Cementless acetabular fixation at fifteen years. A comparison with the same surgeon's results following acetabular fixation with cement

BACKGROUND: Loosening of the acetabular component is the major long-term problem associated with total hip arthroplasty with cement. The purpose of the present study was to evaluate the minimum thirteen-year results associated with cementless acetabular components that had been inserted by a single surgeon and to compare them with the results associated with cemented acetabular components that had been inserted by the same surgeon. METHODS: One hundred and twenty consecutive, nonselected primary total hip replacements were performed in 108 patients with use of a Harris-Galante-I cementless acetabular component and a cemented femoral component with a 28-mm head. The patients were evaluated clinically with use of a standard terminology questionnaire, and they were evaluated radiographically for loosening, component migration, wear, and osteolysis. The rates of revision for aseptic loosening and radiographic evidence of loosening for this cohort were compared with the rates for four previously reviewed consecutive series of hips in which the acetabular component had been inserted with cement. All patients were managed by the same surgeon, were followed for thirteen to fifteen years, and were evaluated with use of the same two criteria (revision and loosening) as the end points for Kaplan-Meier analysis. RESULTS: Sixty-six patients (seventy-two hips) were living and forty-two patients (forty-eight hips) had died after thirteen to fifteen years of follow-up. No acetabular component had been revised because of aseptic loosening, and no acetabular component had migrated. With revision of the acetabular component for any reason as the end point, the survival rate was 81% +/- 8% at fifteen years. With revision of the acetabular component for clinical failure (osteolysis, wear, loosening, or dislocation) as the end point, the survival rate was 94% +/- 8% at fifteen years. Among the seventy hips with at least thirteen years of radiographic follow-up, five had pelvic osteolysis and three had had revision of a well-fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm/yr (0.12 mm/yr when one outlier was excluded). CONCLUSIONS: In terms of fixation, Harris-Galante-I cementless acetabular components performed better than did cemented 22-mm-inner-diameter Charnley acetabular components as well as 28-mm-inner-diameter all-polyethylene and metal-backed acetabular components that had been inserted by the same surgeon. However, the rate of wear was greater in association with the Harris-Galante-I cementless components than it was in association with the Charnley cemented all-polyethylene components.     

Total hip arthroplasty with a cemented, polished, collared femoral stem and a cementless acetabular component. A follow-up study at a minimum of ten years

BACKGROUND: Recent studies have suggested that cemented femoral components with a polished surface may provide superior long-term fixation when compared with femoral components with a roughened surface. The purpose of this study was to evaluate the results of total hip arthroplasty with a cemented femoral component with a polished surface finish and compare them with the results of total hip arthroplasty performed with a similar design of cemented femoral component with a rougher surface finish. METHODS: We retrospectively reviewed a consecutive group of 132 patients (149 hips) in whom primary total hip arthroplasty had been performed by one surgeon using a cemented collared femoral component with a polished (0.1-microm Ra) surface finish and a cementless acetabular component. Ninety-eight patients (115 hips) were followed for a minimum of ten years. We compared the survivorship of this prosthesis with that of a femoral component of similar design but with rougher surfaces (matte or grit-blasted). RESULTS: No polished stems were revised because of aseptic loosening or demonstrated radiographic evidence of loosening; however, eight hips (5.4%) with a polished stem demonstrated osteolysis distal to the greater or lesser tro-chanter. In contrast, six stems (2.0%) with a matte surface finish of 0.8-microm Ra were revised because of aseptic loosening, and an additional five stems were seen to be loose radiographically. Eleven stems (9.2%) with a grit-blasted surface finish of 2.1-microm Ra were revised because of aseptic loosening, and an additional four stems were seen to be loose radiographically. The difference in the prevalence of revision due to aseptic loosening between the group with the 0.1-microm Ra surface and the group with the 2.1-microm Ra surface was significant (p = 0.001), as was the difference between the prevalence of revision due to aseptic loosening between the group with the 0.8-microm Ra surface and the group with the 2.1-microm Ra surface (p = 0.001). No cups were revised because of aseptic loosening, and one hip had radiographic signs of acetabular loosening. CONCLUSIONS: This study demonstrated excellent durability of a prosthesis consisting of a cemented, collared, polished femoral component and a cementless acetabular component. While no hips were revised because of aseptic loosening, distal femoral osteolysis was observed in eight hips (5.4%), a higher prevalence than has been reported by others after similar durations of follow-up of tapered, collarless, polished femoral components.     

