混合型初次全髋关节置换术中骨水泥柄10年以上的随访研究

目的回顾性分析混合型初次全髋关节置换术（THA）中骨水泥柄的临床和影像学疗效及其相关影响因素。方法对1999年1月至2001年12月期间接受混合型初次THA治疗髋部疾病的患者126例（135髋）进行至少10年的随访。观察Harris评分、股骨假体位置、骨水泥壳及其周围骨质变化。假体生存率采用Kaplan-Meier方法进行分析,以无菌性松动导致翻修及单纯骨溶解病灶清除植骨术为随访终点。结果共有79例（85髋）获得10年以上随访。Harris评分由术前（44.5±18.8）分提高至末次随访时（92.1±5.6）分。截至随访终点,在Gruen 1区观察到2髋发生骨溶解,7区4髋发生骨溶解现象。共有4例（4髋）接受翻修手术,其中1例男性患者因骨溶解致髋臼假体松动,同侧股骨近端骨溶解,同期行右髋臼侧翻修及股骨侧骨溶解病灶清除植骨术。另3例因髋臼假体松动行髋臼侧翻修术,影像学及术中见股骨假体稳定。以无菌性松动为随访终点,股骨假体生存率为100%;以无菌性松动翻修、单纯骨溶解病灶清除植骨术为随访终点,股骨假体生存率为98.8%（95%可信区间,12.23~12.32）。结论混合型初次THA术中骨水泥假体的远期生存率令人满意;采用第3代骨水泥技术固定的股骨柄取得与现代非骨水泥假体柄相近的远期生存率。     

非骨水泥假体髋关节翻修术随访报告

[目的]探讨非骨水泥假体在髋关节翻修术中的临床效果.[方法]对本科1997年11月～2007年8月行非骨水泥人工全髋关节翻修术36例(41髋)患者进行了随访,其中29髋行全髋关节翻修,8髋仅翻修髋臼,4髋仅更换股骨柄.随访X线片上的假体变化情况,分析AAOS、Paprosky骨缺损分类对翻修时假体选择的指导作用,对髋关节行Harris功能评定并分析假体生存率.[结果]24例28髋获得随访,平均随访4.6年(1～11年),患者平均Harris评分由术前的38分(11～76分)增加到末次随访时的88分(60～99分).21髋(75%)假体获得良好稳定性;1髋股骨1区形成2 mm宽的透亮线,临床检查无松动迹象;4髋发生骨溶解并假体移位(股骨1髋,髋臼3髋)而需要再翻修,失败率为12.5 %;8髋发生异位骨化;聚乙烯衬垫年平均磨损量为0.08 mm(0～0.25 mm),磨损率仅与外展角变化存在相关.AAOS分类术前、术中的一致性较Parprosky分类高.分别以任何原因进行了再翻修和影像学证明假体松动作为失败标准,利用Kaplan-Meier生存分析计算假体4.6年存活率分别为89%、81%.[结论]非骨水泥型假体可用于初次髋关节置换术失败的翻修.术中对骨缺损进行细致的评估并选择合适的假体固定,能达到令人较满意的临床效果.     

Zweymüller非骨水泥型全髋关节置换术后5～11年随访研究

目的 评估Zweymüller非骨水泥型全髋关节置换术后5～11年疗效.方法 对1996至2002年由同一术者完成且应用Zweymüller假体的初次全髋关节置换术患者进行随访,包括临床评估和放射学评估.结果 共116例142髋符合纳入标准,61例77髋获得随访,随访时间为5～11年,平均7.3年.其中50例64髋同时获临床及放射学评估,5例6髋只获得临床评估,6例7髋只获得放射学评估,随访率为52.6%.Harris评分由术前平均46分提高至末次随访时平均93分,51髋(72.9%)术后疼痛在1个月内缓解,术后扶拐行走时间平均为2个月.X线片随访见远端骨皮质肥厚30髋(42.3%),髓内骨化33髋(46.5%),异位骨化45髋(63.4%).无一例髋臼侧出现透亮带,27髋(38.0%)股骨侧可见透亮带.7髋(9.9%)髋臼侧出现骨溶解,18髋(25.4%)股骨侧出现骨溶解.虽然无已行翻修病例,但3髋因髋臼明显松动移位需行翻修术.以翻修手术或需行翻修手术作为失败的标准,髋臼杯5～11年假体存活率为95.8%,股骨柄的存活率为100%.结论 Zweymüller假体术后5～11年随访总体疗效令人满意,但骨溶解发生率高.     

