Hueter Anterior Approach for Metal-on-Metal Hip Resurfacing Arthroplasty: 555 Cases at a Minimum Five-Year Follow-Up

BackgroundPurpose of this study was to determine implant survivorship and resultant outcomes, including modes of failure, for metal-on-metal hip resurfacing through the Hueter anterior approach (HAA).MethodsRetrospective review of cases from 2006 to 2015, resulted in 555 metal-on-metal hip resurfacing via HAA, mean age 49.4 ± 6.9 years and mean BMI 28.1 ± 5.3. Kaplan-Meier curves were used to assess implant survivorship. Evaluation of technique was based on radiographic assessment of component position at 6 weeks. Patient-reported outcome measures were assessed using 12-Item Short Form Survey 12, University of California Los Angeles activity, Western Ontario and McMaster Universities Osteoarthritis Index, and hip disability osteoarthritis outcome scores.ResultsAt a mean follow-up of 9.18 years, survivorship was 95.0% at 5 years (95% CI: 93.2-96.8 years) and 92.5% at 10 years (95% CI: 90.0-95.0 years); men at 96.1% (95% CI: 94.3-97.9) and 93.8% (95% CI: 91.1-96.5), and women at 88.8% (95% CI: 81.9-95.7) and 85.6% (95% CI: 77.6-93.6), 5 and 10 years, respectively (P = .033). There were 37 revisions to total hips (7%) at a mean time of 3.3 years (SD 2.7). Indications for revision were aseptic loosening of acetabular (n = 12) and femoral component (n = 7) and pseudotumor (n = 6). Radiographic parameters were respectable and consistent, median acetabular inclination angle 41.2° and femoral stem shaft angle 137.7°. Patient-reported outcome measure scores significantly improved and remained stable at 2 and 5 years postoperatively.ConclusionAlthough choice of surgical approach should always be based on surgeon’s technical expertise, this study has shown that HAA is safe and effective for hip resurfacing. Mindful attention to long-term metal ion exposure must still be considered.     

What are the Outcomes After Primary Total Hip and Knee Arthroplasty in Patients With Prior Cerebrovascular Accidents?

BackgroundFor patients who have a history of cerebrovascular accident (CVA) with neurological sequelae undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA), we sought to determine mortality rate, implant survivorship, complications, and clinical outcomes.MethodsOur total joint registry identified CVA sequelae patients undergoing primary THA (n = 42 with 25 on affected hip) and TKA (n = 56 with 34 on affected knee). Patients were 1:2 matched based upon age, sex, body mass index, and surgical year to a non-CVA cohort. Mortality and implant survivorship were evaluated via Kaplan-Meier methods. Clinical outcomes were assessed via Harris Hip scores or Knee Society scores . Mean follow-up was 5 years (range, 2-12).ResultsFor CVA sequelae and non-CVA patients, respectively, the 5-year patient survivorship was 69 versus 89% after THA (HR = 2.5; P = .006) and 56 versus 90% after TKA (HR = 2.4, P = .003). No significant difference was noted between groups in implant survivorship free from any reoperation after THA (P > .2) and TKA (P > .6). Postoperative CVA occurred at an equal rate in CVA sequelae and non-CVA patients after TKA (1.8%); none after THA in either group. The magnitude of change in Harris Hip scores (P = .7) and Knee Society scores (P = .7) were similar for CVA sequelae and non-CVA patients.ConclusionComplications, including the risk of postoperative CVA, implant survivorship, and outcome score improvement are similar for CVA sequelae and non-CVA patients. A 2.5-fold increased risk of death at a mean of 5 years after primary THA or TKA exist for CVA sequelae patients.     

