Cementless and cemented total knee arthroplasty in patients younger than fifty five years. Which is better?

Purpose

The purpose of this prospective, randomised study was to evaluate long-term clinical results, radiographic findings, complications and revision and survivorship rates in patients <55 years at a minimum of 16 years after undergoing bilateral, sequential, simultaneous, cemented and cementless total knee arthroplasties (TKAs) in the same patients.

Methods

Bilateral, sequential, simultaneous TKAs were performed in 80 patients (160 knees). There were 63 women and 17 men with a mean age of 54.3 years (range 49–55), who received a cementless prosthesis in one knee and a cemented prosthesis in the other. The mean follow-up was 16.6 years (range 16–17).

Results

At final review, the mean Knee Society (KS) knee scores (95.8 versus 96.9), Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index (25.4 versus 25.9), range of motion (ROM) (125°versus 128°), patient satisfaction (8.1 versus 8.3) and radiological results were similar in both groups. Femoral component survival rate was 100 % in both groups at 17 years; at 17 years, the cemented tibial component survival rate was 100 % and the cementless tibial component 98.7 %. No osteolysis was identified in either group.

Conclusion

Long-term results of both cementless and cemented TKAs were encouraging in patients with OA who were <55 years. However, we found no evidence to prove the superiority of cementless over cemented TKAs.     

Metal-on-metal hip resurfacing compared with total hip arthroplasty: two to five year outcomes in men younger than sixty five years

Purpose

There are limited studies examining the long-term survivorship for the current generation of metal-on-metal hip resurfacing (MOMHR) implants in the young male population, and fewer studies have been published on prospectively collected outcomes data for total hip resurfacing in the USA. The purpose of this study was to demonstrate the efficacy of MOMHR in comparison with total hip arthroplasty (THA) using validated outcome measures, survivorship and complication rates.

Methods

The study prospectively followed 136 implants in 123 male patients <65 years, all with a primary diagnosis of osteoarthritis and similar comorbidities as determined by the American Society of Anesthesiologists (ASA) score. A single-surgeon cohort of 89 MOMHRs was compared with a similar cohort of 47 THAs. Outcomes were prospectively assessed with the Short-Form Health Survey of 12 questions (SF-12) and Western Ontario and McMaster Universities (WOMAC) questionnaires pre- and postoperatively at yearly intervals. Minimum follow-up was two years, and average follow-up was 3.9 years.

Results

Diagnosis, body mass index (BMI), American Association of Anesthesiologists (ASA) and pre-operative pain and function scores were not significantly different between groups. There was no difference in SF-12 scores postoperatively. At one and two years postoperatively, the MOMHR group had better WOMAC scores than the THA group, but no difference was seen at three to five years postoperatively. There were no revisions in either group over the study period.

Conclusions

This study demonstrated good results for hip resurfacing in men <65 years five years postoperatively and similar function to THA patients.     

Cementless cup fixation in total hip arthroplasty after 5–8 years

A series of 199 total hip arthroplasties was performed using a porous-coated, hemispherical press-fit acetabular cup. At a mean follow-up of 91.5 months 158 cups were available for clinical and radiological review. The mean age of the patients at the time of the index arthroplasty was 62.5 years. The mean Harris Hip score at final follow-up was 87.3. No shells were revised although eccentric polyethylene wear prompted liner replacement in two cases. Osteolysis was noted in six cases but predominantly in relation to the femoral stem. Focal pelvic osteolytic lesions were rare. All the cups were classified as stable on radiography.     

Total hip arthroplasty in patients younger than 30 years of age following developmental dysplasia of hip (DDH) in infancy

Total hip arthroplasty (THA) in young patients is a controversial subject, due to the high failure rates reported in the literature, and even more so in patients with a history of developmental dysplasia of the hip (DDH). A group of 11 patients, all under the age of 30 years at the time of surgery, underwent THA due to congenital dislocation of the hip. Mean age at the time of operation was 23.3 years (range 16-30 years). The mean follow-up period was 9 years (range 3-14 years). The mean preoperative Harris' hip score (HHS) was 56.9 compared with the postoperative HHS of 90.6. Due to aseptic loosening of the cup, 4 patients underwent successful revision arthroplasty. These encouraging medium-term results in our patients suggest that THA may be a good solution for young patients suffering from coxarthrosis due to DDH, at least temporarily, especially when other alternatives, such as arthrodesis or resection arthroplasty, are considered.     

