Results of a hydroxyapatite-coated (Furlong) total hip replacement: a 13- to 15-year follow-up

We describe the survival of 134 consecutive JRI Furlong hydroxyapatite-coated uncemented total hip replacements. The mean follow-up was for 14.2 years (13 to 15).Patients were assessed clinically, using the Merle d'Aubigné and Postel score. Radiographs were evaluated using Gruen zones for the stem and DeLee and Charnley zones for the cup. Signs of subsidence, radiolucent lines, endosteal bone formation (spot welds) and pedestal formation were used to assess fixation and stability of the stem according to Engh's criteria. Cup angle, migration and radiolucency were used to assess loosening of the cup. The criteria for failure were revision, or impending revision because of pain or loosening. Survival analysis was performed using a life table and the Kaplan-Meier curve.The mean total Merle d'Aubigné and Postel score was 7.4 pre-operatively and 15.9 at follow-up. During the study period 22 patients died and six were lost to follow-up. None of the cups was revised. One stem was revised for a periprosthetic fracture following a fall but none was revised for loosening, giving a 99% survival at 13 years. Our findings suggest that the long-term results of these hydroxyapatite-coated prostheses are more than satisfactory.     

Hydroxyapatite-ceramic-coated femoral stems in revision hip surgery

We describe the clinical and radiological results of 120 consecutive revision hip replacements in 107 patients, using the JRI Furlong hydroxyapatite-ceramic-coated femoral component. The mean age of the patients at operation was 71 years (36 to 92) and the mean length of follow-up 8.0 years (5.0 to 12.4). We included patients on whom previous revision hip surgery had taken place. The patients were independently reviewed and scored using the Harris hip score, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Charnley modification of the Merle d'Aubigné and Postel score. Radiographs were assessed by three reviewers for the formation of new bone, osteolysis, osseointegration and radiolucent lines in each Gruen zone.The mean Harris hip score was 85.8 (42 to 100) at the latest post-operative review. The mean WOMAC and Merle d'Aubigné and Postel scores were 34.5 and 14.8, respectively. The mean visual analogue score for pain (possible range 0 to 10) was 1.2 overall, but 0.5 specifically for mid-thigh pain. There were no revisions of the femoral component for aseptic loosening. There were four re-revisions, three for infection and one for recurrent dislocation. Radiological review of all the femoral components, including the four re-revisions showed stable bony ingrowth and no new radiolucent lines in any zone. Using revision or impending revision for aseptic loosening as an end-point, the cumulative survival of the femoral component at ten years was 100% (95% confidence interval 94 to 100). We present excellent medium- to long-term clinical, radiological and survivorship results with the fully hydroxyapatite-ceramic-coated femoral component in revision hip surgery.     

Poor results of the cementless total hip arthroplasty with a nonporous coated acetabular component: AcSys Shearer Cup

Background This study followed patients for a minimum of 7 years after primary total hip arthroplasty using cementless acetabular components and evaluated their outcomes. Methods We followed 73 patients (75 hips), who had undergone total hip arthroplasty with cementless nonporous coated acetabular components (3M AcSys Shearer Cup) for a mean of 9.8 years (range 7–13 years). There were 61 women and 12 men with a mean age of 53 years (range 27–69 years) at surgery. The diagnosis was primary osteoarthritis in 9 hips, osteoarthritis secondary to developmental dysplasia in 58 hips, osteonecrosis of the femoral head in 6 hips, and rheumatoid arthritis in 2 hips. Results Three cups were revised because of aseptic loosening, and one cup was revised following removal of the prosthesis due to deep infection. Radiographic loosening was observed in 22 hips at the latest follow-up. The survival rate at 10 years was 94.7% with revision as the endpoint and 72% with radiographic loosening as the endpoint. The Merle d'Aubigné and Postel hip score showed significant improvement postoperatively and was maintained well even in cases showing radiographic loosening. Conclusions The intermediate radiological results with the AcSys Shearer Cup were unsatisfactory because of the high loosening rate, although the revision rate was low. The nonporous outer surface and the poor fixation mechanism between the metal shell and liner may have contributed to the high failure rate. Regular radiological review is recommended when this cup is used because early loosening is often painless.     