Predictive Factors for Revision and Survivorship Analysis of a Prevalent 36-mm Metal-on-Metal Total Hip Replacement System: A Large Single-Center Retrospective Cohort Study

BackgroundTo our knowledge, this is the largest single-center cohort of the 36-mm Corail-Pinnacle metal-on-metal total hip replacements system, aiming to determine 10-year survivorship and identify predictors of revision. We further assessed year of implantation given reports of manufacturing variations affecting shells made after 2006 predisposing these components to increasing wear.MethodsAll Corail-Pinnacle 36-mm metal-on-metal hips implanted in a single center (2005-2012). The effect of patient and implant-related variables, and year of implantation on revision risk was assessed using Kaplan-Meier, Cox regression, and interrupted time series analysis.ResultsIn total, 1212 metal-on-metal total hip replacements were implanted with a 10-year survival rate of 83.4% (95% confidence interval [CI] = 81.3-85.5). Mean follow-up duration was 7.3 years with 61% of patients reaching a minimum of 7 years of follow-up. One hundred nineteen patients required revision surgery (9.8%). Univariate analysis identified female gender (hazard ratio [HR] = 1.608, CI = 1.093-2.364, P = .016), age at implantation (HR = 0.982, CI = 0.968-0.997, P = .019), smaller 50-mm to 54-mm cup diameter (HR = 1.527, CI = 1.026-2.274, P = .037), and high-offset stems (HR = 2.573, CI = 1.619-4.089, P < .001) as predictors of revision. Multivariate modeling confirmed female gender and high-offset stems as significant predictors of revision. For components implanted after 2007, the number of revisions showed no statistically significant step increase compared to pre-2007 implantation.ConclusionWe observed a high 10-year failure rate (16.6%) with this implant, mostly due to adverse reaction to metal debris. Female gender and high femoral offset stems were significant predictors for all-cause revision. Year of implantation was not significantly associated with an increasing number of revisions from 2007 onwards, although further studies to validate the impact of manufacturing discrepancies are recommended.     

Curved-stem Hip Resurfacing

Hip resurfacing is an attractive concept because it preserves rather than removes the femoral head and neck. Most early designs had high failure rates, but one unique design had a femoral stem. Because that particular device appeared to have better implant survival, this study assessed the clinical outcome and long-term survivorship of a hip resurfacing prosthesis. Four hundred forty-five patients (561 hips) were retrospectively reviewed after a minimum of 20 years' followup or until death; 23 additional patients were lost to followup. Patients received a metal femoral prosthesis with a small curved stem. Three types of acetabular reconstructions were used: (1) cemented polyurethane; (2) metal-on-metal; and (3) polyethylene secured with cement or used as the liner of a two-piece porous-coated implant. Long-term results were favorable with the metal-on-metal combination only. The mean overall Harris hip score was 92 at 2 years of followup. None of the 121 patients (133 hips) who received metal-on-metal articulation experienced failure. The failure rate with polyurethane was 100%, and the failure rate with cemented polyethylene was 41%. Hip resurfacing with a curved-stem femoral component had a durable clinical outcome when a metal-on-metal articulation was used.     

Combining Platelet-Rich Plasma Instillation With Core Decompression Improves Functional Outcome and Delays Progression in Early-Stage Avascular Necrosis of Femoral Head: a 4.5- to 6-Year Prospective Randomized Comparative Study

BackgroundAvascular necrosis of femoral head is a debilitating disease frequently progressing to femoral head collapse and joint destruction. The efficacy of core decompression (CD) remains controversial.MethodsAbout 40 consecutive age-matched and gender-matched patients (53 hips) were randomized into 2 groups by computer-generated algorithm table in a prospective randomized double-blinded comparative study. Group A (platelet-rich plasma [PRP] with CD) included 19 patients (25 hips), and group B (CD only) included 21 patients (28 hips). Postoperative Harris Hip Score and magnetic resonance imaging to quantify the necrotic area by using modified Kerboul angle were done and evaluated. Mean follow-up was 64.3 months (range, 54-72) and 63.7 months (range, 56-72) in groups A and B, respectively.ResultsThere was statistically significant difference between PRP and control groups in pain score (P = .00), functional score (P = .02), and Harris Hip Score (P = .00) at final follow-up. There was no progression in stage 1 disease. Stage 2 disease showed 24% progression in group A and 43% progression in group B. The difference was statistically significant (P = .025). Survivorship from femoral head collapse, any procedure, and total hip arthroplasty was 84%/68% (P = .00), 76%/57% (P = .02), and 92%/78% (P = .01) in 2 groups, which was statistically significant.ConclusionPRP use after CD provides significant pain relief, better midterm functional outcome, retards the progression, and enhances the survivorship free from reoperation for hip arthroplasty and femoral head collapse in early stages of avascular necrosis of hip than CD alone.     

