The Harris-Galante cementless THA: a 19- to 25-year follow-up study

The goal of this study was to evaluate the long-term survivorship of primary cementless total hip arthroplasty (THA) using Harris-Galante porous I acetabular and Harris-Galante porous femoral components. From July 1985 to December 1991, we performed primary cementless THA on 76 hips (70 patients). Twenty-nine patients (31 hips) died due to causes unrelated to the THA, and 6 patients (7 hips) were lost to follow-up. Of 76 hips (70 patients) studied, 38 hips (35 patients) were available for follow-up at a mean 22.5 years (range, 19-25 years) postoperatively. Mean patient age at index procedure was 51.2 years (range, 42-65 years). Average Harris Hip Score was 40.5 points preoperatively and 85.8 points at final follow-up. No patient had an early or late postoperative deep infection. Radiographically, the acetabular component fixation was stable in all 38 hips. The femoral component was bone-ingrown in 26 hips, stable-fibrous in 10, and unstable in 2. One unstable hip required revision of the femoral component. Dissociation of the polyethylene liner occurred in 3 hips without fractures of the metal locking tines and required revision of the polyethylene liner and the articular head. A total of 4 hips had documented revision, and 1 femoral component failed radiographically. The survival rate with the endpoint defined as revision surgery and radiographic loosening was 86.8% at 22.5 years of follow-up. Mean polyethylene wear was 0.085 mm/year (range, 0.031-0.15 mm). This study found that the Harris-Galante porous I acetabular and Harris-Galante porous femoral components produce excellent long-term results.     

The Harris-Galante Porous acetabular component at intermediate follow-up

Outcome of the acetabular component in 90 consecutive primary noncemented total hip arthroplasties (THAs) was prospectively studied. The acetabular cup consisted of a hemispherical titanium alloy shell with a titanium fiber-mesh porous coating and a modular polyethylene liner (Harris-Galante Porous-1, Zimmer, Warsaw, Ind). The cup was implanted using line-to-line reaming with adjunctive dome screw fixation. The femoral component consisted of a titanium alloy stem with titanium fiber-mesh porous coating and a 28-mm cobalt-chrome modular head. Mean patient age was 53 years (range: 27-75 years); male:female ratio was 48:42; and mean follow-up was 6 years (range: 4.5-8 years). One acetabular component was revised for aseptic loosening. Of 81 unrevised hips available for follow-up, mean Harris hip score was 57 preoperatively and 96 at final follow-up (72% excellent, 15% good, 1 3% fair, and none poor). Of 61 unrevised hips with adequate radiographic follow-up, radiographic failure (complete periprosthetic radiolucency) was evident in 3 (4.9%) and periacetabular osteolysis in none. Radiographic failure did not correlate with poor clinical outcome. Linear polyethylene wear rate (mean: 0.13 mm/year) did not correlate with age, gender, weight, outcome, or cup abduction angle, but did correlate with the presence of femoral periprosthetic osteolysis (0.18 mm/year with femoral osteolysis versus 0.11 mm/year without; P= .01). This series of porous-coated hemispherical cups demonstrated excellent intermediate-term clinical and radiographic outcome, comparable with similarly favorable results reported by the prosthesis designers. A potentially adverse effect of polyethylene wear on the longevity of a THA was supported by a positive correlation between polyethylene wear rate and femoral osteolysis.     

The relationship between increased hip range of motion, wear, and locking mechanism failure in the Harris-Galante acetabular component

We performed both clinical and radiographic evaluations of 178 patients (190 hips) who had undergone cementless total hip arthroplasties using Harris-Galante I/II porous cups after an average 12-year follow-up period (range, 8-18 years). We revised 15 Harris-Galante I/II porous cups (7.8%), and the locking mechanism was broken in 10 revised cups (67%). There was a significant association between locking mechanism failure and linear polyethylene wear. We observed a significant positive correlation between linear polyethylene wear and increased ranges of motion such as flexion, adduction, and external rotation at the last follow-up visit after the primary operation. Increased ranges of motion seen in Asians induced higher linear polyethylene wear and locking mechanism failure due to impingement of the neck and cup.     

