Long-Term Results of Porous-Coated Anatomic Total Hip Arthroplasty for Patients With Osteoarthritis of the Hip

Between 1986 and 1997, 136 porous-coated anatomic (PCA) total hip arthroplasties were performed for patients with osteoarthritis of the hip, and data were available for 60 hips at final follow-up (mean follow-up, 15.2 years). Of these, 18 hips had undergone revision: 12 for the acetabular component, 10 for the femoral component, and 4 for both components. Survival rate at 23 years postoperatively was 60% for the acetabular component and 82% for the femoral component. Multivariate Cox proportional hazards regression showed that annual polyethylene wear rate, size, and abduction angle of the acetabular component were significantly associated with acetabular component revision surgery, and that annual polyethylene wear rate and filling ratio of the femur were associated with femoral component revision surgery.     

Cementless Anatomic Total Hip Femoral Component With Circumferential Porous Coating for Hips With Developmental Dysplasia: A Minimum Ten-Year Follow-Up Period

Anatomic femoral components are optimized for primary osteoarthritis, and few long-term results for their use are available for developmental dysplasia of the hip (DDH). We reviewed 135 uncemented total hip arthroplasties in which an anatomic femoral component was used in 106 patients with DDH, excluding femurs with neck–shaft angles of > 160° and femurs with anteversion of > 50°. The mean age of patients at surgery was 49.4 years (range, 33–66 years), and the mean duration of follow-up was 13.5 years (range, 10–18 years). No osteoporotic femurs were included in our study group. Despite 18 acetabular revisions, no femoral component was removed for any reason. No femoral loosening was seen at the final follow-up examination. An anatomic femoral component with circumferential porous coating can produce good clinical and radiologic findings in young patients with good bone quality who have DDH without excessive femoral deformity.     

Uncemented Total Hip Arthroplasty Using a Tapered Femoral Component in Obese Patients: An 18–27 Year Follow-Up Study

The purpose of this study was to evaluate the efficacy of an uncemented tapered femoral component in obese patients at a mean follow-up of 23 years. We retrospectively reviewed 119 consecutive uncemented total hip arthroplasties in 105 obese patients using a tapered femoral component between 1983 and 1987. The mean body mass index of these patients was 34 (range 30–47). Complete clinical and radiographic follow-up was obtained on the 55 hips in 47 patients who survived a minimum of 18 years (range 18–27 years). Three femoral components (6%) have been revised, none for aseptic loosening. One was loose by radiographic criteria. These results demonstrate that an uncemented tapered stem can provide excellent fixation in obese patients out to 27 years.     

Stable Fixation but Unpredictable Bone Remodelling Around the Lord Stem : Minimum 23-Year Follow-Up of 66 Total Hip Arthroplasties

Early designs of uncemented hip implants turned out to be failures mainly because the prerequisites for durable implant fixation were unknown. One exception was the chrome–cobalt stem of the Madreporic Lord prosthesis. We prospectively studied this prosthetic design in 107 hips that underwent surgery in 1979–1986. At the last follow-up, five stems and 54 cups had been revised, corresponding to stem and cup survival rates of 92% ± 3% and 45% ± 5% at 26 years. In all, 66 hips with remaining Lord stems were available for clinical follow-up 26 years (24–29) after the index operation. The mean total Harris hip and pain scores were 81 (SD 14) and 41 (SD 5).     

Total Hip Arthroplasty Using Highly Cross-Linked Polyethylene in Patients Younger Than 50 Years With Minimum 10-Year Follow-Up

The purpose of this study was to investigate the relatively long-term outcomes in 50 patients (54 hips) younger than 50 years of age who underwent total hip arthroplasty using highly cross-linked polyethylene (HXLPE) liners. With a minimum follow-up of 10 years, mean age at time of surgery was 38.9 years (range, 15–50 years). Survivorship was 100%. There was no radiographic evidence of osteolysis or component loosening. Mean steady-state femoral head penetration rate was 0.020 ± 0.0047 mm/yr. Clinical outcomes were excellent, with mean Harris hip score of 91.2 (range, 72–99) points at final follow-up.     