Midterm Outcomes and Frequency of Osteolysis of Total Hip Arthroplasty Using Cementless Modular Stem for Asian Patients

BackgroundModular stems are useful for total hip arthroplasty (THA) in anatomically difficult dysplasia. Here, we present mean 6.8-year outcomes of cementless primary THA using S-ROM-A (modified modular stem for Asian patients) femoral prosthesis in anatomically difficult cases.MethodsCharts of 373 patients (461 hips) undergoing THA (mean age, 58 years) were reviewed for clinical evaluation of modified Merle d’Aubigné-Postel score and Kaplan-Meier survivorship with revision for any reason as the end point. For radiographic analysis, 331 patients (412 hips) followed up for ≥5 years were included. Bearing couples were metal-on-metal (n = 145), metal-on-polyethylene (n = 120), and ceramic-on-polyethylene (n = 147). Radiography and multiplanar computed tomography were performed.ResultsNo postoperative dislocation or deep infection occurred. Mean modified Merle d’Aubigné-Postel score improved significantly (10.9 points preoperatively, 16.7 points at last follow-up; P < .001). Cumulative 5- and 10-year stem survival rates were 100% and 84%, respectively (95% confidence interval, 75%-93%). All stems were classified as bone ingrown fixation. Osteolysis occurred in metal-on-metal (42.8%) and metal-on-polyethylene (15.8%) groups. Mean time to osteolysis was ~3 years, with no significant difference between 3 groups (P = .264). In logistic regression, lower cup inclination angle was significantly associated with osteolysis (odds ratio, 0.914; 95% confidence interval, 0.84-0.99; P = .029).ConclusionS-ROM-A femoral prosthesis achieved excellent midterm fixation, and the modular system was useful in primary THA with severe deformity. Bearing couples are potentially associated with adverse reactions to metal debris. S-ROM-A with ceramic-on-polyethylene bearing couples may be an option for anatomically difficult THA.     

Hip Resurfacing Arthroplasty for Ankylosing Spondylitis

We compared the results of the metal-on-metal hip resurfacing with the ceramic-on-ceramic total hip arthroplasty (THA) in 2 groups. The preoperative and postoperative ranges of motion (ROMs) were recorded. At the latest follow-up, both of the groups make satisfactory clinical and radiographic results. There was no significant difference in Harris hip score of the 2 groups, but the ROM of the hips in hip resurfacing group was significantly wider than THA group (P < .01). Hip resurfacing has better ROM improvement than THA, with the same pain relief. Its high stability and low dislocation rate allow patients to do early function exercises, which is important for ankylosing spondylitis (AS) patients to avoid reankylosis. Hip resurfacing may be a reasonable option for young AS population.     

Total Hip Arthroplasty in Patients With Osteogenesis Imperfecta

BackgroundOsteogenesis imperfecta (OI) comprises a spectrum of disorders that result in bone fragility. This presents unique challenges when performing total joint arthroplasty in patients with OI. The purpose of this study is to determine the survivorship and clinical outcomes of total hip arthroplasty (THA) in patients with OI.MethodsWe retrospectively reviewed our institution’s total joint registry from 1969 to 2018 for all primary THAs in patients with a history of OI. There were 11 patients (13 hips) with a mean follow-up of 13 years (range 6-20). Survivorship free of component revision was determined using Kaplan-Meier analysis. Patient-reported clinical outcomes were assessed using Harris Hip Scores.ResultsAt final follow-up, the status of the implant was known in all 13 hips. One patient (1 hip) was deceased. Four hips (31%) underwent revision surgery at a mean of 9 years (range 5-17). Survivorship free of component revision was 52% at 20 years. Mean Harris Hip Scores at final follow-up were fair (75, 47-97), but significantly improved compared to available preoperative scores (P = .0015). No intraoperative complications occurred during the 13 primary THAs.ConclusionTHA in patients with OI is associated with high revision rates and low survivorship at long-term follow-up. Although this is a very challenging patient population, THA provided these patients with improved functional outcomes. To the authors’ knowledge, this is the largest series of primary THA in patients with OI reported in the literature and therefore provides surgeons with important data regarding the expected outcomes following THA in this unique patient population.Level of EvidenceLevel IV.     

