Revision total hip arthroplasty using a cementless acetabular component: technique and results

One hundred thirty-eight acetabular revisions for aseptic loosening were performed in 132 patients using a cementless hemispherical component coated with titanium mesh and inserted with supplemental screw fixation. Twelve patients died, 9 were lost to follow-up and 6 could not return, leaving 111 patients (115 hips) at mean 100 months follow-up. Thirteen hips required revision (11%); 4 for recurrent dislocations, 6 for sepsis, and 3 stable cups were revised (at the time of stem revision). No cup was revised for aseptic loosening. Radiographic review was available for 105 patients (109 hips) at mean 98 month follow-up (78 to 135 months). One hundred cups (91%) were considered stable. Seven cups were possibly unstable (7%), one cup was probably unstable (1%), and one septic hip had an unstable cup (1%). Four percent of the cups showed a complete radiolucency. A partial progressive radiolucency was seen in 3%, a partial nonprogressive radiolucency in 54%, and no radiolucency was present in 39%. A screw radiolucency was seen in 2%, and osteolysis at the cup margin in 4%. Revision of the acetabulum with a cementless porous-coated hemispherical fiber-metal component seems to be superior to the results reported for acetabular revisions with cement at similar follow-up.     

Cementless hemispheric acetabular component in total hip replacement

A series of 198 total hip arthroplasties was performed using a porous-coated, hemispheric press-fit cup. One hundred and twenty-seven cups were available for clinical and radiological examination at mean follow-up of 10.6 years. The mean age at the index procedure was 61.2 years. The mean Harris hip score at final follow-up was 89.8. Three cups were revised for aseptic loosening and two liners were changed for eccentric wear and pelvic osteolysis. Nine additional patients showed mild or suspected osteolysis. Two cups were rated "fibrous" stable. There was no correlation between additional screw fixation of the press-fit cup and osteolysis or revision.     

Wear and periprosthetic osteolysis of modular, hemispheric acetabular cups]

Osteolysis associated with polyethylene wear has become one of the most prevalent complications associated with uncemented modular, hemispherical cups. Sixty-five consecutive total hip arthroplasties (ABG i, Howmedica, Stryker) were followed 6-12 years. Cumulative survivorship for the cup was 55.7% after 10 years. There were 20 cups revisions because of polyethylene wear and periprosthetic osteolysis (14 cups) or cup loosening (6 cups). Stability was assessed intraoperatively, 14 cups were revised, whereas 6 new polyethylene cups were cemented into stable metal-back of acetabular component. The average annual wear of revised cups was 0.32 mm. The annual wear of not revised cups was 0.12 mm. The differences were statistically significant (p = 0.002). The mean area of osteolysis was 472 mm2 (SD 257 mm2). There was no significant correlation between wear and area of osteolysis. There was significant correlation R = 0.54, p = 0.014) between time to revision and area of osteolysis. There were no significant differences of wear of polyethylene inlay or area of osteolysis between stable and unstable acetabular cups.     

The Harris-Galante Porous acetabular component at intermediate follow-up

Outcome of the acetabular component in 90 consecutive primary noncemented total hip arthroplasties (THAs) was prospectively studied. The acetabular cup consisted of a hemispherical titanium alloy shell with a titanium fiber-mesh porous coating and a modular polyethylene liner (Harris-Galante Porous-1, Zimmer, Warsaw, Ind). The cup was implanted using line-to-line reaming with adjunctive dome screw fixation. The femoral component consisted of a titanium alloy stem with titanium fiber-mesh porous coating and a 28-mm cobalt-chrome modular head. Mean patient age was 53 years (range: 27-75 years); male:female ratio was 48:42; and mean follow-up was 6 years (range: 4.5-8 years). One acetabular component was revised for aseptic loosening. Of 81 unrevised hips available for follow-up, mean Harris hip score was 57 preoperatively and 96 at final follow-up (72% excellent, 15% good, 1 3% fair, and none poor). Of 61 unrevised hips with adequate radiographic follow-up, radiographic failure (complete periprosthetic radiolucency) was evident in 3 (4.9%) and periacetabular osteolysis in none. Radiographic failure did not correlate with poor clinical outcome. Linear polyethylene wear rate (mean: 0.13 mm/year) did not correlate with age, gender, weight, outcome, or cup abduction angle, but did correlate with the presence of femoral periprosthetic osteolysis (0.18 mm/year with femoral osteolysis versus 0.11 mm/year without; P= .01). This series of porous-coated hemispherical cups demonstrated excellent intermediate-term clinical and radiographic outcome, comparable with similarly favorable results reported by the prosthesis designers. A potentially adverse effect of polyethylene wear on the longevity of a THA was supported by a positive correlation between polyethylene wear rate and femoral osteolysis.     