Long-term survival of the Charnley low-friction total hip arthroplasty

A survivorship analysis of 1,151 Charnley low-friction total hip arthroplasties performed as a primary procedure showed the following 15-year failure probabilities: hip revision 13%, cup revision 8%, femoral revision 12%, radiographic femoral loosening 13%, and radiographic cup loosening 49%. Pain scores diminished gradually with time so that at 15 years, the probability of a Charnley pain score less than 5 was 70%. The data suggest that the Charnley low-friction hip arthroplasty has a finite life span.     

Survival analysis of cementless grit-blasted titanium total hip arthroplasties

Although about 200000 cementless Zweymüller-Alloclassic total hip arthroplasties (THAs) were carried out worldwide in the last decade, the survival analysis of these prostheses was not available in the 2000 report of the Swedish national hip arthroplasty registry. We report a prospective survivorship analysis of 200 consecutive grit-blasted cementless Alloclassic primary THAs carried out since 1988. Using surgical, clinical and radiological endpoints for the stem and the threaded cup the ten-year survivorship was 91.5% for reoperation for any cause, 96.4% for hip pain (Merle d'Aubigné score < 5 points, clinical failure), 99.4% for definite aseptic loosening (radiological failure) and 99.3% for revision for aseptic loosening. Using the Swedish registry criteria of primary osteoarthritis and revision for aseptic loosening as the endpoint, the survival rate of 99.1% at ten years for the subgroup of 157 Alloclassic THAs in osteoarthritis compares favourably with that of the best modern cemented hip replacements reported in the Swedish arthroplasty registry.     

Press-fit metal-backed alumina sockets: a minimum 5-year followup study

Two hundred thirty-four consecutive alumina-on-alumina hip replacements using a press-fit metal-backed socket, performed on 214 patients (98 women, 116 men) have been reviewed. These included 201 primary procedures and 33 revision procedures. The median age of the patients at the time of surgery was 62 years (range, 21-83 years). Fourteen patients (16 hips) died from unrelated causes. Eleven patients (11 hips) underwent a total hip arthroplasty revision for recurrent dislocation (one hip), deep infection (two hips), fracture of alumina femoral head (one hip), persistent hip pain (one hip) and aseptic loosening (six hips). The survival rate after 9 years was 93.4% when revision of the prosthesis was considered the end point, and 97.4% if revision of the prosthesis for aseptic loosening was considered the end point. Results were assessed in the surviving patients with a minimal 5-year followup (170 patients, 184 hips). At the median followup of 7.8 years, the average Merle d'Aubigné and Postel score had improved from 11.9- to 17.7. Results were graded as excellent in 148 hips (80.5%), very good in 31 hips (17%), good in two hips (1%), and fair in three hips (1.5%). Radiologic data were documented for 134 patients (143 hips). Three sockets (2%) had a complete and nonprogressive radiolucent line less than 1-mm thick, one stem (0.7%) had lucencies involving five zones, and two stems (1.4%) had isolated femoral osteolysis. Neither component migration nor acetabular osteolysis were detected. A press-fit metal-backed socket may offer a good solution for alumina socket fixation when combined with a careful surgical technique of implantation.     

The hydroxyapatite-coated JRI-furlong hip. Outcome in patients under the age of 55 years

We present the clinical and radiographic outcome of 68 consecutive primary total hip replacements performed in 54 patients under the age of 55 years using a hydroxyapatite-coated femoral component and threaded cup with a modular ceramic head (JRI-Furlong). We reviewed 62 (91%) hips at a median follow-up of 8.8 years (5 to 13.8) after implantation; six (9%) were lost to follow-up. At review there had been four (6%) revisions but only one for aseptic loosening (acetabulum). Radiographic review of the remaining hips did not identify any evidence of femoral or acetabular loosening. The median Harris and Merle d'Aubigné and Postel hip scores were 95.9 (42.7 to 100) and 17 (3 to 18) respectively. The JRI-Furlong hip gives promising functional and radiographic results in young patients in the medium term.     

