Cemented collarless (exeter-CPT) versus cementless collarless (PCA) femoral components: A 2- to 14-year follow-up evaluation

The purpose of this study was to compare the intermediate results of total hip arthroplasty with a cemented, collarless, femoral prosthesis design (Exeter, Howmedica, Middlesex, UK and CPT, Zimmer, Warsaw, IN) with those of a cementless, collarless, porous-coated femoral component (PCA, Howmedica). A total of 151 hips in 128 patients were reviewed. In the cemented group, 85 Exeter-CPT prostheses were used in 71 patients with an average follow-up period of 6.5 years. In the uncemented group, 66 PCA prostheses were placed in 57 patients with an average follow-up period of 7 years. Harrington hip scores improved from 50.1 to 80.7 for the PGA group and from 49.5 to 87.3 for the Exeter-CPT group. The patient satisfaction rates were 89 and 96%, respectively. Sixty-eight patients with Exeter or CPT prostheses had excellent function and no significant thigh pain after 2 years. One Exeter stem was revised 10 years after the primary surgery because of localized osteolysis due to cement defect. Two Exeter sockets were revised because of aseptic loosening. In the PCA group, the incidence of thigh pain that persisted beyond 2 years was 39.4%, and there were high incidences of distal cortical hypertrophy (66.6%) and bead loosening (45.5%). Sixteen hips were revised for aseptic stem loosening, uncontrollable thight pain, or stem fracture (1 hip), and seven were revised because of migration and aseptic loosening of the socket. The cementless ingrowth stems failed earlier (around 5 years), whereas the cemented stems continued to perform well past 14 years. In this study, the cemented, collarless, collarless, porous-coated anatomic design at an average follow-up period of 7 years (range, 2–14 years).     

Acetabular revision with morsellised allogenic bone graft and a cemented metal-backed component

Failure of total hip arthroplasty with acetabular deficiency occurred in 55 patients (60 hips) and was treated with acetabular revision using morsellised allograft and a cemented metal-backed component. A total of 50 patients (55 hips) were available for clinical and radiological evaluation at a mean follow-up of 5.8 years (3 to 9.5). No hip required further revision of the acetabular component because of aseptic loosening. All the hips except one had complete incorporation of the allograft demonstrated on the radiographs. A complete radiolucent line of > 1 mm was noted in two hips post-operatively. A good to excellent result occurred in 50 hips (91%). With radiological evidence of aseptic loosening of the acetabular component as the end-point, the survivorship at a mean of 5.8 years after surgery was 96.4%. The use of impacted allograft chips in combination with a cemented metal-backed acetabular component and screw fixation can achieve good medium-term results in patients with acetabular bone deficiency.     

Long-term survivorship of cemented all-polyethylene acetabular components in patients > 75 years of age

Between 1974 and 1982, 132 consecutive hips in 112 patients >75 years of age were treated with primary total hip arthroplasty for osteoarthritis using a cemented all-polyethylene T28 socket and cemented T28 or TR28 stem with a 28-mm head size. At the time of review, 94 patients (110 hips [83%]) had died and 18 patients (22 hips [17%]) were still living (mean age at follow-up, 93 years). Five hips (5 patients) were lost to follow-up. Clinical follow-up averaged 8.9 years for the entire group and 14.6 years for patients still living. Only 2 acetabular components have been revised (1 for recurrent dislocation, 1 for infection). No acetabular component has required revision for aseptic loosening. Survivorship free of acetabular revision for aseptic loosening at 10 years was 100%; free of symptomatic acetabular loosening, 97.4% (95% confidence interval, 91.8-100%); and free of acetabular loosening, 95.9% (95% confidence interval, 89.7-100%). The commonest complication was postoperative hip dislocation, which occurred in 11 hips (8.7%) and which required reoperation in 2 hips. Cemented acetabular components implanted in patients >75 years of age with a diagnosis of osteoarthritis showed a high rate of survivorship free of revision and free of symptomatic aseptic loosening.     