Cementless total hip arthroplasty for osteonecrosis of the femoral head in systemic lupus erythematosus: a study with 10–16 years of follow-up

Objectives

The purpose of the present study was to describe the long-term results of total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE).

Methods

From 1994 to 2001, 18 cementless THAs (14 SLE patients) were included in the present study. Four hips (three patients) were lost to follow-up. The remaining 14 hips (11 patients) were available for evaluation. The mean follow-up period was 13.1 (range, 10.0–16.4) years. The follow-up rate was 77.8 %. The mean age at the time of surgery was 35.2 (range, 27.4–51.0) years.

Results

Mean preoperative Harris Hip Score was 37.4 (range, 17.1–63.1) points, which improved to 94.5 (range, 73.9–100) points at final follow-up. Two hips had dislocation and were treated successfully with closed reduction. No patient in this study group had deep venous thrombosis or pulmonary embolism. One hip had peroneal nerve palsy. No superficial or deep wound infection was observed. Two hips of two patients required reoperation due to dislodgement of a polyethylene insert. With revision of the acetabular component for any reason considered to be a failure, the 10-year survival rate was 93 % (95 % CI, 0.79–1).

Conclusion

We have reported the long-term results of THA for ONFH with SLE. Although several reports have noted that the results of THA for ONFH are less favorable than those for osteoarthritis, the long-term results of THA for ONFH with SLE were acceptable. THA is an acceptable option for patients with advanced-stage or an extended region of ONFH.     

Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up

Background  

Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up.     

Revision total hip arthroplasty using a cementless tapered revision stem in patients with a mean age of 82 years

Purpose

A tapered straight cementless stem was used for revision in a group of old and very old patients. We wanted to know whether the use of this implant could achieve satisfactory results despite age and osteoporosis.

Methods

We retrospectively analysed data of 77 elderly patients (77 hips) who underwent revision in cemented and uncemented primary total hip arthroplasties (THA). The patients had a mean age of 82.2 years (range, 75–92 years) at revision surgery. They were monitored for a mean follow up of 7.1 years (range, 5.0–10.2 years). During the minimum follow-up period 11 patients died of unrelated causes, leaving 66 patients (66 hips) for evaluation.

Results

During the period of study three stems failed due to aseptic loosening, three hips dislocated and were successfully treated by closed reduction and bracing. No infection, osteolysis or significant stress shielding around the stems was observed. The survivorship at an average of 7.1-year follow-up was 95.5%.

Conclusions

These results indicate that this stem is an excellent alternative in revision THA in patients of 75 years or older.

     

Evaluation of clinical outcomes of cementless total hip arthroplasty in patients under 30 years of age

Background

Historically, performing a successful hip joint replacement in patients aged fewer than 30 years has been an orthopedic challenge. The newer generation of prostheses and surgical techniques has the potential to increase the longevity of implants. The purpose of this study was to evaluate the outcomes of cementless hip arthroplasty in patients aged fewer than 30 years.

Materials and methods

In this cross-sectional study, 41 patients (46 hips) were studied with a mean age of 24, 4 (from 17 to 30 years) of whom underwent cementless metal–polyethylene hip arthroplasty from 2004 to 2007. The Harris hip score (HHS) was used to assess the functional consequences. Patients were followed up in terms of early complications (thrombophlebitis of the lower limbs, dislocation, hematoma and infection) and late complications (aseptic loosening, dislocation and reoperation) at weeks 3 and 6, at 3 and 6 months, 1 year after surgery and annually thereafter.

Results

Patients were followed for an average of 5 years and 2 months (from 51 to 82 months). One early complication (symptomatic thrombophlebitis) and one late dislocation (2.2 %) were observed. There were no cases of aseptic loosening or osteolysis at the end of follow-up. The preoperative HHS was 59.6 (from 41 to 76), which rose to 82 and 83.5 after the 1-year and final follow-up, respectively, which was a significant increase.

Conclusions

Hip arthroplasty using a new generation of cementless proximal porous prosthesis with resistant polyethylene to cover the joint surfaces in patients aged fewer than 30 years is satisfactory and is accompanied by low complications.     