Unsatisfactory results with the cementless Omnifit acetabular component due to polyethylene and severe osteolysis

A high incidence of acetabular osteolysis (43%), associated with osteolytic lesions in the proximal femur (22.6%) and leading to a high revision rate, was experienced with the Omnifit total hip prosthesis. We reviewed the clinical and radiological results with 429 Omnifit total hips in 356 patients after a mean follow-up of 60 months. Time to revision and wear of the polyethylene liner with different acetabular shell types were specifically analysed. Pelvic osteolysis first became manifest in the acetabular bone opposite to the holes in the metal shell. Osteolysis occurred predominantly adjacent to the central hole in the metal shell of threaded cups; widespread and larger defects were found in press fit cups with peripheral screw holes. Kaplan Meier survival analysis demonstrated a higher probability for retaining the threaded cup at 6 years (96%; 95%-confidence interval: 93-99%) compared to the survival of the press fit cup (66%; 95%-CI: 56-77%). The results suggest a negative relationship between backside wear, the larger number of holes in the cup, the extent of osteolysis and survival rate of the press fit cups. Based on these findings and supported by similar reports about osteolysis related to the same cup design, it was hypothesised that backside wear due to the insufficient locking mechanism of the Omnifit acetabular cup was the major cause of the unsatisfactory results in our patients. For this reason we discontinued using this type of uncemented socket.     

Survivorship and Patient-Reported Outcomes of an Uncemented Vitamin E–Infused Monoblock Acetabular Cup: A Multicenter Prospective Cohort Study

BackgroundAddition of vitamin E to polyethylene is theorized to reduce the potential for oxidative wear in acetabular components. This paper presents a multicenter prospective cohort study that reports on outcomes from use of a Vitamin E–infused highly cross-linked polyethylene acetabular cup.MethodsPatients were recruited across nine medical institutions. Clinical outcome measures recorded were the Harris Hip Score, visual analogue score for pain and satisfaction. Evidence of implant loosening or osteolysis was collected radiologically. Cup survival and reasons for revision in relevant cases were also recorded. Data collection was undertaken preoperatively, at 6-12 weeks, 6 months, 1 year, 2 years, and 5 years. A total of 675 patients were recruited, with 450 cases available at final review. Data regarding cup survival was available to 8 years and 9 months postoperatively.ResultsImprovements in both the Harris Hip Score and visual analogue score for pain and satisfaction were recorded at all time points, with these being maintained through the length of follow-up. In total, 89% of cups were implanted within the Lewinnek safe zone. A lucent line was identified in one case, with no evidence of acetabular osteolysis observed throughout the follow-up period. Cup survival was 98.9% at 8 years and 9 months. No revisions for aseptic loosening were observed.ConclusionsThe use of a vitamin E–infused polyethylene acetabular cup demonstrates reassuring patient-reported outcomes, radiological measures, and cup survival at medium to long-term follow-up.     

High osteolysis and revision rate with the hydroxyapatite-coated ABG hip prostheses65 hips in 56 young patients followed for 5–9 years

Background?There are few reports on the outcome of uncemented HA-coated cups in young patients.Patients?I evaluated the 7-year (5–9) results of HA-coated hip prosthesis (ABG, Stryker) in a consecutive series of 65 primary arthroplasties on 56 patients (mean age 44 years). 2 patients were lost to follow-up and 3 died.Results?The cumulative survival rate with revision for any reason as endpoint at 9 years was 98% (95% CI, 96–100) for the stem, 69% (61–77) for the acetabular metal backing, and 59% (50–67) for the polyethylene liner. 15 of 65 cups were revised on average 6 years after the primary operation and 3 more are planned. Revisions were done in 3 hips because of loosening and migration of the cup, and in 12 hips because of wear and progressive osteolysis around stable components. Only hips with migration had clinical symptoms. Visual inspection of polyethylene liners revealed wear of the articulation in all cases, loosening of the locking mechanism in 10 cases and nonarticular surface deformity in 7 hips. All original stems are in situ although femoral osteolysis was seen in 12 cases and 1 hip was reoperated because of periprosthetic traumatic fracture. Despite the high revision rate, the clinical improvement was good: the average pre- and postoperative Harris Hip Scores at the most recent follow-up were 41 and 90, respectively.Interpretation?While the results on the femoral side were good, the survival rates of the acetabular cups were poor and we stopped using ABG I hip prostheses.     

