Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second- and third-generation techniques

Background  

Techniques of cemented total hip arthroplasty have developed over time. We present the outcomes of Charnley total hip arthroplasty performed using improved second- and third-generation cementing techniques.     

Cemented total hip arthroplasty with contemporary techniques. A five-year minimum follow-up study

A retrospective clinical and roentgenographic review was performed on 251 consecutive cemented total hip arthroplasties (THA) performed from 1978 to 1980 that had been followed a minimum of five years (range, five to seven years). All arthroplasties involved the use of a Harris Design II femoral stem, an intramedullary plug, a cement gun, and pulsatile lavage of both the acetabulum and the femoral canal. At the final follow-up examination, 98% of the patients had excellent results. The average Harris hip score was 47 points preoperative and 97 points postoperative. There were three definitely loose femoral stems, one probably loose, and two possibly loose. There was one loose acetabular component, no revisions or operations were performed. When comparing this series with a similar study, there were statistically improved results in all parameters. Results from this study of cemented THAs using contemporary techniques and prosthetic stem design represent the standard for comparison when evaluating alternative THA systems.     

Charnley total hip arthroplasty with cement. Minimum twenty-five-year follow-up

BACKGROUND: This report presents the results of the senior author's initial twenty-five-year experience with the use of Charnley total hip arthroplasty with cement. The purpose of this paper was to evaluate the long-term results of total hip arthroplasty. METHODS: Between July 1970 and April 1972, the senior author (R. C. J.) performed 330 Charnley total hip replacements with cement using a hand-packing cement technique in 262 patients. Fifty-one patients (sixty-two hips) who were alive at least twenty-five years post-operatively were evaluated from a clinical standpoint with use of a standard-terminology questionnaire. The average age of this group at the time of surgery was fifty-six years (range, thirty-five to seventy-one years) compared with sixty-five years (range, twenty-one to eighty-nine years) for the entire group. All patients were evaluated for radiographic changes at the time of their most recent follow-up. Of the fifty-one patients (sixty-two hips) who were alive at least twenty-five years postoperatively, thirty-one (thirty-six hips) had a follow-up radiograph made at a minimum of twenty-five years after the surgery. The average duration of radiographic follow-up for the fifty-one patients was 22.7 years (range, two to twenty-seven years). RESULTS: Of the sixty-two hips in the fifty-one patients who were alive at least twenty-five years postoperatively, fourteen (23 percent) had been revised. Three (5 percent) had the revision because of loosening with infection; eleven (18 percent), because of aseptic loosening; and none, because of dislocation. The prevalence of revision due to aseptic loosening of the acetabular component in all 316 hips (excluding those that were lost to follow-up or that were revised for infection or dislocation) was 6 percent (eighteen hips), whereas the prevalence in the fifty-nine hips (excluding the three revised for infection) in the patients who were alive at least twenty-five years after the arthroplasty was 15 percent (nine hips). The prevalence of revision because of aseptic loosening of the femoral component in all 316 hips was 3 percent (nine hips), and the prevalence in the fifty-nine hips in the living patients was 7 percent (four hips). In the group of living patients, osteolysis occurred in Gruen zone 1 or 7 in thirty-three hips and in Gruen zones 2 through 6 in two hips. Ballooning acetabular osteolysis occurred in five hips. Of the 327 hips for which the outcome was known after a minimum of twenty-five years, 295 (90 percent) had retained the original implants until the patient died or until the most recent follow-up examination. Of the sixty-two hips in patients who lived for at least twenty-five years after the surgery, forty-eight (77 percent) had retained the original prosthesis. CONCLUSIONS: Our follow-up study at twenty-five years following Charnley total hip arthroplasty with cement demonstrates the durability of the results of the procedure. These results should provide a means for comparison with the results of newer cementing techniques as well as those associated with newer cemented and cementless hip designs.     