股骨皮质骨开窗技术在髋关节翻修术中的应用

目的 探讨股骨前外侧皮质骨开窗技术在髋关节翻修术中取出股骨远端稳定固定骨水泥的价值.方法 2005年5月至2009年6月,共14例(14髋)因各种原因致髋关节置换术后失败患者接受全髋关节翻修手术.其中男性10例,女性4例,年龄54～75岁,平均66岁.翻修原因为股骨头置换术后髋臼磨损5例、全髋关节置换术后假体周围骨溶解并松动6例、骨水泥柄股骨近端骨溶解柄断裂1例、髋臼骨溶解假体松动翻修同时行股骨柄翻修1例,感染后二期翻修时远端骨水泥取出困难1例.14例(14髋)股骨柄均为骨水泥同定.术中按术前计划开窗部位、开窗范围于股骨皮质骨开一长方形骨窗.通过骨窗直视下彻底清除髓腔内稳定固定的骨水泥,修整股骨髓腔.植入翻修柄后将皮质骨开窗骨瓣原位回植,双股钢丝捆绑固定.术后定期随访拍摄x线片.观察皮质骨开窗骨瓣与周围骨愈合情况、骨瓣有无移位、股骨柄有无下沉以及有无捆绑钢丝断裂等.结果 10例患者术后获得随访,平均随访时间24.6个月.股骨皮质骨开窗长度2.5～6.0 cm,平均3.4 cm,宽度0.8～1.4 cm,平均1.2 cm.股骨开窗远端以远部分发生纵形劈裂骨折1例.无术中皮质骨穿孔及股骨干骨折.向远段扩大开窗1例,扩大长度1.5 cm.开窗部位皮质骨骨瓣原位回植选择2～3道双股钢丝固定,平均2.3道.随访期间2例发牛假体柄下沉(平均2.5 mm),无皮质骨瓣移位以及捆绑钢丝断裂,术后3～5个月皮质骨瓣已于周围骨纤维愈合.随访期间无一例因各种原因致再次翻修.结论 股骨皮质骨开窗技术在髋关节翻修术中有助于直视下彻底取出股骨髓腔远端稳定固定的骨水泥,同时不会造成股骨骨丢失、不影响翻修柄植入后的稳定固定.     

H/G非骨水泥型人工全髋关节置换术后中期随访结果

目的：观察H/G非骨水泥型人工全髋关节置换术后中期的随访结果。方法：对35例40髋H/G非骨水泥型人工髋关节置换术后进行了6年-10年2个月，平均7.5年的随访。临床随访根据Harris的评分方法进行评分，X线随访根据Amstutz的分区方法将股骨侧分为7个区，髋臼侧分为4个分区进行观察。结果：临床随访：Harris评分术后3年平均95分，5年平均89分，7.5年平均83分。Harris评分低于85分者6髋，其中4髋髋臼假体松动，1髋塑料内衬脱落，1髋负重疼痛。X线随访：股骨侧，股骨假体周围出现区域性透亮还25髋（62.5%），无出现全周透亮带的病例；髓腔骨骨化20髋（50.0%）；假体远端骨皮质增厚18髋（45.0%）；7区即股骨距处骨溶解10髋（25.0%）；2髋出现7mm以内的假体下沉。髋臼侧，出现透亮带20髋（50.0%），其中区域性透亮带12髋，全周透亮带8髋，目前已有4髋施行了翻修手术；骨溶解7髋（17.5%），其中1区4髋，2区髋臼螺钉周围骨溶解3髋；骨吸收2髋（5.0%），为翻修术中植骨的病例；塑料内衬脱落1髋（2.5%）。结论：中期随访显示，临床及X线随访结果均较初期随访为差。松动关节明显增多，特别是在X线随访中，假体周围出现的异常骨反应明显高于初期随访所见。虽然目前大部分仅限于X线所见，临床上尚无症状，但应进行密切观察。此外，1髋因金属髋臼卡子松动导致塑料内衬脱落而行翻修术，此种情况应引起注意。     