Poor outcome of the PCA and Harris-Galante hip prostheses. Randomized study of 171 arthroplasties with 9-year follow-up.

155 patients (171 hips) with a mean age of 50 years (24-64) were randomized to uncemented PCA (84 hips) or Harris-Galante type I (87 hips) total hip arthroplasty. Clinical and radiographic evaluations were done regularly. The improvements in the Harris hip and pain scores did not differ. Osteolysis developed in 5 PCA and 17 Harris-Galante hips. 13 hips in the PCA and 16 in the Harris-Galante (HG) group were revised because of mechanical failures and 1 hip (HG) because of infection after a mean follow-up of 9 years. Decreased 10-year survival rate, based on revision as end-point, was noted for the PCA (85%), compared with the Harris-Galante cup (99%). The corresponding survival rate of the PCA stem (96%) was higher than that observed for the Harris-Galante design (86%). When radiographic failures were included, the survival rates of the 4 different components dropped to between 73% and 94%. These findings indicate that further revisions will be necessary and continuous radiographic follow-up is indicated to enable revision before severe bone destruction has occurred. Although the PCA and the Harris-Galante designs differed as regards the survival of the individual components, the overall clinical and radiographic survival rates of these cementless total hip arthroplasties were poor.     

Polyethylene liner failure in second-generation Harris-Galante acetabular components

Polyethylene liner failure of cementless acetabular components has been reported to be the most common complication of current modular cups. We performed a retrospective review of 128 consecutive primary total hip arthroplasties in 111 patients who had a second-generation Harris-Galante cup (Harris-Galante II, Zimmer, Warsaw, Ind). The mean length of the follow-up period was 8.0 years (range 5-12.9 years), with 26 cups (20.2%) having undergone revision by that time. Twenty-two hips (17.3%) had failure of the polyethylene liner. We found that polyethylene liner failure remains the main cause of revision of this modular cup. The main difference between our population of patients and other populations that have used this cup and liner is our population's cultural inclination toward squatting and leg crossing, body positions that increased the risk of impingement and eccentric wear.     

Second-generation cementless total hip arthroplasty. Eight to eleven-year results.

BACKGROUND: Second-generation cementless femoral components were designed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces. We examined the eight to eleven-year results of total hip arthroplasty with a cementless, anatomically designed femoral component and a cementless hemispheric acetabular component. METHODS: Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating (Anatomic Hip) and a cementless hemispheric porous-coated acetabular component (Harris-Galante II) were performed in eighty-five patients. These patients were prospectively followed clinically and radiographically. Six patients (seven hips) died and five patients (seven hips) were lost to follow-up, leaving seventy-four patients (seventy-eight hips) who had been followed for a mean of ten years (range, eight to eleven years). The mean age at the time of the arthroplasty was fifty-two years. RESULTS: The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up; 86% of the hips had a good or excellent result. Thigh pain was reported as mild to severe after seven hip arthroplasties. No femoral component was revised for any reason, and none were loose radiographically at the time of the last follow-up. Two hips underwent acetabular revision (one because of dislocation and one because of loosening). Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point. The ten-year survival rate was 96.4% +/- 2.1% for the total hip prosthesis, 100% for the femoral component, and 96.4% +/- 2.1% for the acetabular component. Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight (93%) of the -seventy-three hips with complete radiographic follow-up. Femoral osteolysis proximal to the lesser trochanter was noted in four hips (5%). No osteolysis was identified distal to the lesser trochanter. Periacetabular osteolysis was identified in twelve hips (16%). Five patients underwent exchange of the acetabular liner because of polyethylene wear. CONCLUSIONS: This second-generation cementless, anatomically designed femoral component provided excellent clinical and radiographic results with a 100% survival rate at ten years. The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty.     