初次全髋关节置换术后5年以上随访结果与分析

目的评估初次全髋关节置换术（THA）后5年以上患者的临床疗效、并发症及其影响因素。方法对中山大学附属第一医院关节外科2006年6月前行THA的273例患者（305髋）进行随访,截至末次随访时,191例（206髋）患者获得随访,随访时间平均为9.3年（5-21年）,临床随访内容包括SF-36量表、术前、术后Harris评分及各种并发症。影像学评估包括骨盆正位、患髋正侧位片,判断人工假体位置、假体周围骨质以及并发症情况。结果随访率为69.96%,SF3-6体能方面总分由术前的（30.92±3.90）分（24~39分）提高至（53.69±3.97）分（44~62分）,在精神方面的总分则由术前的（45.91±5.63）分（37~56分）提高至（57.06±7.26）分（43~72分）。术前Harris评分为（46.71±10.76）分（5~68分）,末次随访时为（92.83±4.88）分（56~100分）。假体的5年生存率为98.06%,10年生存率为94.17%,15年生存率为85.92%,20年生存率为81.55%。混合型假体、非骨水泥型假体的翻修率分别为2.4%、5.6%。术后并发症包括跛行（17例）、脱位（3例3髋）、深静脉血栓（1例1髋）、假体周围骨折（1例1髋）、无菌性松动（9例9髋）、异位骨化（6髋）和感染（0例）等。结论本组病例整体疗效满意、假体生存期长,但随访率偏低,病例数偏少,需进一步完善随访机制,提高随访率。     

Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study.

BACKGROUND: The purpose of this retrospective study was to report the results, after a minimum of 18.5 years of follow-up, in a consecutive series of total hip arthroplasties performed with an alumina-on-alumina combination. METHODS: One hundred and eighteen consecutive total hip arthroplasties were performed in 106 patients between 1979 and 1980. The prostheses combined a 32-mm alumina head and an all-alumina socket. Both components were cemented in eighty-five hips, both components were implanted without cement in twenty-nine, and only the stem was cemented in four. The mean age of the patients at the time of the index arthroplasty was 62.2 years (range, thirty-two to eighty-nine years). RESULTS: At the 18.5 to 20.5-year follow-up evaluation, forty-five patients (fifty-one hips) were alive and had not had a revision, twenty-five patients (twenty-five hips) had undergone revision of one or both components, twenty-seven patients (thirty hips) had died, and nine patients (twelve hips) had been lost to follow-up. The mean Merle d'Aubigné hip score (and standard deviation) was 16.2 +/- 1.8 points at the latest follow-up evaluation. The rate of survival at twenty years, with revision for any reason as the end-point, was 85.6% for the cementless cups compared with 61.2% for the cemented cups and 84.9% for the cementless stems compared with 87.3% for the cemented stems. Wear of the prosthetic components was undetectable on plain radiographs. Periprosthetic cystic or scalloped lesions requiring the use of allograft bone during revision were present in three of the twenty-five revised hips. In addition, seven hips had moderate acetabular osteolysis treated with a 4-mm-larger cup. No fracture of the alumina socket or head was recorded. The mean acetabular wear rate in this series was <0.025 mm/yr. CONCLUSION: With the alumina-on-alumina total hip arthroplasty, minimal wear rates and limited osteolysis can be expected up to twenty years after the operation, provided that sound acetabular component fixation is obtained.     

Charnley total hip arthroplasty. A ten- to 14-year follow-up study

The long-term results of 325 consecutive Charnley total hip arthroplasties (THAs) were assessed at an average of 62 and 140 months (five-year and ten-year follow-up examinations) postoperatively. Cases developing deep infection during the first five years were not included. Pain, walking ability, and mobility were rated as advocated by Charnley. The results were then graded as excellent, good, fair (clinically successful), and failure. At the five-year follow-up evaluation, 77 hips were excluded; 92% (228/248) of the results were successful. At the ten-year follow-up examination, interest was focused on the 228 hips graded as successful after five years. Sixty-six were excluded, one that had not been included at the five-year evaluation was traced, and 92% (150/163) were again clinically successful. The failure rate owing to mechanical causes during the first five years and between the five-year and ten-year follow-up examinations was 6.9% and 6.7%, respectively. The clinical results were considered highly satisfactory because only 50% of the hips judged successful at the ten-year examination had roentgenographically intact components. There is good reason to have great confidence in the Charnley THA.     

Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study

BACKGROUND: Ceramic-on-ceramic couplings are attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. Disappointing experiences with alumina ceramic bearings in the past have led to many improvements in the manufacture and design of ceramic implants. The purpose of the present study was to report the results of contemporary alumina-on-alumina total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum duration of follow-up of five years. METHODS: We evaluated the results of a consecutive series of 100 primary alumina-on-alumina total hip arthroplasties that had been performed with use of a metal-backed socket and a cementless stem in eighty-four patients. All of the patients were sixty-five years of age or younger (mean age, forty-one years), and a single surgeon performed all of the procedures. After a minimum duration of follow-up of sixty months, one patient (one hip) had died and four patients (six hips) had been lost to follow-up, leaving a total of seventy-nine patients (ninety-three hips) available for study. All of these patients were evaluated clinically and radiographically with special attention to wear, periprosthetic osteolysis, and ceramic failure. RESULTS: The mean Harris hip score was 97 points at the time of the latest follow-up evaluation. All prostheses demonstrated radiographic evidence of bone ingrowth. No implant was loose radiographically, and no implant was revised. Ceramic wear was not detectable in the thirty-seven hips in which the femoral head could be differentiated from the cup on radiographs. Periprosthetic osteolysis was not observed in any hip. A fracture of the alumina femoral head and a peripheral chip fracture of the alumina insert occurred in one hip following a motor-vehicle accident. CONCLUSIONS: The results of contemporary alumina-on-alumina total hip arthroplasty with a metal-backed socket and a cementless stem were encouraging after a minimum duration of follow-up of five years. We believe that these improved alumina-on-alumina bearing implants offer a promising option for younger, active patients.     

The Harris-Galante total hip arthroplasty: a minimum 8-year follow-up study

A total of 93 Harris-Galante Porous I (HGP- I) prostheses were analyzed with a mean follow-up of 10.2 years. Thigh pain (28 hips) correlated with unstable fixation (P<.005), female gender (P<.045), young age (P<.05), poor distal femoral fill (P<.002), subsidence (P<.0001), and osteolysis (P<.05). Thirteen stems and 6 metallic shell cups were revised. Kaplan-Meier analysis showed 13-year survival rates of 92.5% +/- 5.8% for the metallic shell cup, 79.7% +/- 13% for the HGP-I cup, and 76.3% +/- 14.0% for the stem. Five polyethylene liners were changed because of wear >1 mm. Radiographic loosening occurred in 8 cups. Radiographic bone ingrowth was present in 54 stems, stable fibrous fixation was present in 24 stems, and unstable fixation was present in 15 stems. The mean polyethylene wear was 0.17 mm/y. Eleven hips (11.8%) had acetabular osteolysis, and 24 (25.8%) had femoral osteolysis, the latter being more frequent in unstable stems (P<.007). The HGP-I metallic cup shows better clinical and radiographic results than the stem, which frequently is associated with pain, unstable fixation, and osteolysis. Excessive polyethylene wear is frequent.     

Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report

The purpose of the current study was to update the results of a prospective, single-surgeon series of primary Charnley total hip arthroplasties performed with cement. This investigation is one of the first studies in which hips treated with total hip arthroplasty with cement were followed for a minimum of thirty years. Twenty-seven patients (thirty-four [10.3%] of the hips in the initial study group) were alive at a minimum of thirty years postoperatively. These patients served as the focus of the present study. Revision because of aseptic loosening of the acetabular component was performed in 7.3% (twenty-three) of the hips from the original study group (excluding those revised because of infection or dislocation) and 26% (eight) of the hips in the living cohort. Revision because of aseptic loosening of the femoral component was performed in 3.2% (ten) of the hips from the original study group (excluding those revised because of infection or dislocation) and 10% (three) of the hips in the living patients. Since the twenty-five-year review, three hips were revised (one because of acetabular loosening, one because of femoral loosening, and one because of instability). This end-result study demonstrated the remarkable durability of cemented Charnley total hip replacements over a span of three decades, with 88% of the original prostheses intact at the time of the final follow-up or at the patient's death.     