Results of a cemented straight titanium alloy femoral stem after mean follow-up of 13 years

The first consecutive series of 250 implantations of a cemented femoral shaft prosthesis made of titanium alloy (Bicontact®, Aesculap, Tuttlingen, Germany) in 239 patients are included in this prospective follow-up study. Average time of follow-up evaluation was 12.6 years (range 11.8–13.8 years). At follow-up, 116 patients with 112 hips have died and only two could not be located. Follow-up rate was 99.2% for the patients still alive at time of follow-up evaluation. Eight patients have been revised, two for infection, one for aseptic loosening of a varus-malaligned stem and two for aseptic loosening in cases with osteolysis; two radiologically well-fixed stems had been revised during acetabular revision. Two additional stems were regarded loose according to radiologic criteria. Survival estimate (with revision as an endpoint) showed a calculated cumulative survival rate of 95.8% after 14 years [confidence limits: 98.0% (upper) and 91.4% (lower)]. The average HARRIS hip score at time of follow-up was 77.3 points. Radiologically, signs of loosening could be detected in two stems: in both cases osteolyses developed together with significant polyethylene wear. One of these patients experienced severe pain, so an indication for revision is given, the other has only mild pain and revision had not been indicated so far. In conclusion, the long-term follow-up results with this cemented titanium femoral component are encouraging and are comparable to other successful cemented femoral components in primary total hip arthroplasty. No increased risk for aseptical loosening was associated with the combination of titanium and cement in this specific stem.     

Total hip arthroplasty with a modified cementing technique using hydroxyapatite granules

Results of total hip arthroplasties with a modified cementing technique using hydroxyapatite were evaluated. Femoral and acetabular components were inserted with cement after hydroxyapatite granules (phi = 100-300 microm). The study group comprised 268 hips in 232 patients. The diagnosis was osteoarthritis in 197 patients. After a mean follow-up of 10.3 years, 5 patients died and 30 patients were lost to follow-up, leaving 218 hips (197 patients; mean age, 58.2 years) for evaluation. Three hips were revised because aseptic (1) and septic (2) loosening of acetabular components. Six other sockets were defined as radiologically loose, and no femoral component was loose. Osteolysis was identified in 2 femora and 0 acetabula. The overall loosening rate was 3.2% for acetabular components and 0% for femoral components. These results show that the loosening rate of cemented total hip arthroplasty components, especially the acetabulum, is reduced markedly with this modified cementing technique.     

Revision total hip arthroplasty with cemented femoral component

We reviewed retrospectively the results of 28 hips (25 patients) after revision of the femoral component with use of a cemented stem, because of aseptic loosening. The mean duration of follow-up was 4.43 years (range 2–12 years). Over the course of the study period, repeat revision was done in 4 hips after an average of 4.45 years. Three hips had a repeat revision of the femoral component because of aseptic loosening and one for a deep infection. The rate of loosening of the femoral component was 32.4% (9 hips) at an average of 5.22 years. The 5-year survival rate was 76.9% with mechanical failure as end point; and 90% with re-revision of femoral component because of aseptic loosening as end point. The cement mantle was the principal factor, which was significantly associated with a better survival rate of femur fixation (P < 0.05). No correlation was noted between quality of bone loss at the time of revision, bone graft or the use of long stems, and the survival rate of femoral component. By improving the cementing technique and in selected patients, the use of cemented femoral stem could be a good alternative for aseptic loosening THA.     

Gute langfristige Nachuntersuchungsergebnisse einer zementierten Titan-Geradschaftprothese

A higher-than-average rate of aseptic loosening has been postulated to be associated with the combination of a titanium stem and bone cement. In this prospective follow-up study we therefore investigated our first consecutive series of 250 implantations of a cemented femoral shaft prosthesis made of titanium alloy (BiCONTACT((R)), Aesculap, Tuttlingen, Germany).Average time of follow-up evaluation was 9.7 years (range 8.7-10.3 years). At follow-up, mean patient age was 81 years; 89 patients with 93 hips have deceased and two could not be located. Follow-up rate was 98.7% for the patients still alive at time of follow-up evaluation. Five patients have been revised, two for infection and one for aseptic loosening of a varus-malaligned stem; two radiologically well-fixed stems had been revised during acetabular revision. Survival estimate showed a calculated cumulative survival rate of 97.5% after 11 years [confidence limits: 99.0% (upper) and 94.1% (lower)]. The average Harris hip score at time of follow-up was 82.25 points.Radiologically, signs of loosening could be detected in 3 stems: in one case varus malalignement deteriorated with time and in 2 cases osteolyses developed together with significant polyethylene wear. All 3 patients experienced only mild pain and revision had not been indicated so far. In conclusion, the long-term follow-up results with this cemented titanium femoral component are encouraging and are comparable to other successful cemented femoral components in primary total hip arthroplasty. No increased risk for aseptical loosening was associated to the combination of titanium and cement in this specific stem. Design parameters seem to play an important role in the development of aseptic loosening in cemented titanium stems.     