Mild Coronal Stem Malalignment Does Not Negatively Impact Survivorship or Clinical Results in Uncemented Primary Total Hip Arthroplasties With Dual-Tapered Implants

BackgroundProper component positioning in total hip arthroplasty (THA) is crucial for implant fixation and hip stability. The purpose of this study is to assess if neutral coronal stem alignment (0° ± 3°) improved long-term survivorship in uncemented femoral components.MethodsBetween 2005 and 2010, 1028 primary THAs were performed with 2 contemporary dual-tapered, proximally coated uncemented stem types. Alignment was measured immediately postoperatively and at most recent follow-up. In total, 978 femoral stems (95%) were within 0° ± 3° of the neutral anatomic coronal axis, and the 50 stems (5%) outside that range were considered outliers (3.1° of valgus to 4.8° of varus). Outcomes analyzed included implant survivorship, Harris Hip Scores, and incidence of dislocation. Mean follow-up was 5 years.ResultsSurvivorship free of aseptic femoral component loosening was 99.3% and 98.2% at 5 and 8 years in the neutral group vs 100% at 5 and 8 years in the outlier group (P = .98). Survivorship free of femoral component revision for any reason was 99.1% and 97.3% at 5 and 8 years vs 100% at 5 and 8 years, respectively (P = .80). Harris Hip Scores were similar (89 in both groups; P = .84) at most recent follow-up. The incidence of mild to moderate thigh pain was also similar in both groups (6.1% vs 6%, P = .85). The incidence of dislocation was 1.5% at 8 years, and similar between both groups (P = .77).ConclusionSlight malalignment of contemporary dual-tapered uncemented THA femoral components does not appear to negatively impact survivorship or clinical outcomes, which is in contrast to cemented femoral components.Level of evidence IIICase-control study.     

Eighteen-Year Follow-Up Study of 2 Alternative Bearing Surfaces Used in Total Hip Arthroplasty in the Same Young Patients

BackgroundThis study compares the long-term functional, radiographic, and computed tomography scan outcomes and implant survivorship of ceramic-on-ceramic total hip arthroplasty (C-O-C THA) and ceramic-on-highly cross-linked polyethylene total hip arthroplasty (C-O-HXLPE THA) in the same patients.MethodsIn this randomized, prospective trial conducted between January 1999 and April 2003, 133 patients (266 hips) younger than 55 years were enrolled. Each patient received C-O-C THA in 1 hip and a C-O-HXLPE THA in the other. The mean follow-up was 17.1 years (range, 15-18 years); there were 84 men and 49 women with a mean age of 53 ± 7 years (range, 25-55 years).ResultsAt the latest follow-up, mean Harris hip scores (94 vs 93 points; P = .861), pain scores (43 vs 42 points; P = .651), and patient satisfaction scores (7.8 vs 7.6 points; P = .379) were not different between the 2 groups. Eight hips (3%) in the C-O-C THA had an audible squeaking sound. The mean annual penetration rate of HXLPE was 0.0162 ± 0.032 mm per year. No osteolysis was recorded on radiographs or computed tomography scans in either group. At 17.1 years, the survival rate of the acetabular component was 97% in the C-O-C bearing group and 98% in the C-O-HXLPE bearing group (P = .923). The survival rate of the femoral component was 99% in both groups.ConclusionBoth C-O-C THA and C-O-HXLPE THA functioned well, with no osteolysis at mean of 17.1-year follow-up.     