Total hip arthroplasty in patients with high dislocation: a concise follow-up, at a minimum of fifteen years, of previous reports

We report the updated results at a minimum of fifteen years after eighty-four consecutive total hip arthroplasties performed in sixty-seven female patients with high dislocation of the hip. Sixty-four arthroplasties were performed in forty-nine patients, between 1976 and 1994, with Charnley low-friction acetabular and femoral components inserted with cement; nineteen arthroplasties were performed in seventeen patients, between 1990 and 1994, with the hybrid technique (acetabular component inserted without cement and femoral component inserted with cement); and one arthroplasty was done in 1991, with cementless acetabular and femoral components. All patients were followed prospectively on the basis of clinical assessment according to the Merle D'Aubigné and Postel scoring system, as modified by Charnley, and with radiographic analysis. At the time of the latest follow-up, twenty-six hips (41%) in the low-friction arthroplasty series, ten hips (53%) in the hybrid series, and the one hip with the cementless components had been revised for various reasons. The primary reason for revision in the low-friction arthroplasty group was aseptic loosening of the components (twenty-four hips), whereas the predominant reason for the revisions in the hybrid series and in the hip with cementless components was progressive polyethylene liner wear (six hips). After the minimal follow-up of fifteen years, twenty-five low-friction hip replacements and eight hybrid-type hip replacements had remained intact for an average of twenty-one years (range, seventeen to thirty-two years) and sixteen years (range, fifteen to nineteen years), respectively. These findings may be used in comparisons of results with newer techniques and designs.     

Total hip arthroplasty with cement and without acetabular bone graft for severe hip dysplasia. A concise follow-up, at a minimum of twenty years, of a previous report

We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery. Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% +/- 8% with revision because of aseptic loosening as the end point and 82% +/- 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods.     

A stemmed acetabular component in the management of severe acetabular deficiency

We evaluated the use of a stemmed acetabular component in the treatment of severe acetabular deficiency during revision and complex primary total hip arthroplasty. There were 31 hips of which 24 were revisions (20 for aseptic loosening, four for infection) and the remainder were complex primary arthroplasties. At a mean follow-up of 10.7 years (6 to 12.8), no component had been revised for aseptic loosening; one patient had undergone a revision of the polyethylene liner for wear. There was one failure because of infection. At the latest follow-up, the cumulative survival rate for aseptic loosening, with revision being the end-point, was 100%; for radiographic loosening it was 92% and for infection and radiographic loosening it was 88%. These results justify the continued use of this stemmed component for the reconstruction of severe acetabular deficiency.     

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%).     

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.     

A constrained liner cemented into a secure cementless acetabular shell

BACKGROUND: Constrained acetabular components have been used to treat hips with recurrent instability following total hip arthroplasty and hips that demonstrate instability during revision surgery. In such hips, when a secure cementless acetabular shell is present, the surgeon can cement a constrained liner into the existing shell. The purpose of this study was to evaluate the clinical and radiographic outcome of this technique with use of a tripolar constrained liner that was cemented into a well-fixed cementless acetabular shell. METHODS: Between 1988 and 2000, constrained liners were cemented into thirty-one well-fixed cementless acetabular shells at three centers. The average age of the patients at the time of the index surgery was 72.1 years, and the indications for the procedure were recurrent hip instability in sixteen hips and intraoperative instability in fifteen hips. The patients were evaluated with respect to the clinical outcome and radiographic evidence of shell loosening and osteolysis. RESULTS: At an average duration of follow-up of 3.9 years, twenty-nine liners (94%) were securely fixed in the cementless shells and two constrained liners had failed. One liner failed because it separated from the cement, and one failed because of fracture of the capturing mechanism. Both hips were successfully revised with another cemented tripolar constrained liner. No acetabular component demonstrated radiographic evidence of progressive loosening or osteolysis. CONCLUSIONS: A constrained tripolar liner cemented into a secure, well-positioned cementless acetabular shell provides stability and durability at short-term follow-up. Careful attention to the preparation of the liner, the sizing of the component, and the cementing technique are likely to reduce the failure of this construct, which can be used for difficult cases of total hip instability.     