Long-Term Survival of the Cemented Exeter Universal Stem in Patients 50 Years and Younger: An Update on 130 Hips

BackgroundThere is variable evidence regarding survivorship beyond 20 years of total hip arthroplasties in young patients. We report the long-term results of the Exeter cemented hip system in patients ≤50 years at minimum of 20 years.MethodsClinical and radiological outcomes of 130 consecutive total hip arthroplasties in 107 patients aged 50 years or younger at primary operation were reviewed; 77% had a diagnosis other than osteoarthritis. All patients were followed at 5-year intervals, no patients were lost to follow-up, and the status of every implant is known.ResultsMean age at surgery was 41.8 (17-50) years. Mean follow-up was 22.0 (20.0-26.1) years. There were 79 hips surviving, 14 hips (11 patients) deceased, and 37 hips revised. Reasons for revision: 29 hips for aseptic cup loosening (26 stems revised using cement-in-cement, three left in-situ); three stems for femoral osteolysis, two related to acetabular polyethylene wear (14.1 and 17.0 years), one with Gaucher’s disease (21.1 years); one broken stem (12.9 years); one cup for instability (4.3 years–stem revised using cement-in-cement); and two hips with infection (8.5 and 23.8 years). There were no cases of aseptic loosening of the Exeter stem. There were no radiologically loose stems although eight patients had radiological evidence of loosening of the cemented cup. Survivorship at 22 years was 74.9% for revision for all causes and 96.3% for revision of the stem for aseptic loosening or lysis.ConclusionThe Exeter cemented stem has excellent survivorship at minimum 20 years in young patients. Acetabular component survivorship was less favorable, but the advent of highly cross-linked polyethylene may improve this in the long term.     

Cemented revision of failed uncemented femoral components of total hip arthroplasty

BACKGROUND: The long-term results of revision of failed primary cemented femoral components with use of cement have been reported, but there is little information about the results of revision of failed uncemented femoral components with use of cement. The purpose of the present study was to examine the minimum five-year results for patients in whom a failed uncemented primary femoral component was revised with use of modern cementing techniques. METHODS: Forty-eight consecutive hips (forty-seven patients) in which a failed primary uncemented femoral component was revised with use of cement at one institution from 1985 to 1992 were followed prospectively and reviewed retrospectively. The mean age of the patients at the time of revision was sixty-seven years. Only seven revisions were performed with a long-stem femoral component. The postoperative cement mantle was classified, according to the system of Mulroy and Harris, as grade A in four hips, grade B in twenty-five, grade C1 in seven, grade C2 in twelve, and grade D in none. RESULTS: Eleven femoral components were removed or revised because of aseptic loosening (ten) or deep infection (one). An additional four unrevised femoral components had evidence of probable or definite loosening at the time of the final radiographic follow-up. Thus, fourteen (29%) of the forty-eight femoral implants demonstrated aseptic loosening during the study period. Five of the twenty-nine hips in which the postoperative cement mantle was classified as grade A or B had mechanical failure at the time of the final follow-up, compared with nine of the nineteen hips in which the postoperative cement mantle was classified as grade C1 or C2 (p < 0.05). Among the hips with surviving prostheses, 79% had had moderate or severe pain preoperatively whereas 25% had moderate or severe pain at the time of the final follow-up. The six-year rate of survival of the femoral component was 72% with revision for aseptic loosening as the end point and 67% with mechanical failure (revision for aseptic loosening or radiographic loosening) as the end point. CONCLUSIONS: While revision of a failed uncemented femoral implant with use of cement provided pain relief and improved function for most patients, the rate of loosening at the time of intermediate-term follow-up was higher than that commonly reported after revision of failed cemented implants with use of cement and also was higher than that commonly reported after revision with use of uncemented extensively porous-coated implants. Bone removal at the time of the initial implantation of the stem and bone loss due to subsequent failure of the uncemented implant often left little intramedullary cancellous bone, which may explain the high rate of loosening observed in the first decade after revision in this series.     