Clinical and radiographic evaluation of the Harris-Galante cup: incidence of wear and osteolysis at 7 to 9 years follow-up

A retrospective evaluation of the clinical and radiographic results of the Harris-Galante acetabular cups was performed in 112 patients with 127 total hip arthroplasties. Patients with 14 hips had died, and patients with 20 hips were lost to follow-up. A total of 82 patients with 93 hips was available for follow-up. There were 67 men and 45 women. The mean follow-up was 87 months (range, 48-113 months). There were a total of 9 revisions: 2 for recurrent dislocations, 1 for a loose cup, and 6 for wear and osteolysis. Radiographic evaluation demonstrated that 22 (24%) hips had periacetabular osteolysis, and 16 of these 22 (73%) were associated with the screws. Twenty-two hips (23%) demonstrated osteolytic lesions around the femoral stem. Mean femoral head displacement was of 1.00 mm (range, 0.40-4.5 mm) with a rate of 0.16 mm/yr (range, 0.05-0.44 mm/yr). The Harris-Galante socket has maintained a low implant failure rate at intermediate term, even in these young patients. As follow-up increases, wear of the polyethylene and periprosthetic osteolysis may become growing concerns.     

Poor outcome of the PCA and Harris-Galante hip prostheses: Randomized study of 171 arthroplasties with 9-year follow-up

155 patients (171 hips) with a mean age of 50 years (24-64) were randomized to uncemented PCA (84 hips) or Harris-Galante type I (87 hips) total hip arthroplasty. Clinical and radiographic evaluations were done regularly. The improvements in the Harris hip and pain scores did not differ. Osteolysis developed in 5 PCA and 17 Harris-Galante hips. 13 hips in the PCA and 16 in the Harris-Galante (HG) group were revised because of mechanical failures and 1 hip (HG) because of infection after a mean follow-up of 9 years. Decreased 10-year survival rate, based on revision as end-point, was noted for the PCA (85%), compared with the Harris-Galante cup (99%). The corresponding survival rate of the PCA stem (96%) was higher than that observed for the Harris-Galante design (86%). When radiographic failures were included, the survival rates of the 4 different components dropped to between 73% and 94%. These findings indicate that further revisions will be necessary and continuous radiographic follow-up is indicated to enable revision before severe bone destruction has occurred. Although the PCA and the Harris-Galante designs differed as regards the survival of the individual components, the overall clinical and radiographic survival rates of these cement-less total hip arthroplasties were poor.     

Cementless Total Hip Arthroplasty in Patients with Osteonecrosis After Kidney Transplantation

This study was to determine the mid- to long-term survivorship of cementless metal-on-metal THA in 52 patients (74 hips) who underwent THA for osteonecrosis of the femoral head with a cementless THA. The mean follow-up was 10.2 years. The mean age at operation was 42.1 years (range, 25–62 years). The survivorship analysis with revision as the end point estimated a 96.6% chance of THA survival during 16.4 years. The average Harris hip score at last follow-up was 89.2 points (range, 74–100). Two patients (two hips) required revision surgery for extensive acetabular osteolysis at 9 years and acetabular liner dissociation at 2 years. The survival rates of cementless THA in these patients are encouraging. However, the possibility of metallic wear related complications are raising concern.     

Long-term results of cementless anatomic total hip replacement in dysplastic hips

This perspective study analyzes the long-term outcomes of cementless anatomic total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Between 1990 and 2004, 100 ABG total hip prosthesis were implanted in 87 patients with DDH. The average follow-up was 9 years (range 4–18 years). The mean Harris Hip Score was 87.13 (SD = 14.6) at the last follow-up. Radiographic analysis showed good results for the stems, while in 38% of the hips we recorded periacetabular bone resorption. Mean linear polyethylene wear was 0.23 mm/year. Ten revisions have been performed, survival rate was 99% for the stems and 90% for the cups. Cementless THA with hemispherical cup and anatomical stem is recommended when possible for patients with DDH although high rates of polyethylene wear and subsequent osteolysis have been the limiting factor in the long-term success of this implant.     