人工全髋关节置换术后翻修的假体选择

目的探讨人工全髋关节置换术后翻修的假体选择. 方法 1995年1月～2002年6月进行全髋关节翻修术33例(33髋),其中男7髋,女26髋.翻修原因:无菌性松动22例,感染后松动8例(其中2例合并窦道形成);股骨头置换术后髋臼磨损3例,不伴有假体中心性脱位.对无菌性松动和股骨头磨损患者采用骨水泥固定型假体13例,生物固定型假体12例,股骨侧翻修假体均选择骨水泥固定型广泛涂层假体,8例感染患者均行一期骨水泥固定型全髋置换. 结果随访6个月～7年6个月,平均3年11个月.2例出现X线透亮带,但无临床不稳;4例遗留持续性疼痛,无假体脱位、断裂.本组Harris评分由术前的24～47分(平均38.6分),上升为术后的68～88分(平均82.4分),满意率87.9%. 结论无菌性松动是全髋关节置换术后翻修的主要原因.髋臼侧翻修假体可选择骨水泥型假体、也可选择生物型假体,股骨侧翻修假体均选择骨水泥固定型广泛涂层假体,感染后的翻修选择骨水泥假体较好.     

大转子延长截骨在全髋关节翻修术中应用的临床评价

目的 回顾性研究采用大转子延长截骨(extended troehanteric osteotomy,ETO)行全髋关节翻修术后股骨柄的位置变化,评价ETO在股骨假体稳定件髋关节翻修术中的作用.方法 1998年1月至2007年6月,采用ETO对股骨柄或骨水泥壳固定稳定性全髋关节33例33髋进行翻修.翻修术后采用Harris评分和MOMAC评分评估髋关节功能,摄动态X线片观察截骨块愈合、假体位置改变及股骨柄与股骨髓腔匹配等情况.结果 25例随访12～103个月,平均63个月.Harris评分由术前平均38.4分,提高到末次随访时88.7分;WOMAC评分由术前平均56.2分,降至末次随访时42.8分.大转子截骨块均在术后4～10个月骨性愈合.3例发生股骨柄下沉.平均3.4mm.股骨柄假体出现外翻、内翻各1例.无术中或术后骨折、钢丝断裂、感染、假体周围骨溶解以及异位骨化发生.术后关节脱位1例.结论 对假体固定稳定性股骨柄进行翻修,采用ETO有利于假体的安全取出,术后截骨块愈合率高,延长截骨不影响假体稳定性.股骨柄下沉、位置改变、截骨块骨折等并发症发生率低.     

髓内打压植骨结合广泛多孔涂层长柄假体在股骨侧严重骨缺损（PaproskymA型）翻修术中的应用

目的 探讨股骨侧严重骨缺损（Paprosky ⅢA型）翻修中应用髓内打压植骨结合广泛多孔涂层长柄假体的临床疗效.方法 2006年3月～2010年9月,对38例（38髋）Paprosky ⅢA型股骨骨缺损患者行翻修重建,其中男24例,女14例,平均年龄62岁.翻修原因：骨溶解、无菌性松动29例,全髋关节置换术（THA）术后感染二期翻修6例,假体周围骨折3例（Vancouver B3型）.股骨侧干骺端骨缺损采用同种异体颗粒骨髓腔内打压植骨进行修复,股骨柄采用全涂层长柄假体（7～10英寸）.术后定期随访,髋关节功能评价采用Harris评分,影像学采用X线片及CT观察：假体柄有无松动下沉、股骨近端应力遮挡情况、植入的异体颗粒骨与宿主骨整合情况.结果 38例均获得随访,平均随访53.4个月（23～62个月）,Harris评分由术前平均42分（32～47分）,提高至末次随访时平均86分（69～95分）.无患者发生脱位、假体周围骨折.1例术后感染,行再次二期翻修;1例假体柄在术后6个月内下沉4.24 cm,再次翻修时选择更粗的假体柄,末次随访时假体柄稳定;其余所有患者假体柄均牢固固定.3例出现轻-中度应力遮挡.15例近端皮质骨密度及厚度有增加,厚度平均增加约1.8 mm（0.7～3.5 mm）,植入骨与宿主骨逐渐整合并增加了骨缺损区的骨质储备.结论严重骨缺损（Paprosky ⅢA型）的股骨翻修中,采用髓内颗粒骨打压植骨可以很好的修复股骨中上段骨缺损,重建股骨干骺端.依靠广泛多孔涂层长柄假体在远端的牢固压配固定,结合股骨干骺端髓内紧密打压植骨,使假体柄在股骨中上段及远端均能获得较好的初始稳定性,近期临床和影像学结果满意,远期疗效有待观察.     