Hip prosthesis revisions with LS stem: indications and results

The authors present a study that includes 350 patients affected with loosening of hip arthroplasty and submitted to revision with a Wagner LS stem at the 4th Division of the Rizzoli Orthopaedic Institute. Several different types of cotyle (Fitek, Wagner, Standard Cup, cemented cotyle with support ring, Octopus system) were used depending on the anatomopathologic findings, combined with autoplastic grafts. Staging and grading of loosening were based on the four G.I.R. grades. A clinical evaluation of results was based on the Merle D'Aubigné parameters modified by Charnley. For radiographic evaluation the De Lee Charnley areas were studied for cotyle, the Gruen areas for the femoral stem. Overall, good results were obtained in 175 patients, fair in 137, poor in 38.     

Nonself-centering Bateman bipolar endoprosthesis for nontraumatic osteonecrosis of the femoral head: a 12- to 18-year follow-up study

We studied the long-term results of bipolar endoprosthetic replacement in 12 patients (12 hips) 12 to 18 years after surgery. These patients had Ficat stage III nontraumatic osteonecrosis of the femoral head. The original Bateman universal proximal femoral endoprosthesis, which did not have a self-centering mechanism, was inserted without cement as a primary surgical intervention. Three patients underwent revision surgery, 3, 17, and 17 years after surgery, respectively. The reasons for revision surgery were migration of the stem in 2 patients and migration of both the stem and the outer cup in 1. In the remaining 9 patients, the total Merle d'Aubigné and Postel score was 16.1 ± 1.3 at the time of follow-up. Radiographs showed migration of the endoprosthesis in 1 of these 9 patients. Thus, 11 of the 12 patients retained the endoprosthesis 12 years or more after implantation. We concluded that the original Bateman endoprosthesis was effective in delaying the need for total hip replacement for more than 10 years in patients with Ficat stage III nontraumatic osteonecrosis of the femoral head. Received: May 15, 2001 / Accepted: August 24, 2001     

Long-term results with the cementless CLS stem in hip replacement

OBJECTIVE: The present work aims at evaluating the clinical and radiological long-term results of the cementless CLS stem in hip replacement. METHOD: Sixty-six consecutively operated patients were examined clinically and radiologically at an average follow-up time of 10.7 (7.6 - 13.8) years. The clinical evaluation was done with the Merle d'Aubigné and the Harris hip scores. The radiological evaluation included the evaluation of radiolucencies as well as the occurrence of heterotopic ossifications. RESULTS: A total of four stems had to be revised (two infections, two periprosthetic fractures). No stem revision had to be done because of aseptic loosening. This results in a survival rate of 94.5% according to Kaplan-Meier. The mean Merle d'Aubigné scores increased from 9.0 preoperatively to 16.0 points at follow-up. The mean follow-up Harris hip score was 87.3 points. Periprothetic osteolytic zones were observed in 45% of the cases, particularly in the Gruen zones 1 and 7. These osteolytic zones were mainly found in connection with cementless polyethylene cups. CONCLUSION: The results of this study confirm the positive short and medium-term results with the CLS stem in a long-term process. The formerly described phenomenon of the residual thigh pain with cementless stems was clearly minimized.     

Impacted corticocancellous allografts and cement for femoral revision of total hip arthroplasty using Lubinus and Charnley prostheses

Femoral revision of total hip arthroplasty using impacted morcellized allografts and a cemented Lubinus SP-II prosthesis (Waldemar Link GmbH & Co, Hamburg, Germany) or Charnley standard prosthesis (De Puy, Leeds, UK) was performed in patients with loss of bone stock grade II-IV according to the Endoclinic classification from first to eighth revision. We report the results from 57 hips in 56 patients, with a median of 64 months' follow-up. Modified Merle d'Aubigné-Postel postoperative scores increased significantly from preoperative to postoperative values for the Lubinus group and for the Charnley group. Few complications were seen in this follow-up period. Five stems had minor subsidence. Mechanical failures were 4% for both groups. Radiologic examinations provided evidence of frequent trabecular remodeling of the graft, especially for the Lubinus prosthesis.     