High osteolysis and revision rate with the hydroxyapatite-coated ABG hip prostheses: 65 hips in 56 young patients followed for 5-9 years

BACKGROUND: There are few reports on the outcome of uncemented HA-coated cups in young patients. PATIENTS: I evaluated the 7-year (5-9) results of HA-coated hip prosthesis (ABG, Stryker) in a consecutive series of 65 primary arthroplasties on 56 patients (mean age 44 years). 2 patients were lost to follow-up and 3 died. RESULTS: The cumulative survival rate with revision for any reason as endpoint at 9 years was 98% (95% CI, 96-100) for the stem, 69% (61-77) for the acetabular metal backing, and 59% (50-67) for the polyethylene liner. 15 of 65 cups were revised on average 6 years after the primary operation and 3 more are planned. Revisions were done in 3 hips because of loosening and migration of the cup, and in 12 hips because of wear and progressive osteolysis around stable components. Only hips with migration had clinical symptoms. Visual inspection of polyethylene liners revealed wear of the articulation in all cases, loosening of the locking mechanism in 10 cases and nonarticular surface deformity in 7 hips. All original stems are in situ although femoral osteolysis was seen in 12 cases and 1 hip was reoperated because of periprosthetic traumatic fracture. Despite the high revision rate, the clinical improvement was good: the average pre- and postoperative Harris Hip Scores at the most recent follow-up were 41 and 90, respectively. INTERPRETATION: While the results on the femoral side were good, the survival rates of the acetabular cups were poor and we stopped using ABG I hip prostheses.     

Uncemented cups with and without screw holes in primary THA: a Swedish Hip Arthroplasty Register study with 22,725 hips

Background and purpose — Uncemented cups in total hip arthroplasty (THA) are often augmented with additional screws to enhance their primary stability. We investigated whether there is a difference in the risk for revision between cups with screw holes and cups without screw holes.

Patients and methods — We analyzed the risk for cup revision of uncemented cups registered in the Swedish Hip Arthroplasty Register (SHAR) between 2000 and 2017 with respe ct to the presence of screw holes. Only patients with primary osteoarthritis (OA) were included. 22,725 cups, including 12,354 without screw holes and 10,371 with screw holes, were evaluated. Revision rates at 2 and 10 years after the primary operation were analyzed.

Results — At a median follow-up time of 3.4 years (0–18), 459?cup revisions were reported. The main reasons for cup revision during the whole observation time were infection, 52% of all cup revisions, and dislocation, 26% of all cup revisions. The survival rate with cup revision due to aseptic loosening as endpoint was 99.9% (95% CI 99.8–99.9) at 2 years for both cups with and cups without screw holes, and the survival rates at 10 years were 99.5% (CI 99.3–99.7) and 99.1% (CI 98.6–99.5), respectively. Cups without screw holes showed a decreased risk of revision due to any reason at both 2 years (adjusted hazard ratio [HR] 0.6, CI 0.5–0.8) and 10 years (HR 0.7, CI 0.5–0.9).

Interpretation — We found a very low revision rate for aseptic loosening with modern, uncemented cup designs. Cups with screw holes had an increased risk of revision due to any reason in patients with primary OA     

Design rationale in early clinical trials with a hemispherical threaded acetabular component

Ninety-eight cases of a titanium hemispherical screw cup were followed for 1-3 years (average, 2 years). To differentiate stem problems from acetabular problems, as and because the early results of the cemented stem are well known, the authors studied only those uncemented screw cups with a cemented stem. Of five cases with acetabular pain, one was definitely loose and two were probably loose and require revision. With increasing experience, the selection criteria for the use of an uncemented screw cup have become increasingly rigid; today, the loose cases would probably be handled with a bipolar implant. In most cases initial radiolucency decreased with time, and on clinical radiographs the vast majority showed no radiolucency. The overall Harris rating was 91% (excellent). The early results for this component are quite promising, but further longitudinal studies are required.     

Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report

In a previous report, we presented our results of forty-two acetabular reconstructions, performed with use of impaction bone-grafting and a cemented polyethylene cup, in thirty-seven patients who were younger than fifty years and had a minimum of fifteen years of follow-up. The present update study shows the results after twenty to twenty-eight years. Eight additional cups had to be revised--four because of aseptic loosening, three because of wear, and one during a revision of the stem. Three additional cups were considered loose on radiographs. Survivorship of the acetabular reconstructions, with an end point of revision for any reason, was 73% after twenty years and 52% after twenty-five years. With revision for aseptic loosening as the end point, survival was 85% after twenty years and 77% after twenty-five years; for signs of loosening on radiographs, survival was 71% at twenty years and 62% at twenty-five years. In conclusion, our previous results have declined but the technique of using impacted morselized bone graft and a cemented cup is useful for the purpose of restoring bone stock in young patients whose acetabular defects require primary or revision total hip arthroplasty.     