羟基磷灰石涂层股骨柄假体全髋关节置换术的中期疗效

目的 评价羟基磷灰石涂层股骨柄假体伞髋关节置换术的中期疗效.方法 2000年2月至2001年2月,采用U2钛合金羟基磷灰石涂层股骨柄假体行非骨水泥全髋关节置换术65例(70髋),男20例,女45例;年龄40～82岁,平均63岁.术前诊断:股骨颈骨折30例,髋关节骨关节炎15例,股骨头缺血性坏死9例,人工股骨头术后松动8例,类风湿髋关节炎2例,髋关节融合术后1例.分别于术后1周、3个月、6个月随访,以后每年随访1次,对髋关节功能(Harris评分)和X线片进行复查.结果 4例死于癌症,余61例(66髋)获7～8年随访,平均7.5年.末次随访时髋关节Harris评分85～100分,平均96分.3髋(4.5%)出现轻度大腿痛,无一髋需行翻修术治疗.术后1年内假体下沉小于1.5 mm者7髋,此后未再出现假体下沉.术后3～6个月在Gruen 2区和6区近段羟基磷灰石涂层部位出现典型的骨锚固征及松质骨和皮质骨密度增高影像.此后所有患者包括年龄大于70岁和Dorr C型髓腔者均无柄端周围的骨质增生或"底座征",也尤股骨近段或远段髓内骨溶解及假体松动.按Engh标准评定全部患者均获骨性固定.结论 羟基磷灰石涂层能增强股骨柄假体的初始固定,促进早期骨长入和生物学固定,阻止聚乙烯磨屑的髓内迁移和远段髓内骨溶解,用于非骨水泥全髋置换术中期疗效满意.     

羟基磷灰石涂层股骨柄假体全髋关节置换术的中期疗效

目的 评价羟基磷灰石涂层股骨柄假体伞髋关节置换术的中期疗效.方法 2000年2月至2001年2月,采用U2钛合金羟基磷灰石涂层股骨柄假体行非骨水泥全髋关节置换术65例(70髋),男20例,女45例;年龄40～82岁,平均63岁.术前诊断:股骨颈骨折30例,髋关节骨关节炎15例,股骨头缺血性坏死9例,人工股骨头术后松动8例,类风湿髋关节炎2例,髋关节融合术后1例.分别于术后1周、3个月、6个月随访,以后每年随访1次,对髋关节功能(Harris评分)和X线片进行复查.结果 4例死于癌症,余61例(66髋)获7～8年随访,平均7.5年.末次随访时髋关节Harris评分85～100分,平均96分.3髋(4.5%)出现轻度大腿痛,无一髋需行翻修术治疗.术后1年内假体下沉小于1.5 mm者7髋,此后未再出现假体下沉.术后3～6个月在Gruen 2区和6区近段羟基磷灰石涂层部位出现典型的骨锚固征及松质骨和皮质骨密度增高影像.此后所有患者包括年龄大于70岁和Dorr C型髓腔者均无柄端周围的骨质增生或"底座征",也尤股骨近段或远段髓内骨溶解及假体松动.按Engh标准评定全部患者均获骨性固定.结论 羟基磷灰石涂层能增强股骨柄假体的初始固定,促进早期骨长入和生物学固定,阻止聚乙烯磨屑的髓内迁移和远段髓内骨溶解,用于非骨水泥全髋置换术中期疗效满意.     