Long-Term Results of Total Hip Arthroplasty in Young Patients With Osteonecrosis After Allogeneic Bone Marrow Transplantation for Hematological Disease: A Multicenter,Propensity-Matched Cohort Study With a Mean 11-Year Follow-Up

BackgroundThe number of young patients with hematological disease requiring total hip arthroplasty (THA) is expected to increase. We aimed to investigate the long-term THA outcomes in patients with osteonecrosis of the femoral head (ONFH) following allogeneic bone marrow transplantation (BMT) for hematological disease.MethodsAll patients who underwent THA for osteonecrosis after BMT from 1997 to 2012 were identified at 2 institutions. Using propensity scores, 75 THAs in 45 patients were matched for age, gender, body mass index, American Society of Anesthesiologists score, and year of surgery with 75 THAs in 58 patients with idiopathic ONFH without a history of hematological disease (1:1 ratio). The mean age at surgery was 36.7 years and 52% were men. Clinical and radiographic evaluations were performed and clinical scores were obtained at last follow-up. Kaplan-Meier analyses were used to compare survivorship.ResultsAt a mean follow-up of 10.6 ± 3.5 years, clinical, radiographic, and survivorship outcomes, and the Harris hip scores were similar between both groups. The 13-year survivorship for all-cause revision was 93.4% for the BMT group and 95% for the control group (P = .928). No significant differences were observed between groups in the rates of reoperation (4% vs 5.3%, P = 1.000), 90-day readmission (all 5.3%), or overall mortality (4.4% vs 1.7%, P = .681). No hips had periprosthetic joint infection or septic loosening in either group. Osteolysis occurred in none of the BMT patients and in 2 hips (2.7%) of the control patients (P = .497).ConclusionThis large cohort multicenter survey at 11-year follow-up shows that contemporary cementless THA in young hematological disease patients after allogeneic BMT is not associated with a higher risk for surgical complications, revision, reoperation, readmission, and mortality compared to a matched cohort of idiopathic ONFH.     

The ten-year survival of the Birmingham hip resurfacing: an independent series

Recent events have highlighted the importance of implant design for survival and wear-related complications following metal-on-metal hip resurfacing arthroplasty. The mid-term survival of the most widely used implant, the Birmingham Hip Resurfacing (BHR), has been described by its designers. The aim of this study was to report the ten-year survival and patient-reported functional outcome of the BHR from an independent centre. In this cohort of 554 patients (646 BHRs) with a mean age of 51.9 years (16.5 to 81.5) followed for a mean of eight years (1 to 12), the survival and patient-reported functional outcome depended on gender and the size of the implant. In female hips (n = 267) the ten-year survival was 74% (95% confidence interval (CI) 83 to 91), the ten-year revision rate for pseudotumour was 7%, the mean Oxford hip score (OHS) was 43 (SD 8) and the mean UCLA activity score was 6.4 (SD 2). In male hips (n = 379) the ten-year survival was 95% (95% CI 92.0 to 97.4), the ten-year revision rate for pseudotumour was 1.7%, the mean OHS was 45 (SD 6) and the mean UCLA score was 7.6 (SD 2). In the most demanding subgroup, comprising male patients aged < 50 years treated for primary osteoarthritis, the survival was 99% (95% CI 97 to 100). This study supports the ongoing use of resurfacing in young active men, who are a subgroup of patients who tend to have problems with conventional THR. In contrast, the results in women have been poor and we do not recommend metal-on-metal resurfacing in women. Continuous follow-up is recommended because of the increasing incidence of pseudotumour with the passage of time.     

Total Hip Arthroplasty in Patients With Osteopetrosis

BackgroundOsteopetrosis is an inherited bone disease associated with high risk of osteoarthritis and fracture non-union, which can lead to total hip arthroplasty (THA). Bone quality and morphology are altered in these patients, and there are limited data on results of THA in these patients. The goals of this study were to describe implant survivorship, clinical outcomes, radiographic results, and complications in patients with osteopetrosis undergoing primary THA.MethodsWe identified 7 patients (9 hips) with osteopetrosis who underwent primary THA between 1970 and 2017 utilizing our total joint registry. The mean age at index THA was 48 years and included two males and five females. The mean follow-up was 8 years.ResultsThe 10-year survivorship free from any revision or implant removal was 89%, with 1 revision and 1 resection arthroplasty secondary to periprosthetic femoral fractures. The 10-year survivorship free from any reoperation was 42%, with 4 additional reoperations (2 ORIFs for periprosthetic femoral fractures, 1 sciatic nerve palsy lysis of adhesions, 1 hematoma evacuation). Harris hip scores significantly increased at 5 years (P = .04). Five hips had an intraoperative acetabular fracture, and 1 had an intraoperative femur fracture. All postoperative femoral fractures occurred in patients with intramedullary diameter less than 5 mm at a level 10 cm distal to the lesser trochanter.ConclusionPrimary THA in patients with osteopetrosis is associated with good 10-year implant survivorship (89%), but a very high reoperation (58%) and periprosthetic femoral fracture rate (44%). Femoral fractures appear associated with smaller intramedullary diameters.     