Results of metal-on-metal hip resurfacing in patients 40 years old and younger

The prevalence of total hip arthroplasty in young patients is small but increasing. We analyzed the results of metal-on-metal hip resurfacing (MMHR) in patients aged 40 years or less. In total 74 operations were performed on 64 patients. Mean age at operation was 33.2 years. HHS averaged 92.3 points at latest follow-up, mean UCLA activity was 8.2. Patients with comorbidity evinced lower scores in HHS, in UCLA activity and in quality of life than patients without comorbidities. Eight revisions (10.8 %) were performed, of which seven due to adverse reaction to metal debris. Seven-year survival was 90.5 %. The functional outcome of hip resurfacing in this cohort was excellent, but overall survival was unsatisfactory. Further analysis is required to verify the role of hip resurfacing among young and active patients.     

Comparison of metal on metal versus polyethylene–ceramic bearing in uncemented total hip arthroplasty in patients with haemophilic arthropathy

Purpose

We report the results of a consecutive series of 12 cases with haemophilic hip arthropathy treated with uncemented total hip arthroplasty (THA). Our hypothesis was that THA results in the haemophilic group would be inferior to those in the nonhaemophilic group.

Methods

The clinical histories of 12 consecutive THAs in eight patients (all men) with hereditary bleeding disorders (haemophilia A and B and von Willebrand disease) were reviewed retrospectively. The results were compared with an age- and sex-matched control group without haemophilia, with special emphasis on bearing surfaces (Metasul metal-on-metal; polyethylene–ceramic articulation).

Results

The mean follow-up of the control group was 9.7 (range five to 24) years and was similar to the haemophilia group, with 10.4. Survival in the Metasul haemophilic group was 22.2 % after 18 years, which significantly differed from the Metasul control group (100 % after 24 years). Survival of the polyethylene–ceramic haemophilic group was similar to the control group (100 % after seven years in both groups).

Conclusions

The metal-on-metal bearing surface in patients with haemophilia gave inferior results compared with nonhaemophilic patients. The use of metal-on-metal bearings in haemophilia is debatable.     

Cementless short stem hip arthroplasty METHA? as an encouraging option in adults with osteonecrosis of the femoral head

Introduction

The implantation of a total hip arthroplasty is the standard treatment for patients with progressive osteonecrosis. However, there is uncertainty about the type of arthroplasty that provides the best outcome and whether short stem arthroplasty represents a reasonable alternative for young patients in order to have more options in case of revision. This uncertainty exists due to the lack of studies analysing contemporary short stem arthroplasty in osteonecrosis.

Aim

The aim of this study was to determine the outcome of the METHA^? short stem arthroplasty in patients with progressive osteonecrosis.

Patients and methods

This study evaluated the clinical and radiological short- to midterm results after implantation of the cementless short stem arthroplasty METHA^?. 73 hips in 64 patients with progessive osteonecrosis after implantation of the METHA^? arthroplasty were investigated by measuring the clinical outcome, the Harris Hip Score (HHS) and visual analogue pain scale for the preoperative stage and follow-up. Radiological analyses of X-rays were conducted to assess the bone ingrowth as well as subsidence, osteolysis or fracture.

Results

The pain scale improved from preoperatively 7.8 to postoperatively 1.7, while the HHS increased from 41.4 to 90.6 points 34?months post-surgery. Complications associated with revision of the METHA^? short stem included two traumatic femoral shaft fracture and one deep infection. The radiological assessment showed good bone ingrowth in all patients despite osteonecrosis.

Conclusion

The study confirms encouraging results as well as good bone ingrowth of the cementless short stem arthroplasty METHA^? even in patients with osteonecrosis.     

Should we use ceramic-on-ceramic coupling with large head in total hip arthroplasty done for displaced femoral neck fracture?

Intracapsular femoral neck fractures are very common orthopedic injuries; total hip arthroplasty has been demonstrated to be an optimal option, but one of the major concerns remains the fact that it may dislocate. The aim of this study is to retrospectively review patients with a displaced intracapsular femoral neck fracture who underwent total hip arthroplasty to realize whether the use of large-diameter ceramic-on-ceramic coupling has the potential to substantially reduce the risk of such a complication. Among 690 hip replacements performed in a period of 8 years, we have selected 86 total hip arthroplasties done for displaced intracapsular fracture of the femoral neck in 64 women and 22 men with a mean age at operation of 67.9 years. Ceramic-on-ceramic coupling was chosen in 38 cases, a 36-mm head was used in 36 cases. At the latest follow-up, there were no cases requiring revision surgery and periprosthetic osteolysis was undetectable. There were no cases of dislocations. New-generation ceramic-on-ceramic bearings with heads of large diameter should therefore be considered to address the problem of dislocation after total hip replacement is done for displaced femoral neck fracture.     