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

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

Hybrid total hip arthroplasty with a precoated offset stem. Four to nine-year results

BACKGROUND: Use of modern cementing techniques for fixation of femoral components in total hip arthroplasty has had excellent clinical and radiographic results in most patients. However, several authors have described early loosening of femoral components with roughened and precoated finishes. The purpose of this study was to examine the performance of the precoated Iowa stem, which has increased offset, and to compare the results with those of another cemented precoated femoral component with standard offset used at our institution. METHODS: We carried out a prospective analysis of 102 primary hybrid total hip arthroplasties (a cementless acetabular component and a cemented femoral component) performed with use of the Iowa femoral component in ninety-five patients at our institution. The Iowa stem was used in hips that required greater offset than is available with standard stems as determined by preoperative templating. The average age of the patients at the time of the index procedure was sixty-nine years. Sixteen patients (seventeen hips) died before the forty-eight-month minimum follow-up period had elapsed. Two patients were lost to follow-up, and radiographic follow-up was incomplete for one. The mean duration of clinical and radiographic follow-up of the remaining eighty-two hips in the seventy-six surviving patients was sixty-five months (range, forty-eight to 104 months). RESULTS: The average preoperative Harris hip score of 47 points (range, 16 to 69 points) improved to an average of 87 points (range, 24 to 100 points) at the time of the review. Two hips underwent femoral component revision. Four femoral stems were radiographically loose at an average of thirty-four months. Femoral osteolysis was seen in five hips (6 percent) at an average of fifty-four months postoperatively. No acetabular component was revised because of aseptic loosening. According to Kaplan-Meier analysis, the seven-year survival rate, with an end point of femoral revision, osteolysis, or stem debonding, was 90.6 percent (95 percent confidence interval, 0.87 to 0.94). CONCLUSIONS: The prevalence of revision, osteolysis, and loosening after total hip arthroplasty with the Iowa femoral component at our institution was higher than that seen in our series of Harris Precoat stems, which had a survival rate of 98.4 percent (95 percent confidence interval, 0.97 to 1.00) at ten years with the same end points. The design of the Iowa stem may make it difficult to achieve a good cement mantle, and, in combination with the geometry and increased offset of the stem, may compromise the long-term survival of this cemented femoral component.     

Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head

BACKGROUND: The rate of failure of primary total hip arthroplasty in patients with osteonecrosis of the femoral head is higher than that in patients with osteoarthritis. The purpose of this prospective study was to document the clinical and radiographic results of arthroplasty with so-called third-generation cementing and the results of second-generation cementless total hip arthroplasty in ninety-eight consecutive patients with osteonecrosis of the femoral head. METHODS: Fifty patients who had had simultaneous bilateral total hip arthroplasty with a cemented stem in one hip and a cementless stem in the other and forty-eight patients who had had a unilateral total hip arthroplasty with a cementless stem were included in the study. A cementless acetabular component was used in all hips. The presumed cause of the osteonecrosis was ethanol abuse in fifty-seven patients, unknown in twenty-seven, fracture of the femoral neck in nine, and steroid use in five. There were eighty men and eighteen women. The mean age at the time of the arthroplasty was 47.3 years (range, twenty-six to fifty-eight years). Clinical and radiographic evaluations were performed preoperatively; at six weeks; at three, six, and twelve months; and yearly thereafter. The average duration of follow-up was 9.3 years. RESULTS: The average Harris hip scores in the group treated with unilateral arthroplasty (97 points) and the group treated with bilateral arthroplasty (94 points) were similar at the time of final follow-up. They were also similar between the group treated with cement (mean, 96 points) and that treated without cement (95 points). No component had aseptic loosening in either group. In one hip, a cemented femoral stem (2%) and a cementless cup were revised because of infection. Two cementless stems (2%) were revised because of fracture of the proximal part of the femur with loosening of the stem. Annual wear of the polyethylene liner averaged 0.22 mm in the group treated with cement (a zirconia head) and 0.14 mm in the group treated without cement (a cobalt-chromium head). The prevalence of osteolysis in zones 1 and 7 of the femur was 16% in the group treated with cement and 24% in the group treated without cement. CONCLUSIONS: Advancements in surgical technique and better designs have greatly improved the long-term survival of cemented and cementless implants in young patients with osteonecrosis of the femoral head. Although there was no aseptic loosening of the components, a high rate of linear wear of the polyethylene liner and a high rate of osteolysis in these high-risk young patients remain challenging problems.     