Effect of previous surgery on the results of total arthroplasty of the hip joint

Clinical and radiological results as well/as complications after 123 total hip arthroplasties performed as secondary procedure have been evaluated. These patients underwent primary operation because of femoral neck fracture or intertrochanteric osteotomy in the treatment of hip osteoarthritis. The scores of clinical results according to the Merle d'Aubigené and Postel scale were as follows: pain 4.48, walk 3.99, movements 4.02. Radiological features of loosening of the cup were observed in 14.4 per cent and of the stem in 17.3 per cent of those investigated. Early infections were 3 times higher and summed with late infections constituted 8.8 per cent of those operated on. Deep infections and aseptic loosening caused revision in 11.5 per cent of those investigated.     

Acetabular reconstruction using a cementless cup and hydroxyapatite granules: 3- to 8-year clinical results

We investigated 17 patients undergoing consecutive revision or conversion total hip arthroplasties with a cementless cup for acetabular bone defects. Patients were all women and the average age at the time of surgery was 61.2 years. All bone defects were filled and packed with porous hydroxyapatite (HA) granules. The average follow-up was 5.6 years (range, 3-8 years). The average Merle d'Aubigné functional hip score was 15.6 at the latest follow-up vs 11.6 before surgery. No patients needed additional revision surgery. In 4 cases in which a superior deficiency had been covered with HA granules, the cup migrated superior to the host bone but without any detrimental effect. The remaining 13 cases showed no migration of the cup. We conclude that acetabular reconstruction with a cementless cup and HA granules seems to provide encouraging intermediate results.     

Analysis of survivorship after total hip arthroplasty using a ceramic head

To determine the clinical efficacy of an alumina ceramic head, 119 cemented total hip arthroplasties in 97 patients using an alumina head coupled with ethylene oxide gas sterilized polyethylene were reviewed. Eighty-two patients (101 hips) with greater than 10 years followup were evaluated clinically and radiographically (range, 10-17.6 years), and 97 patients (119 hips) were evaluated for survivorship analysis (range, 0.6-17.6 years). The average functional hip scores according to Merle d'Aubigné and Postel improved from 8.6 preoperatively to 15.0 at the final followup, and 57 patients (64 hips) had no pain. The average polyethylene wear rate was 0.15 mm/year (range, 0.04-0.34 mm/year). Patients with polyethylene wear greater than 3 mm showed significantly higher rates of acetabular loosening. Fifteen-year survival rates (with 95% confidence intervals) with radiographic evidence of aseptic loosening as the end point were 46.8% +/- 13.4% in acetabular components and 91.9% +/- 6.6% in femoral components. Fifteen-year survival rates of hip arthroplasties with revision because of aseptic loosening as the end point were 75.3% +/- 10.2% and 97.9% +/- 3.0%, respectively. Results of the current study suggest that using an alumina head instead of a metal head may not be beneficial when coupled with ethylene oxide gas sterilized polyethylene.     

Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years

This article summarises a clinical and radiographical analysis of 30 acetabular revisions in patients younger than 55 years old, performed with impaction bone grafting and cemented cups. Preoperative Merle D’Aubigne and Postel functional score was an average 7 points. At a mean follow-up of 86.5 months (range 34–228) functional score averaged 16.3 points. Radiolucent lines with no clinical impact were observed in 7% of DeLee and Charnley acetabular zones evaluated. Massive radiological migration, consistent with clinical failure, was observed in two cups. Three patients underwent re-revision surgery (10%): two due to infection and one due to mechanical failure. Reconstruction survival rate was 89% (CI 95% 71.9–96.4) overall, and 96% (CI 95% 82.6–99.3) ruling out cases of infection. Impacted bone allograft constitutes one of the reconstructive techniques of choice in acetabular revision surgery of young patients. Restoration of bone stock is essential in this group of patients due to the possibility of future revisions.

