eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were randomized to receive either a total hip arthroplasty or a hemiarthroplasty. The mean age of the patients was seventy-five years. Outcome was assessed with use of the Oxford hip score, and final radiographs were assessed. RESULTS: After a mean duration of follow-up of three years, the mean walking distance was 1.17 mi (1.9 km) for the hemiarthroplasty group and 2.23 mi (3.6 km) for the total hip arthroplasty group, and the mean Oxford hip score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip arthroplasty group. Patients in the total hip arthroplasty group walked farther (p=0.039) and had a lower (better) Oxford hip score (p=0.033) than those in the hemiarthroplasty group. Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up. None of the hips in the hemiarthroplasty group dislocated, whereas three hips in the total hip arthroplasty group dislocated. In the hemiarthroplasty group, two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision. In the total hip arthroplasty group, one hip was revised because of subsidence of the femoral component. CONCLUSIONS: Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.