Ten-year survival of the MS-30 matt-surfaced cemented stem

The Morscher-Spotorno (MS-30) femoral stem is a stainless-steel, straight, three-dimensionally tapered, collarless implant for cemented fixation in total hip replacement.We report the results at ten years of a consecutive series of 124 total hip replacements in 121 patients with the matt-surfaced MS-30 stem and an alumina ceramic head of 28-mm diameter. All the stems were fixed with Palacos bone cement with gentamicin using a modern cementing technique. They were combined with an uncemented, press-fit cup. The mean period of observation was 10.2 years (8.3 to 12.1) and no patient was lost to follow-up. Twenty-seven patients (22%) died with the implant in situ. Nine could only be interviewed by telephone. We included 85 patients with 88 hips in the clinical and radiological follow-up examinations.None of the stems or cups had been revised. The Harris hip score was excellent or good in 97% (85 hips) and moderate in 3% (three hips). Radiologically, six hips (6.8%) had osteolysis adjacent to the stem, mostly in Gruen zone 7. Twenty (22.7%) showed one or more radiolucent lines. Twenty-two stems (25%) had subsided by 2 mm to 5 mm. In these cases two showed osteolysis (9.1%) with subsidence and four without (6.1%). Radiolucent lines were seen in seven with migration (31.8%) and in 13 without (19.7%). No infections and no acetabular osteolysis were observed.The clinical results were excellent with survivorship after ten years of 100% and only a slightly statistically non-significant higher rate of osteolysis and radiolucency in cases of subsidence.     

Cementless total hip arthroplasty using a threaded cup and a rectangular tapered stem. Follow-up for ten to 17 years

We carried out a clinical and radiological review of 103 cementless primary hip arthroplasties with a tapered rectangular grit-blasted titanium press-fit femoral component and a threaded conical titanium acetabular component at a mean follow-up of 14.4 years (10.2 to 17.1). The mean Harris hip score at the last follow-up was 89.2 (32 to 100). No early loosening and no fracture of the implant were found. One patient needed revision surgery because of a late deep infection. In 11 hips (10.7%), the reason for revision was progressive wear of the polyethylene liner. Exchange of the acetabular component because of aseptic loosening without detectable liner wear was carried out in three hips (2.9%). After 15 years the survivorship with aseptic loosening as the definition for failure was 95.6% for the acetabular component and 100% for the femoral component.     

Fifteen-year results of the Müller CoCrNiMo Straight Stem

Between September 1980 and May 1982, 112 primary unilateral total hip arthroplasties with the original cemented M. E. Müller Straight stem (manufactured from Protasul-10, a CoCrNiMo alloy) were inserted in 109 consecutive patients, all combined with non-cemented, non-coated polyethylene RM cups. Forty-three patients (40%) died during the follow-up period, all with the implant in place. Of the 66 surviving patients, 2 (1.8%) were lost to follow-up, and 7 (6.3%) were unable to attend the 15-year clinical and radiological follow-up. Eight stems (7.3%) had to be revised for aseptic loosening and 3 stems (2.7%), for septic loosening. The 15-year survivorship of the Müller Straight stem regarding aseptic loosening is, therefore, 92.7%. Forty-six patients with 49 total hip replacements could be evaluated clinically and radiologically after 15 years. The mean duration of clinical follow-up for these 46 patients (42.2%) was 14.8 years (range 12.8– 16.5 years). There were 22 women (48%) and 24 men (52%). The mean age at the time of the operation was 62 years (range 38–80 years), and 78 years (range 59– 93 years) at the time of the latest follow-up. The mean Harris Hip Score at the latest follow-up evaluation of the 49 hip joints was 85 points (range 34–100 points). Of the 46 patients, 39 (85%) had a good or excellent clinical result. Radiographic follow-up was performed for 49 hips: 35 (70%) had linear or focal osteolysis in one or more zones of the stem, but only 4 (8%) had evidence of definitive loosening (linear radiolucency of over 2 mm all around the stem). Subsidence of over 2 mm was found in 20 hips (41%), 6 of them within the cement mantle. There was no correlation between subsidence and pain. The cause for the poor results is primarily the high rate of aseptic loosening of the non-coated, non-cemented all-polyethylene RM cups, with a loosening rate of 63% and a revision rate of 25% after 15 years. Received: 18 December 1999     