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Résumé  Nous avons analysé cliniquement et radiographiquement 30 révisions acétabulaires chez des patients jeunes agés de moins de 55 ans, révision réalisée avec une greffe impactée et une cup cimentée. Le score pré-opératoire de Postel Merle d’Aubigné était en moyenne à 7 points. Après un suivi moyen de 86,5 mois (de 34 à 228 mois) le score post-opératoire de Postel Merle d’Aubigné était en moyenne à 16,3 points. Des liserés sans traduction clinique ont été observés dans 7% des cas et analysés selon DeLee et Charnley. Une migration massive radiographique avec un échec clinique a été observé dans deux cas. 3 patients ont nécessité une nouvelle révision (10%), 2 pour infection et 1 pour échec clinique. Le taux de survie de cette reconstruction a été de 89% (intervalle de confiance 95% 71.9–96.4) et de 96% (intervalle de confiance 95% 82.6–99.3) pour les cas d’infection. L’allogreffe impactée constitue une technique de choix pour la reconstruction lors d’une révision acétabulaire chez des patients jeunes. La restauration du stock osseux est essentielle dans ce groupe de patients et permet d’anticiper de futures révisions.

     

Acetabular revision with impacted grafting and a reinforcement ring: 42 patients followed for a mean of 10 years

We analyzed the outcome of 42 cemented cup revisions (40 patients) with morselized bone grafts and a reinforcement ring after median 10 (7-16) years. The acetabular component migrated a mean of 7 (5-8) mm in 5 hips. The migration stopped after 2 years except in 1 hip, the only one revised because of mechanical loosening. 3 other hips were revised because of infection. Among the other 38 hips (36 patients), the Merle d'Aubigné score increased from 9 to 15 points.     

Cemented total hip arthroplasty with autogenous acetabular bone grafting for hips with developmental dysplasia in adults: the results at a minimum of ten years

We carried out primary cemented total hip arthroplasty (THA) on 25 hips in 21 patients with developmental dysplasia of the hip, using autogenous acetabular bone grafts. The socket was placed at the level of the true acetabulum and bone from the femoral neck was used as graft. Five hips were excluded, leaving 20 which were followed up for a mean of 12.9 years (10 to 18). The mean modified Merle d'Aubigné and Postel functional scores were 5.6 for pain, 4.3 for mobility and 4.2 for range of movement. Radiological examination showed aseptic loosening in three sockets but not in the stems. The bone grafts had united and showed no evidence of late failure.     

Five-year clinical, radiological and postmortem results of the Cambridge Cup in patients with displaced fractures of the neck of the femur

The Cambridge Cup has been designed to replace the horseshoe-shaped articular cartilage of the acetabulum and the underlying subchondral bone. It is intended to provide physiological loading with minimal resection of healthy bone.The cup has been used in 50 women with displaced, subcapital fractures of the neck of the femur. In 24 cases, the cup was coated with hydroxyapatite. In 26, the coating was removed before implantation in order to simulate the effect of long-term resorption.The mean Barthel index and the Charnley-modified Merle d'Aubigné scores recovered to their levels before fracture. We reviewed 30 women at two years, 21 were asymptomatic and nine reported minimal pain. The mean scores deteriorated slightly after five years reflecting the comorbidity of advancing age. Patients with the hydroxyapatite-coated components remained asymptomatic, with no wear or loosening. The uncoated components migrated after four years and three required revision. This trial shows good early results using a novel, hydroxyapatite-coated, physiological acetabular component.     

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

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

Radiography assessment of the hip joint after the implantation of cementless ceramic cup and metal cup]

Radiographic assessment of the hip joint and clinical results after implantation of cementless Mittelmeier ceramic cup and metal Parchofer-Munch cup are presented. Material included 151 hips (56 ceramic cups and 95 metal cups). A-P radiograph and Engh criteria served for radiological assessment of the cup. Vertical, horizontal and angular migration as well as radiolucency in three De Lee zones were evaluated on postoperative and follow-up radiographs. Vertical migration and increased radiolucency within III De Lee zone were the most frequent findings. All types of migration and increased radiolucency in De Lee zones were observed more often after ceramic cup implantation.