Hybrid alumina total hip arthroplasty using a press-fit metal-backed socket in patients younger than 55 years. A six- to 11-year evaluation

Between 1990 and 1992, we implanted 71 hybrid alumina-on-alumina hip arthroplasties in 62 consecutive patients under the age of 55 years, with a mean age of 46 years at surgery. There were 56 primary and 15 secondary procedures. The prostheses involved a cemented titanium alloy stem, a 32 mm alumina head, and a press-fit metal-backed socket with an alumina insert. Three patients (four hips) died from unrelated causes. Four hips had revision surgery for either deep infection, unexplained persistent pain, fracture of the alumina head, or aseptic loosening of the socket. The nine-year survival rate was 93.7% with revision for any cause as the end-point and 98.4% with revision for aseptic loosening as the end-point. The outcome in the surviving patients (50 patients, 57 hips) with a minimum five-year follow-up (mean eight years) was excellent in 47 hips (82.5%), very good in eight (14%), good in one and fair in one. A thin, partial, lucent line, mainly in zone III was present in 38% of the sockets and one socket had a complete lucency less than 1 mm thick. One stem had isolated femoral osteolysis. There was no detectable component migration nor acetabular osteolysis. This hybrid arthroplasty gave satisfactory medium-term results in active patients. The press-fit metal-backed socket appeared to have reliable fixation in alumina-on-alumina hip arthroplasty. The excellent results using cemented fixation of the stem may be related to the low production of wear debris.     

Charnley型人工全髋置换术后10年以上随访的X线分析

目的:通过对骨水泥固定的Charnley型人工全髋置换术患者10年以上X线随访,探讨骨水泥型人工全髋的固定效果、松动及影响寿命的因素等。方法:获得10年以上随访的38例45髋作为研究对象,平均随访14.6年。X线包括术后及最后随访时髋关节正侧位片。结果:髋臼假体松动有24髋(53％),其中明显松动(definite loosening)14髋(13％),可能松动(possible loosening)10髋(22％)。臼杯磨损共35髋(78％),平均磨损率为0.123mm/年;股骨假体柄松动有12髋(27％),其中明显松动8髋(18％),可能松动4髋(9％)。假体柄周围骨溶解18髋(40％)。本组45髋中8髋(18％)行翻修术,其中4髋因髋臼假体松动单纯髋臼假体翻修,其余4例行髋臼和股骨假体全部翻修。结论:骨水泥固定的Charnley型人工全髋置换术后10年以上长期随访结果,股骨假体的固定效果较好,但髋臼假体的固定效果并不满意。聚乙烯臼杯磨损不可避免,作为人工关节材料,聚乙烯对金属的关节组合应重新考虑。采用改良的骨水泥固定方法对人工全髋假体的早期稳定性和长期寿命非常重要。从髋臼假体的固定效果来看,金属臼(metal shell)假体的非骨水泥固定效果优于聚乙烯臼的骨水泥固定效果。     

Hip arthroplasty with a collared straight cobalt-chrome femoral stem using second-generation cementing technique: a 10-year-average follow-up study

Clinical and radiographic results of 116 patients who had undergone 132 hip arthroplasties at our institution from 1983 to 1988 with a collared cemented straight cobalt-chrome femoral stem using second-generation cementing technique were reviewed. Twenty hips in 20 patients who were part of the original cohort were lost to follow-up. Mean age at the time of surgery was 68.2 years. Mean radiographic follow-up was 9.6 years with a minimum follow-up of 5 years. Ten-year survivorship of the component was 96.5% with revision considered as an endpoint and 94.2% with either revision or radiographic loosening considered the endpoint. Three implants (2.3%) were revised for aseptic loosening at a mean of 8.1 years after implantation. One implant (0.8%) was revised for septic loosening at 10.5 years after surgery. Of the implants not revised, 1 showed evidence of circumferential bone-cement radiolucencies, and 1 had radiolucencies at the implant-cement interface. Five of the surviving femoral components (5.0%) showed focal areas of cystic osteolysis, and proximal femoral bone resorption under the collar was seen in 32 patients (31.7%). There were no cases of cement fracture or stem subsidence. The biomechanical and material properties of this stem combined with second-generation cementing technique look promising for long-term survivorship.     