A Large-Scale Fifteen-Year Minimum Survivorship of a Cementless Triple Tapered Femoral Stem

BackgroundThis study reports the long-term outcomes of a metaphyseal fit-and-fill cementless femoral component in total hip arthroplasty (THA) with a follow-up of 15-19 years.MethodsWe conducted a retrospective review of 376 consecutive THAs (345 patients), using a triple tapered stem performed between 2000 and 2003 with a view to assessing survivorship and radiological and functional outcomes. Images were assessed for initial alignment, terminal osteolysis, or subsidence, while clinical outcomes were assessed using the St Michael’s Hip Score.ResultsForty-five (11.9%) hips were lost to follow-up, 20 (5.31%) had died before our 15-year cutoff follow-up, and 4 (1.06%) had declined follow-up early on, leaving 307 hips (81.64%, 276 patients) available for both clinical and radiological follow-up at a minimum of 15 years (range 15-19). The mean age at the time of operation was 49.6 years (range 19-71) and the cohort included 131 (42.67%) male and 145 (47.23%) female patients. Seven stems (2.28%) were revised: 4 due to periprosthetic fractures, 2 for periprosthetic joint infection, and 1 for adverse reaction to metal debris at the trunnion. The St Michael’s Hip Score improved from 14.2 (range 9-23) preoperatively to 22.3 (range 13 to 25) at the last documented follow-up (P = .000). Kaplan-Meier survivorship with stem revision for any reason as the end point was 97.70%. Worst-case scenario Kaplan-Meier survivorship, where all lost to follow-up are considered as failures, was 85.3%. No stem was revised for aseptic loosening.ConclusionThis triple tapered stem in THA shows excellent survivorship beyond a minimum of 15 years.     

Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Patients With High Hip Dislocation Secondary to Childhood Septic Arthritis: A Matched Comparative Study With Crowe IV Developmental Dysplasia

BackgroundTotal hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) is performed to manage hips with high dislocations. We compared outcomes of THA with SSO in patients with high hip dislocation resulting from childhood septic arthritis and Crowe IV developmental dysplasia of the hip (DDH).MethodsWe reviewed 60 THAs with SSO performed between May 1996 and December 2013. Thirty-one cases were classified as sequelae of childhood infection and 29 as DDH. Twenty-five hips were selected for each group after the propensity score was matched with preoperative demographics and leg length discrepancy (LLD). Clinical scores, complication and reoperation rates, radiographic results, and survivorships were compared. The mean duration of follow-up was 12.3 (range 5-22) years.ResultsThe average correction in LLD was 2.5 cm for childhood infection and 3.6 cm for DDH (P = .002). The infection group received more transfusions (mean 3.3 vs 2.0 units, P = .002), required more time for union of osteotomy site (mean 6.8 vs 5.2 months, P = .042), and reported lower Harris Hip Score (mean 85.1 vs 91.3, P = .017). Reoperations were performed in 11 (44%) previously infected hips and 3 (12%) DDHs (P = .012). Kaplan-Meier survivorship with an endpoint of revision for any reason was lower in the infection group (83.6%) than in the DDH group (100%) at 10 years (log rank, P = .040).ConclusionTHA with SSO in high hip dislocation secondary to childhood septic arthritis demonstrated less favorable clinical outcomes with increased risks of complication, compared with those performed in Crowe IV DDH with similar degree of chronic dislocation.     