One-Component Revision of Failed Hip Resurfacing from Adverse Reaction to Metal Wear Debris

This study assessed the results of 90 one-component revisions for failed hip resurfacing due to adverse reaction to metal wear debris (76 acetabular, 14 femoral). Patients with a femoral head size 40–45 mm (n = 33) received a two-piece titanium meshed shell with a cross-linked polyethylene liner and patients with femoral head size 46–54 mm (n = 43) received metal-on-metal components. Patients with femoral head size > 45 mm who wished a metal-polyethylene bearing received a dual mobility femoral prosthesis. The mean follow-up was 61 months and the procedure was successful in 97% of the patients. Three failures required re-revision; there was one deep infection. There were no dislocations. One-component revision is a reasonable alternative to revision to total hip arthroplasty.     

Minimum 20-Year Follow-Up Results of Revision Total Hip Arthroplasty With Improved Cementing Technique

A consecutive, non-selective cohort of 83 (77 patients) cemented total hip arthroplasty revisions using contemporary cementing techniques was analyzed at a minimum of 20 years following the index procedure. No patients were lost to follow-up. The average age at revision was 62.4 years (23 to 89). Twenty-two hips (26.5%) had had a reoperation, eighteen (21.7%) for aseptic loosening, 3 (3.6%) for femoral prosthesis fracture and 1 (1.2%) for dislocation. The incidence of re-revision for aseptic femoral loosening was 7.5% and for aseptic acetabular loosening was 21.7%. These results confirm that cemented femoral revision using improved cementing techniques is a durable option in revision hip surgery. In contrast to this, THA revisions using a cemented acetabular component have been less durable at this length of follow-up.     

Cementless Total Hip Arthroplasty in Patients with Osteonecrosis After Kidney Transplantation

This study was to determine the mid- to long-term survivorship of cementless metal-on-metal THA in 52 patients (74 hips) who underwent THA for osteonecrosis of the femoral head with a cementless THA. The mean follow-up was 10.2 years. The mean age at operation was 42.1 years (range, 25–62 years). The survivorship analysis with revision as the end point estimated a 96.6% chance of THA survival during 16.4 years. The average Harris hip score at last follow-up was 89.2 points (range, 74–100). Two patients (two hips) required revision surgery for extensive acetabular osteolysis at 9 years and acetabular liner dissociation at 2 years. The survival rates of cementless THA in these patients are encouraging. However, the possibility of metallic wear related complications are raising concern.     

Outcome of Porous Tantalum Acetabular Components for Paprosky Type 3 and 4 Acetabular Defects

Porous tantalum acetabular implants provide a potential solution for dealing with significant acetabular bone loss. This study reviews 24 acetabular revisions using tantalum implants for Paprosky type 3 and 4 defects. The mean Harris Hip Score improved from 35 ± 19 (range, 4–71) to 88 ± 14 (range, 41–100), p < 0.0001. Postoperative radiographs showed radiolucent lines in 14 hips with a mean width of 1.3 ± 1.0 mm (range, 0.27–4.37 mm). No gaps enlarged and 71% of them disappeared at a mean of 13 ± 10 months (range, 3–29 months). At a mean follow-up of 37 ± 14 months (range, 24–66 months), 22 reconstructions showed radiograpic evidence of osseointegration (92%). The two failures were secondary to septic loosening. When dealing with severe acetabular bone loss, porous tantalum acetabular components show promising short-term results.     

Midterm Results of Large Diameter Biolox Forte Ceramic Head on Delta Ceramic Liner Articulation in Total Hip Arthroplasty

Seventy-nine patients (94 hips), who underwent cementless alumina-on-alumina total hip arthroplasty (THA) with the use of a 36-mm delta ceramic liner-on-alumina ceramic femoral head, were followed for an average of 6.5 years (range, 5–7.7 years). All acetabular and femoral components were bone-ingrown and neither pelvic nor femoral osteolysis was identified until the latest follow-up. The survivorship with revision surgery as an endpoint was 97.9% (95% confidence interval = 100%–95%). Ceramic related complications such as fracture and squeaking did not occur in any patient. The mid-term results of cementless THA with this type of ceramic articulation are encouraging.     

One-Component Revision in Total Hip Arthroplasty: The Fate of the Retained Component

The purpose of the present study was to evaluate the long-term outcome of the unrevised part in one-component total hip arthroplasty revision (index operation). Forty-four patients (46 hips) with a mean age of 58 years at the time of the index operation were included. At the final follow-up, 4 of the 19 (21%) unrevised acetabular components and 6 of the 27 (22%) unrevised femoral components were subsequently revised at a mean time of 14 and 11 years from the index operation, and 22 and 24 years from the primary operation, respectively. We concluded that revision of a stable component is not justifiable on the basis of its long duration in use or non-ideal position or possible loosening on radiographs.     

Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series.

We performed a prospective study in 108 consecutive patients (116 hips) who were followed for a minimum of 10 years (10-12 years) after primary total hip arthroplasty using an uncemented porous-coated anatomic (PCA) hip prosthesis. The average age of the patients at operation was 48.4 years (range, 19-85 years), and the diagnosis was avascular necrosis of the femoral head in 46 hips, neglected femoral neck fracture in 27, osteoarthrosis secondary to childhood pyogenic arthritis in 24, childhood tuberculous arthritis in 5, and miscellaneous in 14. The average preoperative Harris Hip Score was 55 points, which improved to 87 points at 11 years. Seventy-five hips (65%) were excellent, 11 (9%) were good, and 30 (39%) were poor. The overall rate of revision was 15% (17 of 116 hips). The rate of revision of the femoral component was 11% (13 of 116 hips), and the rate of revision of the acetabular component was 15% (17 of 116 hips). The prevalence of thigh pain was 28% at 11 years. The increase in the incidence of aseptic loosening of the femoral component was found to explain the high incidence of severe thigh pain at 11 years' follow-up. At 11 years, there was femoral osteolysis in 69 hips (59%) and acetabular osteolysis in 65 hips (56%). At 6 years, 20 hips (17%) showed definite wear of the polyethylene liner. At 11 years, 81 hips (70%) showed definite wear of the polyethylene liner. Because the complication rate of the PCA hip prosthesis with respect to loosening, osteolysis, and excessive wear in the polyethylene liner is high, we abandoned the use of this implant.     

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.     

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.     

Acetabular Cup Revision Combined With Tensor Facia Lata Reconstruction for Management of Massive Abductor Avulsion After Failed Total Hip Arthroplasty

We report on 17 patients with massive abductor avulsions after total hip arthroplasty (THA) treated with medialization of the acetabular component and tensor fascia lata (TFL) reconstruction. All patients had severe limp, positive Trendelenburg sign, and avulsion of the abductor insertion confirmed on MRI. Mean age was 69 years (range, 50–83 years), and mean follow-up period was 36 months (range, 18–78 months). After surgery, 9 patients had no limp (47%), 8 patients had a mild limp, and abductor power improved from mean 2.5/5 to mean 3.8 (P < 0.0001). At latest follow-up, the Harris Hip Score was excellent in 6 hips (37%), good in 7 (43%) hips, and fair or poor in 3 (23%). Two patients with mild limp were not satisfied with their procedure.     

The long-term outcome of hip replacement in adults with juvenile idiopathic arthritis: the influence of steroids and methotrexate

Juvenile idiopathic arthritis (JIA) is a chronic disease of childhood; it causes joint damage which may require surgical intervention, often in the young adult. The aim of this study was to describe the long-term outcome and survival of hip replacement in a group of adult patients with JIA and to determine predictors of survival for the prosthesis. In this retrospective comparative study patients were identified from the database of a regional specialist adult JIA clinic. This documented a series of 47 hip replacements performed in 25 adult patients with JIA. Surgery was performed at a mean age of 27 years (11 to 47), with a mean follow-up of 19 years (2 to 36). The mean Western Ontario and McMaster Universities osteoarthritis index questionnaire (WOMAC) score at the last follow-up was 53 (19 to 96) and the mean Health Assessment Questionnaire score was 2.25 (0 to 3). The mean pain component of the WOMAC score (60 (20 to 100)) was significantly higher than the mean functional component score (46 (0 to 97)) (p = 0.02). Kaplan-Meier survival analysis revealed a survival probability of 46.6% (95% confidence interval 37.5 to 55.7) at 19 years, with a trend towards enhanced survival with the use of a cemented acetabular component and a cementless femoral component. This was not, however, statistically significant (acetabular component, p = 0.76, femoral component, p = 0.45). Cox's proportional hazards regression analysis showed an implant survival rate of 54.9% at 19 years at the mean of covariates. Survival of the prosthesis was significantly poorer (p = 0.001) in patients who had been taking long-term corticosteroids and significantly better (p = 0.02) in patients on methotrexate.     