Uncemented Harris-Galante total hip arthroplasty in patients with osteonecrosis of the femoral head. A 10-16-year follow-up study

Background There have only been a few reports regarding the long-term results of uncemented THAs in patients with osteonecrosis.

Patients and methods We evaluated the long-term results of 65 consecutive uncemented total hip arthroplasties (Harris-Galante type I prostheses) in 54 men (59 hips) and 5 women (6 hips) with osteonecrosis of the femoral head. The mean age was 53 (33-64) years. The mean duration of follow-up was 12.5 (10-16) years.

Results 9 femoral stems and 3 acetabular metal shells were revised. 2 polyethylene liners were changed due to excessive wear. A girdlestone procedure was done in 2 patients (2 hips) due to delayed deep infection. The mean polyethylene wear was 0.14 mm per year. 3 non-revised hips had pelvic osteolysis and 18 had femoral osteolysis. The 15-year survival rates, using failure defined as the removal of any component for any reason, were 85 (95% CI; 79-91)% for the acetabular and 80 (74-86)% for the femoral component and 70 (63-77)% for any of the components.

Intepretation The first generation of the HGP design was frequently associated with pain, unstable fixation, and osteolysis. Excessive wear was frequent. The cup showed better durability than the stem.     

A prospective study of 100 consecutive Harris-Galante porous total hip arthroplasties. 2-5-year results.

This is a prospective study of the authors' first 100 Harris-Galante porous total hip arthroplasties (THA) that were followed for 2-5 years. The mean age of the 83 patients was 43 years. Using the Harris hip rating system, 80% of the hips were rated as excellent, 13% as good, 5% as fair, and 2% as poor at final evaluation. Eighty percent of the hips had no pain, 11% had slight or occasional pain, 8% had activity-related pain, and 1% had moderate pain. Eighty-seven percent of the hips had no limp, 8% had a slight limp, and 5% had a moderate limp. One femoral component, placed as a conversion of a loose bipolar hemiarthroplasty, has been removed for loosening. Two other hips have been reoperated, one for lengthening the femoral neck and one for changing the acetabular liner. There were no problems with acetabular screw fixation and no component migrated. Only two hips had 1 mm nonprogressive radiolucent lines in all three zones. Femoral component subsidence of 3 or more mm was measured in 16 hips, but was progressive in only 1. Radiolucent and radiodense lines were frequently seen in the nonporous coated regions of the femoral stem. Loss of proximal medial femoral bone density was seen in 59% of hips, and calcar resorption was seen in 16% of hips. Although the clinical results of this uncemented implant system were good or excellent in 93% of hips, the high incidence of femoral component subsidence is worrisome.     

Three-dimensional polyethylene wear of a press-fit titanium prosthesis: Factors influencing generation of polyethylene debris

Between 1985 and 1990, 108 consecutive Harris-Galante I (Zimmer, Warsaw, IN) total hip arthroplasties were performed by four surgeons at a single hospital. At the time of follow-up evaluation, 80 hips were available for review. The mean rate of linear wear was 0.15 mm/y, mean rate of three-dimensional femoral head displacement was 0.21 mm/y, and mean rate of volumetric wear was 121 mm³/y. Eight hips (10%) in this series had radiologic osteolysis around either the femoral or acetabular component. A significantly greater volumetric wear rate was found in patients who were younger, those with a higher activity level, those who received a 32-mm-diameter femoral head, and those with vertical orientation of their acetabular component. No relationship could be made with patient weight, gender, Harris hip score, or cup diameter.     