Fifteen-Year Results of Total Hip Arthroplasty With Cobalt-Chromium Femoral Heads on Highly Cross-Linked Polyethylene in Patients 50 Years and Less

BackgroundHighly cross-linked polyethylene (HXLPE) is the most commonly used bearing surface in total hip arthroplasty (THA) because of its superior wear properties, but long-term results in young patients are limited. Mid-term survivorship has been promising; however, polyethylene wear rates and need for revision surgeries remain a concern in this population. The purpose of our study is to investigate polyethylene wear rates, implant survivorship, wear-related revisions, and patient-reported outcomes in a young patient cohort at 15-year follow-up.MethodsWe performed a retrospective study of a prospective longitudinal cohort of 82 consecutive patients (89 hips) who underwent primary THA with an HXLPE acetabular liner and a cobalt-chromium femoral head. The mean age at the time of surgery for the cohort was 38.8 years (range 12-50). All patients received HXLPE liners with a cementless acetabular component coupled with a cobalt-chrome femoral head through a posterior approach with a cementless femoral component. All components were from a single manufacturer. We recorded University of California, Los Angeles Activity, and modified Harris Hip Scores. Wear calculations were made using the Martell Hip Analysis Suite (Version 8.0.4.3).ResultsAt average 15 years (range 13.1-18.5), there was a revision-free survivorship of 97.8% in our HXLPE group with no wear-related revisions. We observed a linear wear rate of 0.0185 mm/y (standard deviation 0.05) after accounting for a 1-year bedding-in period. The volumetric wear rate was found to be 12.80 mm³/y (standard deviation 22.69). These numbers are registered as clinically undetectable and are comparable to steady state wear rates in the same cohort of patients at earlier time points. We found no radiographic changes concerning osteolysis. We observed excellent patient-reported outcomes at this time point with improvements in modified Harris Hip Scores (35.3 [22.5], P < .0001) and University of California, Los Angeles Activity Scores (median 6.0, P < .0001).ConclusionAt 15-year follow-up, we demonstrated that HXLPE bearings in this young cohort had excellent wear properties, maintained superior clinical improvements, and underwent no wear-related revision operations. The HXLPE and cobalt-chrome bearing couple continues to be extremely effective 15 years after primary THA in patients less than 50 years.Level of EvidenceIV.     

Patient-Reported Outcomes and Perioperative Complications of Total Hip Arthroplasty Following Joint Preservation Surgery for Hip Dysplasia

BackgroundThere is growing recognition of the importance of patient-reported outcome measures and assessment of patient satisfaction in the evaluation of outcomes following surgical interventions. This study aimed to evaluate patient-reported outcomes and complication rates after total hip arthroplasty following joint preservation surgery for hip dysplasia.MethodsPatient-reported outcomes and complication rates of 85 hips with previous joint preservation surgery (salvage group) were compared with those of 1279 hips without joint preservation surgery (primary arthroplasty group). As a patient-reported outcome measure, the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire was used to evaluate the hip condition both preoperatively and 12 months postoperatively. Operative data and postoperative (within 12 months) complications were investigated.ResultsThe salvage group had a longer operative time (56.8 vs 44.9 minutes, P < .001) and a higher total complication rate (5.9% vs 1.1%, P < .001). Additionally, the salvage group exhibited a lower degree of improvement in the visual analog scale value for satisfaction (75.1 vs 83.1 mm, P = .011), the pain and movement category scores, and the total score of the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (14.2 vs 16.2, P = .031; 13.7 vs 16.0, P = .005; and 42.3 vs 47.9, P = .007, respectively) compared with the primary arthroplasty group.ConclusionThis study demonstrated a lower rate of improvement in patient satisfaction and worse self-reported outcomes in the salvage group. Furthermore, these patients had a longer operative time and a higher risk of operative complications.     

Adverse reaction to metal debris after Birmingham hip resurfacing arthroplasty

Background and purpose — Concern has emerged about local soft-tissue reactions after hip resurfacing arthroplasty (HRA). The Birmingham Hip Resurfacing (BHR) was the most commonly used HRA device at our institution. We assessed the prevalence and risk factors for adverse reaction to metal debris (ARMD) with this device.