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.     

A ten-year follow-up of the Reflection cementless acetabular component

We reviewed the long-term results at ten to 12 years of 118 total hip replacements in 109 patients using a second-generation hemispherical cementless acetabular component (Reflection) designed to address the problem of backside wear. Five patients (five hips) died and six patients (seven hips) were lost to follow-up. The remaining 98 patients (106 hips) had a mean age of 62.9 years (34.0 to 86.2) A rate of revision for aseptic loosening of 0.9%, and predictable results were found with respect to radiological evidence of fixation, lack of pain, walking ability, range of movement and function. One component was revised for aseptic loosening, and of the 101 hips (95.2%) that did not have a revision, minor osteolytic lesions of the pelvis were seen in six (5.9%). Kaplan-Meier survival analysis for the total cohort of 118 hips revealed a 96.4% survival at both ten (95% confidence interval 90 to 98) and 12 years (95% confidence interval 86 to 98).     

Further follow-up on socket fixation using a metal-backed acetabular component for total hip replacement. A minimum ten-year follow-up study

In 1982, Harris and White reported the data after a minimum five-year follow-up of fifty-three total hip replacements in forty-seven patients in whom a cemented metal-backed acetabular component had been used. There actually had been fifty-four total hip replacements in fifty-three hips, as in one hip a revision was done for a traumatic disruption of the initial acetabular component that occurred two months after the first insertion. Six of the fifty-four operations did not qualify for inclusion in this ten-year follow-up study, including four operations in three patients who had died before that time. The remaining forty-eight hips have been followed for ten to 13.5 years (mean, 11.3 years). With one exception, the ages of the patients at the time of the index operation ranged from seventeen to fifty years (mean, forty-one years). Six (12.5 per cent) of the forty-eight hips required revision because of symptomatic aseptic loosening of the acetabular component. In addition, two acetabular components, although they were not loose, were revised concomitantly with revision of the femoral component because of the presence of radiolucent lines at the cement-bone interface of the acetabular implant. One other acetabular component that was not loose was revised because of unexplained pain, one was removed because of sepsis, and for one only the polyethylene liner was exchanged because of damage to the polyethylene when the weld holding the femoral head to the femoral neck failed. Nine additional hips (19 per cent), although they were not revised, showed radiographic evidence of migration, and one (2 per cent) showed radiographic evidence of impending failure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Revision of the acetabular component without cement after total hip arthroplasty. A concise follow-up, at fifteen to nineteen years, of a previous report

We previously reported our results at a minimum of three and seven years after use of a porous-coated acetabular metal shell in a consecutive series of 138 revision total hip arthroplasties. The current report presents the longer-term outcomes of these procedures, at fifteen to nineteen years postoperatively. A total of twenty metal shells (14%) underwent repeat revision. Seven of the repeat revisions were performed because of recurrent dislocation, seven were done at the time of femoral revision surgery, and six were done because of infection. Nineteen of the revised shells were well fixed, and one was aseptically loose. Of the sixty-seven hips in which the acetabular component survived for more than fifteen years after the index operation, two (3%) required a change of the modular acetabular liner because of wear or osteolysis. Nine (16%) of the fifty-seven hips with at least fifteen years of radiographic follow-up had an osteolytic lesion of >1 cm in diameter. The fifteen-year survival rate of the metal shells, with failure defined as revision because of loosening or as radiographic evidence of loosening, was 97%. Revision total hip arthroplasty with this cementless acetabular component has been followed by excellent component survivorship at fifteen years; the most common reasons for repeat revision were recurrent dislocation and infection.     