Cementless acetabular revision for aseptic failure of cemented hip arthroplasty

This study is a 5- to 11-year retrospective followup of 40 hips in 33 patients with cementless acetabular revision for aseptic failure of a cemented total hip arthroplasty. A porous coated, Harris-Galante acetabular component was used in all revisions. Thirty-eight of the 40 hips received acetabular bone grafting at revision. The mean Harris Hip Score improved from 51 points just before the index cementless revision to 87 points at the most recent followup. Twenty-nine of 40 (73%) hips were classified as having a good or excellent result. Radiolucencies were observed in seven of the 40 (18%) hips at the most recent followup, but none of these radiolucencies were complete or progressive. Five of the 40 (13%) hips were rated as failures and required repeat revision. Two (5%) of these failures were caused by aseptic loosening, with both hips having severe acetabular bone damage at the time of the index revision. This failure rate for aseptic loosening was less than that reported for cemented acetabular revision, thereby confirming the efficacy of cementless acetabular components in revision hip surgery in the intermediate term.     

A 10- to 13-year follow-up study of Harris-Galante type prosthesis in total hip arthroplasty

Long-term clinical results of Harris-Galante type prosthesis in total hip arthroplasty (THA) were evaluated in 27 hip joints of 25 patients (2 men and 23 women). Seventeen joints also received bone grafting on the acetabulum. Mean follow-up period was 11 years and 3 months. Clinical out-come was evaluated using the hip score of the Japanese Orthopaedic Association, and the score was good and stable during the monitoring period. Implant stability, bone changes around the implant, and the occupancy rate of the stem in the medullary space were radiologically examined. As a result of stem, there was subsidence in 3 joints and loosening in 6. There were no cases of cup loosening. A pedestal was found in 12 joints, and 4 of them which were associated with a radiopaque line had stem loosening. Among the 21 joints without loosening, 8 had a pedestal but they were not associated with a radiopaque line. The 2 joints which developed osteolysis did not have loosening. Stem loosening was related to the stem occupancy rate in the distal part of the medullary cavity. Postoperative stem occupancy rate could be an important indicator for long-term clinical results. Stems for cementless THA should be designed to have a high occupancy rate in the distal part, and stems should also be carefully chosen to meet individual differences. Received: February 24, 2000 / Accepted: July 21, 2000     

Long-term results with the Harris-Galante press-fit-cup

AIM: The present work aims at evaluating the clinical and radiological long-term results of the Harris-Galante press-fit cup. METHOD: At an average follow-up time of 9.5 years (min. 9, max. 10.3) 123 patients with 138 Harris-Galante press-fit cups (HGP) were examined clinically and radiology. The clinical evaluation was done with the Harris hip score. Together with the HGP, which was inserted in all cases, five different femoral stems were implanted. A lateral approach, according to the technique of Watson-Jones, was used in all cases. RESULTS: The mean follow-up Harris hip score was 89 of 100 points and is assessed as a good result. 7 cups (5%) were classed as being radiological loose, but only one case had also clinical symptoms. A total of 10 cups (6.8%) had to be revised. 3 cups (2 %) had to be revised because of aseptic loosening. This result represents a survival rate of 93.2% according to Kaplan-Meier. CONCLUSION: The long-term clinical and radiological results of the Harris-Galante press-fit cup and there fixation method can assessed as good.     

Polyethylene liner dissociation with the Harris-Galante II acetabular component

Dissociation of the polyethylene liner from its metal shell has been reported as a rare occurrence. During a 4-year period, six hips in five patients who had the Harris-Galante II porous acetabular component implanted as part of a primary or revision total hip arthroplasty presented with acute onset of pain and difficulty ambulating more than 2 years after surgery (range, 27-103 months). Radiographic evaluation revealed an eccentrically placed femoral head within the acetabular component. In patients whose acetabular shells were well-fixed, a polyethylene liner was cemented into the acetabular shell (four hips in three patients), and in one patient (one hip), the acetabular component was revised because of fracture of the metal shell. One patient who had a radiographically well-fixed component refused surgery (one hip). During a 4-year period, from 1990 to 1994, this implant was used resulting in a 2.6% incidence of dissociation. This case series is the largest of this complication for one prosthetic design.     