Metal on Metal Total Hip Arthroplasty Using Modular Acetabular Shells

Metal on metal bearings were reintroduced into the United States for use in total hip arthroplasty approximately a decade ago. We evaluated a consecutive series cohort of 148 patients with 169 hips who underwent THR using a metal on metal bearing surface with a modular acetabular shell that had fixation augmentation with dome screws. At 3 to 8 year follow-up, average 4.7 years, only one component was revised (for femoral loosening). 3 hips demonstrated proximal femoral osteolysis and 3 hips demonstrated pelvic osteolysis. The average follow-up Harris Hip Score was 94 (range, 57–100). Although the results have been excellent, we continue to closely monitor these hips for any long term failures, or concerns.     

Isolated Acetabular Revision With Ceramic-on-Ceramic Bearings Using a Ceramic Head With a Metal Sleeve

The purpose of this study is to evaluate results of isolated acetabular revision with ceramic-on-ceramic bearings using a ceramic head with a metal sleeve. A retrospective review of fifty-three hips was performed. The mean patient age was 49.9 years and the mean follow-up period was 5.7 years. The mean modified Harris hip score improved from 47.5, pre-operatively, to 84.7 at the time of last follow-up (P < 0.001). Two patients reported squeaking of the hip. Three patients experienced loosening cup, necessitating re-revision surgery. There was a significant difference of acetabular bone defect between loose cup group and stable cup group (P = 0.018). There were no ceramic fractures and no osteolysis. The survival rate of the acetabular cup at the mid-term follow-up was 94.3%. In conclusion, ceramic head with a metal sleeve can be a reliable option for isolated acetabular revision.     

Clinical Outcome,Survival and Polyethylene Wear of an Uncemented Total Hip Arthroplasty : A 10- to 12-Year Follow-Up Study of 81 Hips

A complete 10- to 12-year follow-up of an uncemented total hip arthroplasty (THA) was performed regarding survival, clinical outcome, polyethylene wear and influencing factors on wear. Seventy-two patients (75 Mallory Head uncemented THA) with primary osteoarthritis operated on in 1999 or 2000 were included in the survival study. Mean age at the time of operation was 57.9 years (range 37–70). The survival rate after 11.9 years was 96% (95% CI 0.89–1.01). In three cases the acetabular component was revised because of extensive polyethylene wear. Fifty-four patients with 57 THAs were available for clinical and radiological analysis. At a mean follow-up time of 10.7 years (range 10–12) the clinical outcome can be considered comparable to other uncemented THA. Mean polyethylene wear was 1.8 mm (range 0.4–3.8) with an annual wear rate of 0.15 mm/y. There was a significant correlation between polyethylene wear and inclination of the cup as well as male gender.     

Long-term results of total hip arthroplasty with a cemented custom-designed swan-neck femoral component for congenital dislocation or severe dysplasia: a follow-up note

BACKGROUND: This follow-up study updates the results in a consecutive series of nineteen cemented total hip replacements with a swan-neck femoral component in patients with congenital dislocation or severe hip dysplasia. The series was previously reported on in 1993. METHODS: The patients were petite, with an average height of 152 cm and an average weight of 50 kg, and the femoral canals could not accommodate an off-the-shelf femoral component. Sixteen of the nineteen hips were available for follow-up at an average of 13.3 years (range, eleven to twenty years). Fourteen hips had up-to-date clinical and radiographic examinations. RESULTS: At the time of the latest follow-up, thirteen hips were rated as excellent; two, as good; and one, as a failure because of loosening of both components requiring revision eleven years after the index operation. Another hip required acetabular revision because of loosening fifteen years after the index operation. The rates of femoral and acetabular component revision were 6% and 12.5%, respectively. Radiographic analysis demonstrated that no femoral component was loose. One cup was definitely loose at 19.5 years, and three cups were possibly loose at an average of fourteen years. The radiographic rate of acetabular loosening was 33%. The total rate of cup failure (radiographic loosening and revision) was 43%. CONCLUSIONS: The excellent clinical and radiographic results associated with the swan-neck femoral component, and the 94% rate of survival, at an average of 13.3 years (range, eleven to twenty years) indicate that the biomechanical objectives of this custom-designed prosthesis for patients with congenital dislocation or severe hip dysplasia were met. On the basis of this favorable long-term experience, we still use this prosthesis when the anatomic abnormality cannot be adequately addressed by use of a commercially available prosthetic component.