Radiographic comparison of cementing techniques in total hip arthroplasty

Using a single prosthetic design, the authors conducted a radiographic comparison of the results of changes in cementing techniques in 58 total hip arthroplasties with respect to the initial postoperative and equivalent follow-up radiographs. The study period, 1975-1982, spanned the advent of cement restrictors, canal preparation, and pressurization techniques. In matched patients, the use of modern cementing techniques and canal preparation led to a significant improvement in the initial postoperative radiographic appearance and subsequent loosening rate of the femoral component, suggesting that these techniques may change the expected rate of late femoral component loosening, based on previous studies done with prepressurization cementing techniques.     

Charnley total hip arthroplasty with cement. Fifteen-year results

The results of the first 333 Charnley total hip arthroplasties that were performed with cement at the Mayo Clinic were reviewed a minimum of fifteen years postoperatively. Data were available for 166 of 170 hips of patients who were still alive. One hundred and thirty patients died, and thirty-seven hips were revised. At the time of this study, 80 per cent of the living patients had no pain, and 152 of the 160 hips remained much better than before the operation. Kaplan-Meier analysis of probable loosening of one or both components, on the basis of roentgenographic evidence, demonstrated a probability of loosening of 3 per cent incidence at one year after operation, 13 per cent at five years, 19 per cent at ten years, and 32 per cent at fifteen years. The probability of failure (that is, revision or symptomatic loosening) was 0.9 per cent at one year, 4.1 per cent at five years, 8.9 per cent at ten years, and 12.7 per cent at fifteen years. We did not identify a dramatic increase in the incidence of loosening or failure at any of the follow-up periods (one, five, ten, or fifteen years). With the Mayo Clinic clinical and roentgenographic system for scoring the hips, we found that ninety-seven hips had a good or excellent result; fifteen, a fair result; and thirteen, a poor result. (The scoring could not be completed for forty-one hips). The functional results deteriorated slightly over time.(ABSTRACT TRUNCATED AT 250 WORDS)     

Revision total hip arthroplasty with cementing technique--five-year results.

AIM: To investigate the result of cemented revision hip arthroplasty. MATERIAL AND METHODS: Twenty-one revision hip arthroplasties for aseptic loosening with cementing technique during the period 1990-2002 were followed-up. There were 12 women and 9 men with mean age at the time of revision 61 years (33 to 76 years). The mean follow-up for the group was 5.2 years (range, 2 to 13 years). The clinical evaluation was performed with the Harris hip score. Implant survival, pain, function and complications were recorded. Plain radiographs were reviewed and the hips were graded for osteolysis and loosening. Wear of the polyethylene was measured. RESULTS: No component was exchanged. Three of the acetabular and three of the stem components in the hips with early cementing technique were loose. In two patients three surgeries were performed for trochanteric problems and persistent pain. Clinical result and bone defects preoperatively as well as wear and osteolysis correlated significantly. DISCUSSION: Stable fixation of the prosthesis is of paramount importance in revision surgery. In cases with severe bone defects stable interface is difficult to be achieved. This may change stress distribution and subsequently lead to loosening. CONCLUSION: Better preoperative planning and improvement in cementing technique may improve results. Other revision techniques may be considered in cases with severe bone deficiencies.     

Long-term follow-up of Charnley arthroplasty of the hip.

A review of 11.5 year (average interval) follow-up examination of 409 low friction arthroplasties performed included only 3 late failures. The excellent results of the successes have been fully maintained for as long as 14 years. This was true with regard to pain, function of walking and mobility. Resorption of the calcar femorale was rare and no correlation was found with the wear of the socket. The average wear of 1.5 mm was less than predicted by Professor Sir John Charnley. Although 10 patients (7.8%) had excessive wear no patient is at present near the stage of requiring replacement of the socket for this reason. No adverse reaction was found to the implant or the cement.     