Blood management for patients with hemoglobin level lower than 130 g/l in total knee arthroplasty

Introduction The risk of requiring allogeneic blood transfusion after total knee arthroplasty has been recently decreased with several methods such as blood donation, blood salvage, and hematinic. For patients with a low baseline hemoglobin level, however, the rate of allogeneic transfusion is still high, and an effective method for avoiding allogeneic blood transfusion has not been established. We introduced intra- and postoperative blood salvage with the Cell Saver for patients with a baseline hemoglobin level lower than 130 g/l and analyzed the frequency of allogeneic blood transfusion.Materials and methods From 1993 to 1997, 218 consecutive total knee arthroplasties were performed, and 155 knees with baseline hemoglobin lower than 130 g/l were included in this study. Baseline hemoglobin ranged from 62 to 129 g/l, with a mean of 110 g/l. All patients were managed with intra- and postoperative blood salvage with the Cell Saver. Preoperative autologous blood donation and/or use of hematinic was performed for 129 knees (group 1) and was not performed for 26 knees (group 2). There were no significant differences between the two groups with regard to preoperative factors. To examine the role of perioperative factors (age, sex, baseline hemoglobin level, revision procedure, preoperative blood donation, and use of hematinic) in determining the requirements for allogeneic transfusion, backward elimination logistic regression analysis was used.Results Seven knees (4.5%) required allogeneic transfusion. Group 1 (2.3%) exhibited a lower rate of allogeneic blood transfusion than group 2 (15.4%) (p=0.016). Hemoglobin levels on the day (p=0.016), 1 week (p=0.0001), and 2 weeks (p=0.007) after surgery were lower in group 1 than in group 2. Backward elimination logistic regression analysis showed that preoperative blood donation (p=0.048) and use of hematinic (p=0.040) were significantly associated with a requirement for allogeneic blood transfusion.Conclusion Preoperative blood donation and use of hematinic were associated with a low incidence of allogeneic blood transfusion after total knee arthloplasty with intra- and postoperative blood salvage, even for patients with a baseline hemoglobin level below 130 g/l.     

The relationship between anemia at admission and outcome in patients older than 60 years with hip fracture

Background  

We have reported that the functional outcome in elderly with hip fracture is related to age at admission, dementia, and anemia. In this study, we examined the relationship between hemoglobin level at admission and walking ability, as well as survival outcome at discharge.     

Review of total hip resurfacing and total hip arthroplasty in young patients who had Legg-Calvé-Perthes disease

Patients with Legg-Calvé-Perthes disease can often be successfully treated with femoral head-preserving measures, such as bracing, or containment procedures with osteotomies. However, in some cases, after resolution of the disease, the femoral head may proceed to collapse or progress to severe arthritis at a young age. If nonoperative methods have failed, the only treatment options available for these adolescents or young adults may be a total hip resurfacing or a total hip arthroplasty (THA). This article focuses on the results and unique technical considerations of resurfacing and THA for patients who have severe hip osteoarthritis after resolved Legg-Calvé-Perthes disease.     

Cementless modular neck stems: are they a safe option in primary total hip arthroplasty?

Purpose

The objective was to assess aseptic complications and functional outcome using a primary total hip arthroplasty with modular neck.

Methods

Prospective cohort of 317 consecutive patients. The mean age was 61.1 (range, 41–84) years. The H-Max-M model (Lima, Italy) system was used in all patients. The functional assessment was made by the Harris Hip Score, Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale for pain. Radiological outcomes were also assessed, and adverse events and complications were noted.

Results

The mean follow-up was 6.1 (range, 2–8) years. Functional outcome significantly improved in most patients. There were 3 deep infections (0.9%) and 17 aseptic complications (5.3%) including 1 intraoperative acetabular fracture, 3 later periprosthetic femoral fractures, 1 broken ceramic insert, 1 acetabular loosening, 3 femoral loosening and 1 broken titanium modular neck in a obese patient. No pseudotumors or elevated serum levels of metal ions were found among the patients with radiolucent lines or aseptic loosening.

Conclusions

The findings in the present study showed that the H-MAX-M stem provided satisfactory functional outcome in most patients with a low rate of complications attributable to the modular neck design. We consider that using this novel modular neck-stem coupling design can be an alternative to the conventional monoblock stems in patients without overweight.