Primary hybrid total hip replacement, performed with insertion of the acetabular component without cement and a precoat femoral component with cement. An average ten-year follow-up study

One hundred and twenty-one primary hybrid total hip replacements were performed in 107 patients. A titanium, porous-coated, hemispherical acetabular component was fixed with screws, and a collared, chromium-cobalt femoral stem, with a roughened surface and a thin layer of methylmethacrylate on the proximal third, was inserted with contemporary cementing techniques (that is, use of a femoral medullary plug, a cement gun, and centrifugation and pressurization of the cement). Fifteen patients (fifteen hips) died before a minimum duration of follow-up of seven years, four patients (four hips) were too ill for a detailed follow-up examination at the time of the study, and two patients (two hips) refused to be evaluated at the time of the latest follow-up. None of these twenty-one hips had had a revision or a reoperation at the time of the latest follow-up. Eighty-six patients (100 hips) were available for clinical follow-up at an average of 120 months (range, eighty-four to 153 months) and for radiographic follow-up at an average of 118 months (range, eighty-four to 153 months). The average age of the patients at the time of the index arthroplasty was sixty-five years (range, forty-five to eighty-seven years). Three acetabular components were revised because of dissociation of the liner in association with a fracture of a locking tine. One well fixed acetabular component was revised because of pelvic osteolysis, and the femoral stem in the same patient was revised because of aseptic loosening. None of the ninety-six remaining acetabular components migrated, was classified as radiographically loose, or was revised because of aseptic loosening. Osteolytic lesions were identified adjacent to five acetabular components, and one of them was treated with bone-grafting around the well fixed acetabular shell. Two hips had a continuous radiolucent line at the interface between the acetabular implant and the bone. Three femoral stems had evidence of radiographic debonding (a radiolucent line that was one millimeter wide or less between the cement and the prosthesis), and they were classified as radiographically loose despite excellent clinical results. Seven hips had osteolytic areas located in the proximal aspect of the most proximal zones of Gruen et al., and five had small osteolytic regions in more distal areas. The Harris hip score for the eighty-two patients (ninety-six hips) who did not have a revision improved from 48 points (range, 22 to 70 points) preoperatively to 92 points (range, 53 to 100 points) at the most recent follow-up examination. Eighty-one patients had no, slight, or mild pain in the hip, and they were satisfied with the clinical result. In the present study, the hybrid total hip replacement with use of the Harris-Galante acetabular component and the Precoat femoral stem continued to provide an excellent result for most patients at an average of approximately ten years after the operation.     

Hybrid total hip arthroplasty with a precoated offset stem. Four to nine-year results

BACKGROUND: Use of modern cementing techniques for fixation of femoral components in total hip arthroplasty has had excellent clinical and radiographic results in most patients. However, several authors have described early loosening of femoral components with roughened and precoated finishes. The purpose of this study was to examine the performance of the precoated Iowa stem, which has increased offset, and to compare the results with those of another cemented precoated femoral component with standard offset used at our institution. METHODS: We carried out a prospective analysis of 102 primary hybrid total hip arthroplasties (a cementless acetabular component and a cemented femoral component) performed with use of the Iowa femoral component in ninety-five patients at our institution. The Iowa stem was used in hips that required greater offset than is available with standard stems as determined by preoperative templating. The average age of the patients at the time of the index procedure was sixty-nine years. Sixteen patients (seventeen hips) died before the forty-eight-month minimum follow-up period had elapsed. Two patients were lost to follow-up, and radiographic follow-up was incomplete for one. The mean duration of clinical and radiographic follow-up of the remaining eighty-two hips in the seventy-six surviving patients was sixty-five months (range, forty-eight to 104 months). RESULTS: The average preoperative Harris hip score of 47 points (range, 16 to 69 points) improved to an average of 87 points (range, 24 to 100 points) at the time of the review. Two hips underwent femoral component revision. Four femoral stems were radiographically loose at an average of thirty-four months. Femoral osteolysis was seen in five hips (6 percent) at an average of fifty-four months postoperatively. No acetabular component was revised because of aseptic loosening. According to Kaplan-Meier analysis, the seven-year survival rate, with an end point of femoral revision, osteolysis, or stem debonding, was 90.6 percent (95 percent confidence interval, 0.87 to 0.94). CONCLUSIONS: The prevalence of revision, osteolysis, and loosening after total hip arthroplasty with the Iowa femoral component at our institution was higher than that seen in our series of Harris Precoat stems, which had a survival rate of 98.4 percent (95 percent confidence interval, 0.97 to 1.00) at ten years with the same end points. The design of the Iowa stem may make it difficult to achieve a good cement mantle, and, in combination with the geometry and increased offset of the stem, may compromise the long-term survival of this cemented femoral component.     