Der zementierte MS-30-Schaft

INTRODUCTION: So far there is only one peer-reviewed long-term publication from the inventors' clinic for the MS-30 stem. MATERIAL AND METHODS: In a retrospective study we followed the first 333 consecutive MS-30 stems. All patients with 5- to 11-year follow-up were clinically and radiographically evaluated. At the time of implantation the criteria of modern cementing techniques were not implemented. Clinical evaluation was done using the scores of Harris and Merle d'Aubigné and Postel. Radiographic evaluation included quality of the cement mantle (true lateral radiographs taken under fluoroscopy), stem subsidence, loosening signs, and the risk for pending failure. RESULTS: At follow-up 12 hips had undergone femoral revision: 3 for aseptic loosening, 6 for infection, 1 for periprosthetic fracture, and 2 for recurrent dislocation. The overall survival for all reasons at 10 years was 96.1%; survival with aseptic loosening as an end point was 99.0%. The median Harris Hip Score at follow-up was 80 (26-100) points. Radiological evaluation revealed a thin cement mantle (<2 mm) in approximately 2/3, predominantly on the lateral views (Gruen zones 8/9). One-third of all reviewed prostheses were considered at risk for pending failure, which strongly correlated with the initial quality of the cement mantle. CONCLUSION: Midterm results with the MS-30 stem are encouraging and an even better long-term outcome can be expected with a better cement technique.     

Mid-term results of Exeter vs Endurance cemented stems

The mid-term results are reported of 2 uniquely different cemented stems implanted and followed prospectively by a single surgeon. The highly polished, collarless, tapered Exeter stem and the Endurance stem, a collared, roughened, satin finished stem, were inserted through a lateral approach using third-generation cement techniques. A total of 118 hips with the Exeter stem with an average follow-up of 7.25 years and 34 hips with the Endurance stem with an average follow-up of 4.57 years are included in the study. The Exeter patients had no revisions for aseptic loosening (0%) of the femoral stem. In contrast, the Endurance patients had 5 revisions and 2 impending revisions for aseptic loosening (20.5%) of the femoral stem with an average time to failure of 3.72 years. The excellent mid-term results of the Exeter stem support its ongoing use. By contrast, because of the poor early results of this modern cemented Endurance stem design, it is no longer used at our institution.     

20-year experience with cemented primary and conversion total hip arthroplasty using so-called second-generation cementing techniques in patients aged 50 years or younger

We present the 20-year experience of 47 hips in 40 patients aged 50 years or younger with cemented primary total hip arthroplasty using second-generation femoral cementing techniques. Average follow-up duration in the 23 patients living at least 17 years was 18.2 years. Overall, 18 hips (38%) had components revised or removed for any reason, at an average duration of 12.6 years. Every revision or reoperation involved removing the acetabular component. Of these 18 acetabular components, 15 (32%) were revised for aseptic loosening. Eleven additional acetabular components were loose by radiographic criteria at final follow-up, yielding prevalence of aseptic acetabular loosening (55%). Four femoral components (8%) were revised for osteolysis without loosening, and 3 (6%) were revised for aseptic loosening. Femoral osteolysis, with or without component loosening, led to revision in 5 ( 11%) hips compared with 6% for aseptic loosening alone. Osteolysis was the primary problem leading to acetabular and femoral component revision in this series of people < or = 50 years old over the first 20 years after the index operation.     

Revision of a cemented acetabular component to a cementless acetabular component. A ten to fourteen-year follow-up study.

BACKGROUND: Although cementless acetabular components are routinely used in revision hip surgery, few investigators have evaluated the retention and efficacy of these components in the long term. In the current study, the clinical and radiographic outcomes of a series of arthroplasties performed by one surgeon with a cementless acetabular component were assessed at a minimum of ten years. METHODS: From 1986 through 1988, sixty-one consecutive revision total hip arthroplasties were performed in fifty-five patients because of aseptic failure of one or both components of a prosthesis in which both components had been cemented. Twenty-eight patients (thirty-two hips) were alive at a mean of 12.9 years (range, 11.5 to 14.3 years) after the operation. In all of the patients, the acetabular component was revised to a porous-coated Harris-Galante component inserted without cement, and the femoral component was revised to an Iowa component affixed with contemporary cementing techniques. The hips were evaluated clinically and radiographically at a minimum of ten years subsequent to the index revision. No hips were lost to follow-up. RESULTS: None of the acetabular components required revision because of aseptic loosening. Two hips (3%) demonstrated radiographic evidence of aseptic loosening of the acetabular component. The polyethylene liner was exchanged during the follow-up period in eight hips. CONCLUSION: After a minimum of ten years of follow-up, cementless acetabular fixation in revision hip arthroplasty had produced durable results that were markedly better than those reported for acetabular fixation with cement.     

