Natural History of Squeaking after Total Hip Arthroplasty

Background  

In recent years, a number of alternative bearing surfaces, such as ceramic on ceramic, are being used in THA. Squeaking after THA is a recently recognized complication; however, its incidence is unknown.     

A Randomized Trial Of Ceramic-On-Ceramic Bearing Versus Ceramic-On-Crossfire-Polyethylene Bearing In Total Hip Arthroplasty: Five-Year Outcomes

This study determined how ceramic-on-ceramic bearing THA affected joint-specific pain, function and stiffness in the first five postoperative years compared with ceramic-on-highly-crosslinked-polyethylene bearing THA. Subjects less than 61 years of age were randomized to ceramic-on-ceramic (CERAMIC) [n = 48] or ceramic-on-highly-crosslinked-polyethylene (POLYETHYLENE) [n = 44] bearing THA. Subjects were assessed using the Western Ontario McMaster Osteoarthritis Index (WOMAC) and the RAND 12-Item Health Survey (RAND-12) preoperatively, and at one and five years postoperatively. 92 subjects(50 (54%) males; average age = 52 (SD 6.6) years) were enrolled. 78 (85%) subjects returned five years postoperatively. All subjects reported improvements at one and five years in all measured indices with no group differences detected. Seven (8%) subjects experienced postoperative THA complications, none related to bearing surfaces; two subjects (POLYETHYLENE) required revision for instability. Both bearing surfaces provided excellent short-term results in younger subjects.     

Incidence,Risk Factors,and Outcome of Ceramic-On-Ceramic Bearing Breakage in Total Hip Arthroplasty

BackgroundCeramic-on-ceramic bearing breakage is a rare but significant complication of total hip arthroplasty. This study aimed to identify risk factors for breakage and to determine the outcome of different revision options.MethodsAll ceramic-on-ceramic primary total hip arthroplasty procedures reported to the Australian Joint Replacement Registry from September 1999 to December 2019 were included. Procedures were subdivided into alumina or mixed ceramic (alumina/zirconia). All breakages were identified. The association between ceramic type and head size was assessed. Subsequent revision rates were compared and cause of revision assessed.ResultsThere were 23,534 alumina and 71,144 mixed ceramic procedures. Breakage was the reason for 1^st revision in 84 alumina (5.27% of all revisions and 0.36% of procedures) and 56 mixed ceramic procedures (2.46% of all revisions; 0.08% of procedures). Alumina had a higher breakage rate than mixed ceramic (HR 2.50 (95% CI 1.75, 3.59), P < .001), and breakage was higher for 36-38mm head sizes using alumina (HR 2.84 (1.52, 5.31), P = .001). 17.8% of 2^nd revisions occur by 3 years, due to dislocation, infection, metal-related pathology, and loosening. A neck adapter sleeve did not reduce 2^nd revisions. Numbers were too low to compare revision bearing surface options.ConclusionCeramic breakage has reduced with mixed ceramics but has a 0.79/1000 incidence at 15-year follow-up. It is unclear what the risk factors are for modern ceramics with increasing head size a risk for alumina only. Risk of 2^nd revision is high and occurs early. The optimal revision option is unknown.     

Long-Term Results of Alumina Ceramic-On-Ceramic Bearings in Cementless Total Hip Arthroplasty: A 20-Year Minimum Follow-Up

BackgroundAlumina ceramic-on-ceramic bearings are used in total hip arthroplasty (THA) because of their wear-resistant and inert properties. In this study, we assessed the clinical and radiographic outcomes of patients undergoing primary cementless ceramic-on-ceramic THA at a minimum follow-up of 20 years.MethodsA series of 301 consecutive primary THAs in 283 patients were assessed. Clinically, patients were assessed with the modified Harris Hip Score (HHS) and pain questionnaires. Anteroposterior radiographs of the pelvis and lateral radiographs of the hip were used to radiologically assess the implant. Patients were classified as lost to follow-up if they could not be contacted on multiple occasions or did not wish to participate further in this study.ResultsAt twenty years after operation, 60 patients had died of a cause unrelated to surgery, 16 had experienced complications requiring reoperation, and 100 hips had both clinical assessments and radiographs at a minimum of 20 years of follow-up. The average HHS improved from 56.1 (range: 17-89) before THA to 92.5 (range: 63-100) at the latest follow-up. The classification of the HHS was good or excellent in 96.4% of patients. Only 1.8% of patients still had moderate residual pain at the thigh or groin. Radiographically, all patients demonstrated bony ingrowth but no clinical symptoms of loosening. The overall survival rate of the implants was 94.2% at 20 years with revision for any reason as the end point.ConclusionLong-Term follow-up in our series showed excellent implant survival, excellent functional outcomes, and minimal late complications. There was no significant radiographic evidence of failure at a minimum of 20 years after THA.Level of evidenceTherapeutic Level IV.     

An Objective Examination for Painful Hip After Total Hip Arthroplasty

An objective method for evaluating the cause of pain in hip arthroplasty was investigated in patients with a radiolucent zone of less than 2 mm at the cement-bone interface or the cement-stem or socket interface. Eight patients with a McKee-Farrar total hip prosthesis followed up for an average of 102 months and 20 patients with a Charnley total hip prosthesis observed for an average of 43 months were studied. Different components of the implant materials, such as cement monomer, BaSO₄, ceramic, acrylic cement, stainless steel and high-density polyethylene, (HDP) were exposed to normal plasma. Contact activation of plasma was found to occur for all materials, except for HDP, yielding plasma kallikrein. The induced prekallikrein activation was markedly reduced in vitro by Trasylol. There was a significant increase in plasma kallikrein activity in the patients with discomfort and/or pain without gross loosening compared with the patients with pain-free hip arthroplasties. Furthermore, statistically significant enhancement of the kallikrein activity was observed in plasma from the femoral vein at the site of operation compared with that from the cubital vein of the same subject. The enhanced plasma kallikrein activity in the patients gradually decreased, as did the clinical symptoms, when Trasylol was administered. It is concluded that measurement of plasma kallikrein activity may produce useful information about the process of total hip arthroplasty and provide an objective evaluation of pain.     