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 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.     

Total hip replacement with a cementless acetabular component and a cemented femoral component in patients younger than fifty years of age

BACKGROUND: We have been using hybrid total hip arthroplasty (a cementless acetabular component and a cemented stem) in young patients. The purpose of this study was to determine the prevalence of aseptic loosening, polyethylene wear, and osteolysis after the use of this technique. METHODS: We studied a prospective consecutive series of sixty-four primary hybrid total hip replacements in fifty-five patients younger than fifty years old. There were forty-three men and twelve women; the average age at the time of the index operation was 43.4 years. The average duration of follow-up was 9.4 years. We used a cementless acetabular component without screw-holes and a cemented femoral component with a 22-mm head in all hips. Clinical follow-up with use of Harris hip ratings and radiographic follow-up were performed at six weeks; at three, six, and twelve months; and yearly thereafter. The sequential annual linear and volumetric wear rates were measured, and bone-remodeling and osteolysis were assessed. RESULTS: The mean preoperative Harris hip score was 44 points, which increased to 95 points at the time of final follow-up. No hip had aseptic loosening. One hip (2%) was revised because of late infection. The average linear wear (and standard deviation) was 0.96 +/- 0.066 mm, with an average annual rate of 0.096 +/- 0.013 mm. The average volumetric wear was 364.7 +/- 25.2 mm (3), with an average annual rate of 43.4 +/- 3.5 mm (3). Six hips (9%) had an osteolytic lesion of <1 cm in diameter in the calcar femorale (zone 7). CONCLUSIONS: Our results show that a hybrid arthroplasty with a cementless acetabular component and a smooth cemented femoral component (Ra, 0.6 mm) is effective for primary total hip replacement in young patients. Although there was no aseptic loosening and a low prevalence of osteolysis at the latest follow-up evaluation, the high rates of linear and volumetric wear of the polyethylene liner in these young patients remain a concern.     

Cementless acetabular fixation at fifteen years. A comparison with the same surgeon's results following acetabular fixation with cement

BACKGROUND: Loosening of the acetabular component is the major long-term problem associated with total hip arthroplasty with cement. The purpose of the present study was to evaluate the minimum thirteen-year results associated with cementless acetabular components that had been inserted by a single surgeon and to compare them with the results associated with cemented acetabular components that had been inserted by the same surgeon. METHODS: One hundred and twenty consecutive, nonselected primary total hip replacements were performed in 108 patients with use of a Harris-Galante-I cementless acetabular component and a cemented femoral component with a 28-mm head. The patients were evaluated clinically with use of a standard terminology questionnaire, and they were evaluated radiographically for loosening, component migration, wear, and osteolysis. The rates of revision for aseptic loosening and radiographic evidence of loosening for this cohort were compared with the rates for four previously reviewed consecutive series of hips in which the acetabular component had been inserted with cement. All patients were managed by the same surgeon, were followed for thirteen to fifteen years, and were evaluated with use of the same two criteria (revision and loosening) as the end points for Kaplan-Meier analysis. RESULTS: Sixty-six patients (seventy-two hips) were living and forty-two patients (forty-eight hips) had died after thirteen to fifteen years of follow-up. No acetabular component had been revised because of aseptic loosening, and no acetabular component had migrated. With revision of the acetabular component for any reason as the end point, the survival rate was 81% +/- 8% at fifteen years. With revision of the acetabular component for clinical failure (osteolysis, wear, loosening, or dislocation) as the end point, the survival rate was 94% +/- 8% at fifteen years. Among the seventy hips with at least thirteen years of radiographic follow-up, five had pelvic osteolysis and three had had revision of a well-fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm/yr (0.12 mm/yr when one outlier was excluded). CONCLUSIONS: In terms of fixation, Harris-Galante-I cementless acetabular components performed better than did cemented 22-mm-inner-diameter Charnley acetabular components as well as 28-mm-inner-diameter all-polyethylene and metal-backed acetabular components that had been inserted by the same surgeon. However, the rate of wear was greater in association with the Harris-Galante-I cementless components than it was in association with the Charnley cemented all-polyethylene components.