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

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

Acetabular revision without cement

We reviewed the clinical and radiologic results of 47 cementless acetabular revisions performed by a single surgeon. The mean follow-up period was 58 months. The American Academy of Orthopaedic Surgeons (AAOS) acetabular defect classification was type I in 4 hips, type II in 9 hips, and type III in 32 hips. All patients received AML (Depuy, Warsaw, IN) Duraloc cup implants. Morcellized allograft was used in 23 hips (49%), and screw augmentation in 22 hips (47%). The Harris Hip score improved from 72 to 90 points. No revisions were performed for aseptic loosening. Nonprogressive thin radiolucent lines were found in a single zone in 10 hips (21%) and in all 3 zones in 5 hips (11%). No migration was found in any cups with radiolucent lines, and the presence of a radiolucent line was considered clinically unimportant. Progressive loosening with migration of the cup was found in 1 hip (2%). Kaplan-Meier survivorship using revision for aseptic loosening or radiologic loosening as end points was 92% at 72 months. No statistically significant difference was found in the survival of the cups fixed with or without screws. These encouraging midterm results confirm the role of cementless acetabular revision.     

Hydroxyapatite-coated RM cup in primary hip arthroplasty

We reviewed 113 patients with 127 primary total hip arthroplasties using a hydroxyapatite-coated RM (Robert Mathys) cup. Average patient age was 61 (30-70) years and mean follow-up was 9.4 (6-13) years. Four patients were lost to follow-up and nine patients died of unrelated causes during the course of the study. Three acetabular components were revised; two cups were radiologically loose and one was revised for marginal erosion. No radiolucency was noted in any of the three zones in the remaining cups. There were no cases of cup migration or dislocation. The life table method predicted a 10-year survival rate of 97.9% with revision of the acetabular component for any cause as the endpoint.     

Early clinical and radiographic analysis of the Fitmore cup

The Fitmore titanium mesh cementless acetabular component in 115 hip arthroplasties was reviewed at an average of 33 months of follow-up. None were revised nor had infection. One hip dislocated 4 years postoperatively. Two femoral components were revised. The average Harris Hip Score at the last follow-up was 90 points. In the 96 sets of radiographs available, there was no loosening or new radiolucency. One hip had nonprogressive osteolysis adjacent to a screw. This press-fit cup has its polar region flattened and is rim loading. Noncontact (gaps) at the acetabular floor is expected and is not critical for fixation. In all but 6 hips, these gaps filled. In 5 hips, a minimal gap (相似文献   

High osteolysis and revision rate with the hydroxyapatite-coated ABG hip prostheses

Background There are few reports on the outcome of uncemented HA-coated cups in young patients.

Patients I evaluated the 7-year (5-9) results of HA-coated hip prosthesis (ABG, Stryker) in a consecutive series of 65 primary arthroplasties on 56 patients (mean age 44 years). 2 patients were lost to follow-up and 3 died.

Results The cumulative survival rate with revision for any reason as endpoint at 9 years was 98% (95% CI, 96-100) for the stem, 69% (61-77) for the acetabular metal backing, and 59% (50-67) for the polyethylene liner. 15 of 65 cups were revised on average 6 years after the primary operation and 3 more are planned. Revisions were done in 3 hips because of loosening and migration of the cup, and in 12 hips because of wear and progressive osteolysis around stable components. Only hips with migration had clinical symptoms. Visual inspection of polyethylene liners revealed wear of the articulation in all cases, loosening of the locking mechanism in 10 cases and nonarticular surface deformity in 7 hips. All original stems are in situ although femoral osteolysis was seen in 12 cases and 1 hip was reoperated because of periprosthetic traumatic fracture. Despite the high revision rate, the clinical improvement was good: the average pre- and postoperative Harris Hip Scores at the most recent follow-up were 41 and 90, respectively.

Interpretation While the results on the femoral side were good, the survival rates of the acetabular cups were poor and we stopped using ABG I hip prostheses.     