Revision Total Hip Arthroplasty: The Femoral Component

The initial results with cemented femoral revision stems were disappointing, with high early loosening rates. The application of second-generation cementing techniques improved results markedly, with loosening rates of 10% at 10 years in a number of series. Bone quality and patient age also appear to be important factors in predicting the success with a cemented revision stem. The use of a long stem is not necessary to obtain these improved results. On the basis of early reports, a recently described technique in which a revision stem is cemented into impacted cancellous allograft appears promising. Results with proximally coated uncemented revision stems have been variable, with failure rates of 4% to 10% reported at only 2 to 4 years. Initial stability must be obtained if proximal coating is to be utilized. Extensively coated revision stems provide initial stability through an interference fit between the porous coating and the diaphysis. With this technique, 10-year survival rates of 90% have been achieved, and the clinical results appear to be equivalent to those obtained with cemented revision stems and modern cementing techniques. Diaphyseal fixation has also been achieved without porous coating, either with modular revision stems or with long, textured titanium stems. Isolated early reports with such stems have been promising, but 10-year results are not yet available.     

Revision Total Hip Arthroplasty: The Acetabular Component

Intermediate and long-term results of revision total hip arthroplasty performed with the use of a cemented acetabular component have been disappointing, with high rates of radiographic and clinical failure. Other methods of acetabular revision involving the use of threaded cups and bipolar implants have also met with high failure rates. Although the long-term results of revision arthroplasty with uncemented acetabular components, especially in terms of polyethylene wear and pelvic osteolysis, are not yet available, the intermediate results have been excellent.     

Outpatient Total Hip Arthroplasty

Patients younger than 65 years were studied to determine what percentage of patients would enroll in a study of outpatient total hip arthroplasty, its safety, and benefits of the program. Of 192 eligible patients, 69 (36%) enrolled, and 53 (77%) of these went home the same day of surgery. Of 53, 44 maintained a diary for the first 3, weeks and 52 completed a satisfaction questionnaire at 6 weeks. Patients were followed for 6 months for occurrence of complications. There were no medical readmissions. Of 52 patients who completed a 6 week questionnaire, 50 (96%) were satisfied with the decision to have outpatient total hip arthroplasty. There were no objective physical benefits identified. This study reports the distribution of acceptance and completion of same day discharge for patients with total hip arthroplasty in a metropolitan population. It confirms safety in selected patients.     

An Initial Experience with Hip Resurfacing Versus Cementless Total Hip Arthroplasty

Background

Hip resurfacing is an alternative to total hip arthroplasty.

Questions/Purpose

We aimed to compare an experienced hip surgeon’s initial clinical results of hip resurfacing with a new cementless total hip arthroplasty (THA).

Methods

The first 55 consecutive hip resurfacing arthroplasties were compared to 100 consecutive cementless THAs using a cylindrical tapered femoral stem. The learning curve between the two procedures was compared utilizing the incidence of reoperation, complications, Harris Hip Scores (HHS), and implant survivorship.

Results

The reoperation rate was significantly higher (p = 0.019) for hip resurfacing (14.5%) versus THA (4%). The overall complication rate between the two groups was not significantly different (p = 0.398). Preoperative HHS were similar between the two groups (p = 0.2). The final mean HHS was similar in both the resurfacing and THA groups (96 vs. 98.3, respectively, p < 0.65). Kaplan–Meier survival analysis with an endpoint of reoperation suggests complications occurred earlier in the resurfacing group versus the THA group (log-rank test, p = 0.007).

Conclusions

In comparison to our initial experience with a cementless THA stem, operative complications occur earlier and more often after hip resurfacing during the learning period. The clinical outcomes in both groups however are similar at 5 year follow-up.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9333-0) contains supplementary material, which is available to authorized users.     

Increase in Benign Squeaking Rate at Five-Year Follow-Up: Results of a Large Diameter Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty

Background

Squeaking is an on-going complication with a variable incidence of 0.5%-20.7%. The mechanism of squeaking has not been understood completely and is most likely multifactorial in nature. Previously, we have reported on a squeaking rate of 7.3% at 2 years. Our current results show a substantial increase in the squeaking incidence from 7.3% to 17.4% with the DeltaMotion articulation at the 5-year follow-up.

全髋关节置换术肢体不等长问题的探讨

目的　探讨全髋关节置换手术中引起肢体不等长的原因以及相应的防治对策。方法　采用术前X线片测量股骨头运动中心至小粗隆的距离及股骨颈截骨高度的方法指导术中对患肢长度的控制。结果　对 4 2例施行人工关节置换术 ,术前测量患肢短缩 - 8 2± 6 5mm ,术后为 - 4 2± 3 5mm ,其中术后肢体等长或长度差异在 5mm以内的为 31例 (73 8% ) ,结果令人满意。结论　全髋置换术后肢体长度的恢复对于提高手术成功率有着重要的意义 ,不能为追求关节的稳定而忽视肢体长度。采用术前X线片测量股骨头运动中心至小粗隆的距离及股骨颈截骨高度来指导术中控制患肢长度的方法较为切实可行。