Patients and methods — From 2003 to 2011, BHR was the most commonly used HRA device at our institution, with 249 implantations. We included 32 patients (24 of them men) who were operated with a BHR HRA during the period April 2004 to March 2007 (42 hips; 31 in men). The mean age of the patients was 59 (26–77) years. These patients underwent magnetic resonance imaging (MRI), serum metal ion measurements, the Oxford hip score questionnaire, and physical examination. The prevalence of ARMD was recorded, and risk factors for ARMD were assessed using logistic regression models. The mean follow-up time was 6.7 (2.4–8.8) years.

Results — 6 patients had a definite ARMD (involving 9 of the 42 hips). 8 other patients (8 hips) had a probable ARMD. Thus, there was definite or probable ARMD in 17 of the 42 hips. 4 of 42 hips were revised for ARMD. Gender, bilateral metal-on-metal hip replacement and head size were not factors associated with ARMD.

Interpretation — We found that HRA with the Birmingham Hip Resurfacing may be more dangerous than previously believed. We advise systematic follow-up of these patients using metal ion levels, MRI/ultrasound, and patient-reported outcome measures.     

Total Hip Arthroplasty With the Wagner Cone Femoral Stem in Patients With Crowe IV Developmental Dysplasia of the Hip: A Retrospective Study

BackgroundThe aim of this study is to assess treatment of Crowe type IV hip dysplasia with the Wagner cone femoral stem combined with transverse subtrochanteric shortening osteotomy and augmenting the osteotomy site using the intercalary segment as a strut autograft.MethodsOne hundred twenty-seven hips of 91 patients diagnosed with Crowe type IV hip dysplasia and treated with total hip arthroplasty using the Wagner cone stem combined with transverse subtrochanteric shortening osteotomy were retrospectively evaluated by clinical and radiographic outcomes as well as complications.ResultsThe mean follow-up was 8.4 years. The Harris Hip Score and the Western Ontario and McMaster University Osteoarthritis Index scores were significantly improved postoperatively (P = .000). Intraoperative femoral cracks were observed in 70 hips (55.1%) and all femurs healed smoothly. Femoral cracks did not have a significant effect on clinical outcomes, except for heterotopic ossifications (P = .032). The probability of 10-year survivorship of the components free of revision for any reasons as end point was 94.5%; when only the femoral components were considered the survivorship was of 96.9%.ConclusionTransverse subtrochanteric shortening and augmenting the osteotomy site using the intercalary segment of bone resected from the shortened femur with the Wagner cone stem is an effective and reliable technique in the management of total hip arthroplasty in Crowe type IV hip dysplasia. Stable and firm placing of the femoral component which leads to an increased frequency of intraoperative femoral cracks does not have an unfavorable effect on clinical and radiological outcomes.     

The Fate and Relevance of the Patella in Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

BackgroundIt remains unclear whether reimplantation of a patellar component during a two-stage revision for periprosthetic total knee arthroplasty infection (PJI) affects patient reported outcome measures (PROMs) or implant survivorship. The purpose of this study was to evaluate whether patellar resurfacing during reimplantation confers a functional benefit or increases implant survivorship after two-stage treatment for PJI.MethodsTwo-stage revisions for knee PJI performed by three surgeons at a single tertiary care center were reviewed retrospectively. All original patellar components and cement were removed during resection and the patella was resurfaced whenever feasible during reimplantation. PROMs, implant survivorship, and radiographic measurements (patellar tilt and displacement) were compared between knees reimplanted with a patellar component versus those without a patellar component.ResultsA total of 103 patients met the inclusion criteria. Forty-three patients (41.7%) underwent reimplantation with, and 60 patients (58.3%) without a patellar component. At a mean follow-up of 33.5 months, there were no significant differences in patient demographics or PROMs between groups (P ≥ .156). No significant differences were found in the estimated Kaplan-Meier all-cause, aseptic, or septic survivorship between groups (P ≥ .342) at a maximum of 75 months follow-up. There was no significant difference in the change (pre-resection to post-reimplant) of patellar tilt (P = .504) or displacement (P = .097) between the groups.ConclusionPatellar resurfacing during knee reimplantation does not appear to meaningfully impact postoperative PROMs or survivorship. Given the risk of potential extensor mechanism complications with patellar resurfacing, surgeons may choose to leave the patella without an implant during total knee reimplantation and expect similar clinical outcomes.Level of EvidenceLevel III.