The use of a tripolar articulation in revision total hip arthroplasty: a minimum of 24 months' follow-up

A retrospective cohort study of 31 hips revised with a tripolar articular construct was performed. Patient demographics and preoperative and postoperative information were recorded. Indications for a tripolar construct were recurrent dislocation and the inability to attain intraoperative stability during hip revision. Nine patients (29%) were revised to the tripolar construct after failure of a constrained liner. Twenty patients (65%) had at least one episode of instability before the most recent revision. At a mean follow-up of 38 months, modified Postel scores improved from a mean of 5.28 to 9.64 (P < .01). Radiographic follow-up revealed no evidence of component loosening/migration, osteolysis, or polyethylene wear. Two patients (7%) required further revision surgery for recurrent instability. A tripolar construct was effective in eliminating or preventing instability in 93% of the complex cases treated. These early results support the use of a tripolar construct in treating recurrent instability or instability encountered at the time of revision hip arthroplasty.     

Long-term clinical results of Charnley total hip arthroplasty using a matte satin-finished stem: a 30-year average follow-up study

Background Although 50 years have passed since Charnley started performing total hip arthroplasties, there are relatively few patient studies with a follow-up period of over 30 years. We studied radiograms of patients who had undergone Charnley total hip arthroplasty between 1975 and 1981 and evaluated the results at 26–35 years (mean 30.5 years) after the operation.Methods The operations were performed in 87 joints of 82 patients (26 males and 56 females) aged 26–81 years (mean age 56 years) at the time of surgery. A monoblock-type Charnley stem with a 22-mm head was used in all patients. The stem had a matte satin surface finish and a flange or round-back shoulder. The socket was made of ultra-high-density polyethylene without a flange. All operations were performed by one surgeon using the original Charnley method in all patients, excluding the first five.Results Thirty years after the operation, 48 patients have died, 5 had an infection, 9 were lost to follow-up, and 20 patients with 24 joints are still alive. In 77 patients (82 joints), after excluding the 5 with infection, the socket and stem survival rates were 54 and 75 % at 30 years after the operation when radiographic loosening or revision surgery was defined as the end point. With revision surgery as the end point, the rates were 68 and 82 %, respectively.Conclusions These results were as favorable as those with surgical techniques (including the first-generation cement technique) and implants in the early period. Although new techniques and implants have since been introduced, their long-term results should exceed those in this study. The results of this study should provide a valuable index with which to compare the long-term studies of current total hip arthroplasty.     

A ten-year follow-up study of 170 Charnley total hip arthroplasties

Between 1971 and 1974, 352 low-friction hip arthroplasties were performed on 296 patients using the precise Charnley technique. One hundred seventy hips in 145 patients were followed either for ten years or to the point at which revision of the total hip arthroplasty was made necessary by infection, aseptic loosening, chronic dislocation, or similar complications. The results of this evaluation revealed an overall revision rate to the ten-year level of 8.8% in 171 hips and an infection rate of 1.4% for all 352 cases. Both clinical and radiologic assessments encourage further use of this technique.     

Late dislocations in patients with Charnley total hip arthroplasty

I analyzed the cases of thirty-two patients in whom a Charnley total hip arthroplasty had dislocated for the first time between five and ten years postoperatively. I evaluated the possible factors that caused the late dislocations. Most of the factors were similar to those that were also present in a control group of patients who had had an arthroplasty that had not dislocated and in a group in which dislocation had occurred at variable times postoperatively. Two significant factors did emerge. First, the patients with late dislocation had a greater range of motion, especially in flexion, than those in the two control groups. Second, the acetabular component showed radiographic evidence of loosening in more of the patients in the group with late dislocation than in either of the control groups. I postulated, but did not prove, that stretching of the pseudocapsule of the hip over time and extremes of motion may lessen soft-tissue constraints and allow for late dislocation.