Cemented Müller straight stem total hip replacement: 18 year survival,clinical and radiological outcomes

AIM: To present the 18 year survival and the clinical and radiological outcomes of the Müller straight stem, cemented, total hip arthroplasty (THA).METHODS: Between 1989 and 2007, 176 primary total hip arthroplasties in 164 consecutive patients were performed in our institution by the senior author. All patients received a Müller cemented straight stem and a cemented polyethylene liner. The mean age of the patients was 62 years (45-78). The diagnosis was primary osteoarthritis in 151 hips, dysplasia of the hip in 12 and subcapital fracture of the femur in 13. Following discharge, serial follow-up consisted of clinical evaluation based on the Harris Hip Score and radiological assessment. The survival of the prosthesis using revision for any reason as an end-point was calculated by Kaplan-Meier analysis.RESULTS: Twenty-four (15%) patients died during the follow-up study, 6 (4%) patients were lost, while the remaining 134 patients (141 hips) were followed-up for a mean of 10 years (3-18 years). HSS score at the latest follow-up revealed that 84 hips (59.5%) had excellent results, 30 (22.2%) good, 11 (7.8%) fair and 9 (6.3%) poor. There were 3 acetabular revisions due to aseptic loosening. Six (4.2%) stems were diagnosed as having radiographic definitive loosening; however, only 1 was revised. 30% of the surviving stems showed no radiological changes of radiolucency, while 70% showed some changes. Survival of the prosthesis for any reason was 96% at 10 years and 81% at 18 years.CONCLUSION: The 18 year survival of the Müller straight stem, cemented THA is comparable to those of other successful cemented systems.     

Ten-year survivorship of rough-surfaced femoral stem with geometry similar to Charnley femoral stem

The aim of this study is to review the 10-year results of 269 cemented total hip arthroplasties performed using the Harvard femoral stem with matte surface finish and Charnley stem-like geometry. This is a retrospective cross-sectional survivorship study. We retrospectively reviewed the results of 269 cemented total hip arthroplasties performed using the Harvard femoral stem in 257 patients (men/women 93:164, mean age 71.2 years) between 1990 and 1994. The median duration of follow-up for the surviving implants was 118 (range 60-129) months. Radiographs were reviewed to evaluate the type of osteoarthritis, cement mantle thickness, alignment of the components, presence of aseptic loosening, and radiolucent lines. Kaplan-Meier survival analysis and Cox proportional hazards analysis were performed to evaluate 10-year survival and the impact of various radiological parameters on the prosthesis survival respectively. Of the 248 eligible patients (260 hips), 6 patients (7 hips) were lost to follow-up, and 67 patients had died at the time of the study; 36 hips (35 patients) underwent revision surgery for aseptic failure (median duration 60 months, range 12-125 months), and 11 hips were revised for septic failure (median duration 24 months, range 10-53 months from the index procedure). The femoral component was revised in all patients, whereas the acetabular component was revised in 27 patients. Ten-year survival for the femoral and acetabular components using aseptic loosening (with and without revision surgery) as an end point was 77.5% (71.5%-83.5%) and 91.1% (87.2%-95%), respectively. Cox regression analysis did not reveal a statistically significant (P > 0.05) effect of various radiological parameters on survival rate. Our results demonstrate that the matte surface finish femoral component (with geometry similar to Charnley femoral component) has less satisfactory long-term survival rate.     

The Metasul metal-on-metal articulation in primary total hip replacement: clinical and radiological results at ten years

We report the clinical and radiological outcome at ten years of 104 primary total hip replacements (100 patients) using the Metasul metal-on-metal bearing. Of these, 52 had a cemented Stuehmer-Weber polyethylene acetabular component with a Metasul bearing and 52 had an uncemented Allofit acetabular component with a Metasul liner. A total of 15 patients (16 hips) died before their follow-up at ten years and three were lost to follow-up. The study group therefore comprised 82 patients (85 hips). The mean Oxford score at ten years was 20.7 (12 to 42). Six of 85 hips required revision surgery. One was performed because of infection, one for aseptic loosening of the acetabular component and four because of unexplained pain. Histological examination showed an aseptic lymphocytic vasculitis associated lesion-type tissue response in two of these. Continued follow-up is advocated in order to monitor the long-term performance of the Metasul bearing and tissue responses to metal debris.     

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.