Failure of HA coating on a gritblasted acetabular cup: 155 patients followed for 7-10 years

We report the outcome of 191 acetabular gritblasted titanium cups with a hemispherical design for press-fit insertion and coated with hydroxyapatite. The prosthesis was made of gritblasted titanium entirely coated with hydroxyapatite. 155 patients aged 15-78 years were operated on during the years 1991-1993 and followed for 7-10 years. During this period, 39 cups were revised because of mechanical loosening, a further 9 had radiolucent lines and 2 focal osteolysis. None of these 11 patients had clinical symptoms. Failure was associated with age, wear and radiolucency/osteolysis. At revision, we found that the soft tissues were discolored, and that most of the coating had disappeared. This design of hydroxyapatite-coated cups has a high rate of debonding and failure.     

Cementless Acetabular Fixation With and Without Screws : Analysis of Stability and Migration

The purpose of this study was to compare initial stability and late migration of 775 cementless acetabular components with and without screw fixation. Screw fixation was used in 509 cups and no screws in 266 cups. Average follow-up in the screw fixation group was 6.32 years (range, 2-10 years) and 6.9 years (range, 2-10 years) in the no-screw group. One component (0.2%, osteolysis) in the screw group and one (0.4%, loss of fixation) in the no-screw group required revision. Osteolytic lesions more than 4 cm² were noted in 8 (1.6%) screw fixation cups and 2 (0.75%) no-screw fixation cups. No cups in either cohort had radiographic evidence of migration. Screw fixation did not have a favorable or adverse effect on the outcome of acetabular reconstruction.     

Low Revision Rates at More Than 10 Years for Dual-Mobility Cups Cemented Into Cages in Complex Revision Total Hip Arthroplasty

BackgroundInstability and aseptic loosening are the two main complications after revision total hip arthroplasty (rTHA). Dual-mobility (DM) cups were shown to counteract implant instability during rTHA. To our knowledge, no study evaluated the 10-year outcomes of rTHA using DM cups, cemented into a metal reinforcement ring, in cases of severe acetabular bone loss. We hypothesized that using a DM cup cemented into a metal ring is a reliable technique for rTHA at 10 years, with few revisions for acetabular loosening and/or instability.MethodsThis is a retrospective study of 77 rTHA cases with severe acetabular bone loss (Paprosky ≥ 2C) treated exclusively with a DM cup (NOVAE STICK; Serf, Décines-Charpieu, France) cemented into a cage (Kerboull cross, Burch-Schneider, or ARM rings). Clinical scores and radiological assessments were performed preoperatively and at the last follow-up. The main endpoints were revision surgery for aseptic loosening or recurring dislocation.ResultsWith a mean follow-up of 10.7 years [2.1-16.2], 3 patients were reoperated because of aseptic acetabular loosening (3.9%) at 9.6 years [7-12]. Seven patients (9.45%) dislocated their hip implant, only 1 suffered from chronic instability (1.3%). Cup survivorship was 96.1% at 10 years. No sign of progressive radiolucent lines were found and bone graft integration was satisfactory for 91% of the patients.ConclusionThe use of a DM cup cemented into a metal ring during rTHA with complex acetabular bone loss was associated with low revision rates for either acetabular loosening or chronic instability at 10 years.     

Reconstruction of the rotation center of the hip after oblong cups in revision total hip arthroplasty

Background

The preoperative bone defect and the reconstruction of the center of rotation of the hip are critical in acetabular revision surgery. Uncemented oblong cups are employed in order to manage these issues. We analyzed the clinical results and rates of revision of two different uncemented oblong cups, the reconstruction of the center of rotation of the hip, as well as the rate of radiological loosening and possible risk factors.

Materials and methods

Forty-five patients (46 hips) underwent acetabular revision surgery using two different uncemented oblong cups. We assessed the clinical results and the survival rate for revision and aseptic loosening. Intraoperative bone loss was classified according to Paprosky, and acetabular reconstruction was assessed according to Ranawat. The mean follow-up was 7.2 years (range 4–11 years).

Results

There were four re-revisions (three due to aseptic loosening); the survival rate for re-revision due to aseptic loosening was 60.1 % at seven years. The mean distance between the center of the femoral head prosthesis and the approximate center of the femoral head improved from 21.5 to 10.2 mm. Thirteen cups showed radiological loosening; the survival rate for radiological loosening at seven years was 40.54 %. A smaller postoperative horizontal distance was correlated with cup loosening.

Conclusions

Although optimal acetabular reconstruction can be achieved by using oblong uncemented cups in revision hip surgery, the clinical and radiological results are not encouraging. Excessive medialization of the cup may increase the rate of loosening.