The use of cementless expansion acetabular component and an alumina-polyethylene bearing in total hip arthroplasty for osteonecrosis

We performed 114 consecutive primary total hip arthroplasties with a cementless expansion acetabular component in 101 patients for advanced osteonecrosis of the femoral head. The mean age of the patients at surgery was 51 years (36 to 62) and the mean length of follow-up was 110 months (84 to 129). The mean pre-operative Harris hip score of 47 points improved to 93 points at final follow-up. The polyethylene liner was exchanged in two hips during this period and one broken acetabular component was revised. The mean linear wear rate of polyethylene was 0.07 mm/year and peri-acetabular osteolysis was seen in two hips (1.9%). Kaplan-Meier analysis indicated that the survival of the acetabular component without revision was 97.8% (95% confidence interval 0.956 to 1.000) at ten years. Our study has shown that the results of THA with a cementless expansion acetabular component and an alumina-polyethylene bearing surface are good.     

Cementless total hip arthroplasty in patients with severely dysplastic hips and a previous Schanz osteotomy of the femur: Techniques, pitfalls, and long-term outcome

Background and purpose Historically, a Schanz osteotomy of the femur has been used to reduce limp in patients with severely dysplastic hips. In such hips, total hip arthroplasty is a technically demanding operation. We report the long-term results of cementless total hip arthroplasty in a group of patients who had all undergone a Schanz osteotomy earlier.Patients and methods From 1988 through 1995, 68 total hip replacements were performed in 59 consecutive patients previously treated with a Schanz osteotomy. With the cup placed at the level of the true acetabulum, a shortening osteotomy of the proximal part of the femur and distal advancement of the greater trochanter were performed in 56 hips. At a mean of 13 (9–18) years postoperatively, we evaluated these patients clinically and radiographically.Results The mean Harris hip score had increased from 51 points preoperatively to 93 points. Trendelenburg sign was negative and there was good or slightly reduced abduction strength in 23 of 25 hips that had not been revised. There were 12 perioperative complications. Only 1 cementless press-fit porous-coated cup was revised for aseptic loosening. However, the 12-year survival rate of these cups was only 64%, as 18 cups underwent revision for excessive wear of the polyethylene liner and/or osteolysis. 6 CDH femoral components had to be revised due to technical errors.Interpretation Our results suggest that cementless total hip arthroplasty combined with a shortening osteotomy of the femur and distal advancement of the greater trochanter can be recommended for most patients with a previous Schanz osteotomy of the femur. Because of the high incidence of liner wear and osteolysÍs of modular cementless cups in this series, nowadays we use hard-on-hard articulations in these patients.     

Minimum 30-Year Results of Bilaterally Implanted Cemented and Cementless Total Hip Arthroplasty in Patients Younger Than 50 Years

BackgroundThe rate of failure of cemented and cementless total hip arthroplasty (THA) in younger patients is higher than that in elderly patients. The purpose of this study is to document the long-term clinical results of THA with the so-called third-generation cementing and the results of second-generation cementless THA in patients <50 years of age.MethodsThis study included 106 patients who had had bilateral THA with a cemented stem in one hip and a cementless stem in the other. There were 78 men and 28 women. Their mean age was 47 years (range, 21-49). The average follow-up duration was 31 years (range, 30-32.5).ResultsThere were similar mean Harris Hip Scores (90 versus 91 points) between the groups at the final follow-up. Forty-six acetabular components (43%) in the cemented group and 48 acetabular components (45%) in the cementless group were revised. Five femoral components (5%) in the cemented group and 4 femoral components (4%) in the cementless group were revised. Survivorship of the acetabular component at 30.8 years was similar in both groups (57% in the cemented group versus 55% in the cementless group). Survivorship of the femoral component at 30.8 years was also similar in both groups (95% in the cemented group versus 96% in the cementless group).ConclusionLong-term fixation of the cemented or cementless femoral stem was outstanding. There was a high rate of the acetabular component revision due to conventional polyethylene wear and periacetabular osteolysis in both hybrid and fully cementless THA groups.