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.     

Total hip arthroplasty with the use of nonmodular cementless acetabular component

Sixty-seven hips in 63 patients who underwent total hip arthroplasties with the use of the nonmodular cementless acetabular component and alumina-on-polyethylene bearing surface were available for complete clinical and radiographic review at a mean follow-up period of 7 (range 5-9) years. The mean age was 59 years (range 34-75) years. The mean preoperative Harris hip score of 50 points improved to 93 points at final follow-up. One (1.5%) hip required revision for a recurrent dislocation. No component was loose radiographically at final follow-up. The mean linear wear rate was 0.07 (range 0.01-0.23) mm/y. At a mean follow-up of 7 years, there was no aseptic loosening. Further follow-up, however, is necessary to determine the potential advantage of nonmodular acetabular component for the development of pelvic osteolysis.     

Factors influencing the longer-term survival of uncemented acetabular components used in total hip revisions

BACKGROUND: There are few longer-term follow-up reports of the results and complications of the use of cementless acetabular components in revision hip arthroplasty. In this study, we analyzed the clinical and radiographic results to determine the factors that affect longer-term survival of titanium-fiber-metal-coated acetabular components. METHODS: During a fourteen-year period, one surgeon performed 211 consecutive unselected cementless acetabular revisions in 194 patients with a mean age of sixty-two years. The same technique was used for all revisions: the component was impacted and was fixed with multiple screws, and bone deficiencies were augmented with supplemental bone graft. Both the acetabular and the femoral components were revised in 142 hips, whereas an isolated acetabular revision was performed in sixty-nine hips. All 211 revisions were included in a survivorship analysis to twelve years. Prospectively determined clinical results in 135 hips and radiographic results in 131 hips were available at a minimum of five years postoperatively. RESULTS: Seven acetabular components were removed: three, because of infection; one, because of recurrent dislocation; and three, because of mechanical loosening. There was asymptomatic radiographic loosening of one additional acetabular component, for a total rate of aseptic loosening of 2%. The twelve-year prosthetic survival rate was 95% (95% confidence interval, 91% to 99%), with failure defined as component removal for any reason. There was no significant difference in the rate of survival of the cup or femoral component between the sixty-nine hips treated with isolated acetabular revision and the 142 hips in which both components were revised. There was a significant difference in the rate of dislocation between the hips treated with isolated acetabular revision (dislocation in fourteen hips, 20%) and those in which both components had been revised (dislocation in eleven hips, 8%; p = 0.03), but there was no difference in component survival if a dislocation occurred. There was a significant association between a patient weight of >82 kg and acetabular failure (p = 0.04). CONCLUSIONS: This titanium-fiber-metal-coated hemispheric component fixed with multiple screws had a twelve-year survival rate of 95% when used in an unselected, consecutive series of acetabular revisions. The rate of dislocation was significantly higher in the patients treated with isolated acetabular revision, and routine postoperative bracing is now recommended for that group.     

Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty

BACKGROUND: Extra-large uncemented components provide several advantages for acetabular revision, but limited information is available on the results of their use. The purpose of this study was to evaluate, at a minimum of five years, the results associated with the use of an extra-large uncemented porous-coated component for acetabular revision in the presence of bone loss. METHODS: Eighty-nine extra-large uncemented hemispherical acetabular components were used for revision after aseptic failure of a total hip arthroplasty in forty-six men and forty-three women (mean age at revision, fifty-nine years; range, thirty to eighty-three years). The revision implant (a Harris-Galante-I or II cup fixed with screws) had an outside diameter of > or = 66 mm in men and > or = 62 mm in women. Seventy-nine patients had a segmental or combined segmental and cavitary acetabular bone deficiency before the revision. Particulate bone graft was used in fifty-four hips and bulk bone graft, in nine. RESULTS: One patient died with the acetabular component intact and two patients were lost to follow-up within five years after the operation. At the time of the last follow--up, four acetabular components had been removed or revised again (two for aseptic loosening). All of the remaining patients were followed clinically for at least five years (mean, 7.2 years; range, 5.0 to 11.3 years). In the hips that were not revised again, only two sockets had definite radiographic evidence of loosening. All four of the sockets that loosened were in hips that had had combined cavitary and segmental bone loss preoperatively. In the hips that were not revised again, the mean modified Harris hip score increased from 56 points preoperatively to 83 points at the time of the most recent follow-up. The most frequent complication, dislocation of the hip, occurred in eleven patients. The probability of survival of the acetabular component at eight years was 93% (95% confidence interval, 85% to 100%) with removal for any reason as the end point, 98% (95% confidence interval, 92% to 100%) with revision for aseptic loosening as the end point, and 95% (95% confidence interval, 88% to 100%) with radiographic evidence of loosening or revision for aseptic loosening as the end point. CONCLUSIONS: This study demonstrates that extra-large uncemented components used for acetabular revision in the presence of bone loss perform very well and have a low rate of aseptic loosening at the time of intermediate-term follow-up.     

The fate of stable femoral components retained during isolated acetabular revision: a six-to-twelve-year follow-up study

BACKGROUND: The decision as to whether to revise a well-fixed femoral component in hips requiring isolated acetabular revision is challenging. The purpose of the present study was to determine the long-term results of, and the complications associated with, retention of a stable and well-fixed femoral component during isolated acetabular revision. METHODS: We retrospectively reviewed the clinical and radiographic results for thirty-one patients (thirty-two hips) who underwent isolated revision acetabuloplasty without removal of a well-fixed femoral component. The reason for acetabular revision was aseptic loosening in thirty-one hips and malposition in one hip. Of the thirty-two femoral components, twenty-one were cemented and eleven were cementless. The average duration of follow-up from the time of the index revision was 8.1 years (range, 6.4 to 12.5 years), and the average duration of total service of the femoral component was seventeen years (range, seven to twenty-five years) from time of the initial implantation. The average age of the patients at the time of the index revision was sixty-six years (range, twenty-nine to eighty-seven years). RESULTS: Thirty-one (97%) of the primary femoral components were judged to be stable and well fixed at the latest follow-up evaluation. One femoral component (3%) was revised because of aseptic loosening, eight years after the index acetabular revision and seventeen years after the initial total hip arthroplasty. Radiographic evaluation of the thirty-one femoral components that were not revised demonstrated no evidence of loosening or subsidence. There were no dislocations, nerve palsies, or intraoperative fractures associated with retention of the femoral component. Twenty-seven (84%) of the acetabular components were judged to be stable at the latest follow-up evaluation. CONCLUSION: In hips treated with isolated acetabular revision, a well-fixed femoral component can be retained successfully without adversely affecting the acetabular exposure; the placement, position, or stability of the acetabular component; or the ability to restore bone stock. The data from the present study support the decision to retain a well-fixed femoral component when the acetabular component needs to be revised.     

Primary total hip arthroplasty with a porous-coated acetabular component. A concise follow-up of a previous report

We previously reported the seven-to-ten-year results of the use of a porous-coated acetabular metal shell in a consecutive series of 204 primary total hip arthroplasties. In the present study, we evaluated the longer-term outcomes of these arthroplasties, at fifteen to eighteen years. One hundred and thirty-six (96%) of the 142 hips available for study retained the original acetabular metal shell. Three of the 142 metal shells failed secondary to aseptic loosening. Ten hips (7%) required a change of the modular acetabular liner because of excessive wear or for the treatment of osteolysis. The fifteen-year rate of survival of the metal shell, with failure defined as revision because of loosening or radiographic evidence of loosening, was 99%. The rate of survival of cementless acetabular reconstructions was excellent at fifteen years, although osteolysis and reoperations were noted to occur much more frequently as the duration of follow-up increased. The majority of the complications were related to wear of the polyethylene liner.