Long-Term Results of Revision Total Hip Arthroplasty Using a Modern Extensively Porous-Coated Femoral Stem

BackgroundThe use of an extensively porous-coated uncemented cobalt-chrome monoblock femoral stem for revision total hip arthroplasty (THA) is well established with excellent mid-term results. The aim of this study is to report the long-term survivorship of these implants in femoral stem revisions.MethodsThis is a long-term retrospective review of prospectively collected data of 55 femoral stem revisions in 55 patients using a contemporary, cementless extensively porous-coated cobalt-chrome monoblock stem. All patients between 2001 and 2006 who underwent first time femoral stem revision with a contemporary, cementless extensively porous-coated cobalt-chrome monoblock stem were included. Harris Hip Score, Western Ontario and McMaster Universities Index, and University of California Los Angeles activity scores were recorded preoperatively and at latest follow-up. Radiographs were analyzed for evidence of loosening, subsidence, osteolysis, and bony union. This study included 55 patients, comprising of 36 females (66%) and 19 males (34%) with a mean age of 66.4 ± 9.3 years at the time of surgery. The mean time interval from index procedure was 9.8 ± 2.9 years. Mean time from revision THA to final follow-up was 13.2 ± 2.17 years with a minimum of 10 years of follow-up.ResultsIndications for revision included aseptic loosening (33), prosthetic joint infection (13), and periprosthetic fracture (10). Significant improvement in Harris Hip Score (85.1 ± 1.77 vs 51.8 ± 2.3, P < .001), Western Ontario and McMaster Universities Index (17.6 ± 0.77 vs 33.3 ± 0.8, P < .001), and University of California Los Angeles (5.25 ± 0.2 vs 2.7 ± 0.36, P < .001) scores were found at latest follow-up compared to preoperative. Fifty-four patients (98%) achieved stable bony ingrowth on radiographic analysis. All 10 patients treated for periprosthetic fractures achieved bony union of their fractures. Two patients suffered intraoperative periprosthetic fractures and were treated with a cable-plating system. There were no mechanical failures and no femoral stem re-revisions. One patient was diagnosed with a deep infection and was treated with chronic suppressive antibiotic therapy due to significant medical comorbidities.ConclusionRevision of the femoral component with a contemporary extensively porous-coated cobalt-chrome femoral stem has excellent functional outcomes, radiographic outcomes, and long-term survivorship with minimal complications.     

Cement-within-cement stem exchange using the collarless polished double-taper stem

The clinical and radiographic outcomes of the cement-within-cement femoral stem exchange technique at revision hip arthroplasty were determined. Twenty-three revisions with a collarless polished double-taper stem design were prospectively monitored at up to 12 years. The most common indications for revision were recurrent dislocation and acetabular revision. Radiographic stem subsidence was measured by the Ein Bild Röentgen Analyse method. There was no stem re-revision and no radiographic loosening. Stem within cement subsidence, an intentional design feature of this stem, averaged 0.8 mm (range, 0-2 mm). The average subsidence was similar to that in primary hip arthroplasty. The excellent long-term results of cemented collarless polished taper stems for primary and revision hip arthroplasty can be extended even further by cement-within-cement exchange, which preserves the femur.     

Total hip arthroplasty with a cementless acetabular component and a cemented femoral component in the treatment of Chinese patients with femoral head necrosis

The purpose of this study was to evaluate midterm clinical and radiographic outcomes associated with hybrid total hip arthroplasty in a consecutive series of 86 Chinese patients (93 hips) with osteonecrosis of the femoral head, which revealed that the mean Harris hip score increased from 39 +/- 6.0 points before operation to 90.4 +/- 4.6 points at the latest follow-up. There was pelvic osteolysis in one hip (1%), which required revision, and some small focal areas of femoral osteolysis in 12 hips (13%) were observed. The mean linear wear rate was 0.143 +/- 0.05 mm/y (0.02-0.45 mm/y). No loosening of the components was observed radiographically. The survival rate of the acetabular and femoral components for revision was 98% (95% confidence interval, 0.96-1.0) and 100% (95% confidence interval, 0.95-1.0). Hybrid total hip arthroplasty in patients with osteonecrosis of the femoral head had a satisfactory clinical and radiographic outcome at a minimum 5 years of follow-up. Because polyethylene wear and osteolysis cannot be avoided, the long-term effect should be further studied.     

Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem

The purpose of the current study was to evaluate the long-term result of a tapered, uncemented femoral component. We retrospectively reviewed the clinical and radiographic records of 121 patients (129 hips) who underwent primary total hip arthroplasty with the use of the Taperloc uncemented stem. Follow-up averaged 11 years (range, 6-15 years). The mean Harris Hip Score at the latest follow-up was 92.1. Thigh pain was reported in 5 patients (3.6%). One stem was revised at 6 years because of severe proximal femoral osteolysis. There was no evidence of radiographic subsidence or loosening around any stems. The overall medium- to long-term outcome of the Taperloc stem is excellent, with a low revision rate and high patient satisfaction.     

The Bicontact cementless primary total hip arthroplasty: long-term results

We report on a prospective series of 201 primary uncemented total hip arthroplasties with a Bicontact prosthesis at a mean follow-up of 12.9 years. The mean Harris hip score improved from 41 before surgery to 89 at final follow-up. Two femoral stems, one each for infection and fracture, and 12 cups were revised. The mean number of years to revision post-primary surgery was 8.7 years (six months to 16 years). The cumulative survival of the prosthesis was 95.42% for any cause at ten years and 93.57% at 12 years. Survivorship for aseptic loosening of the femoral stem was 100%. In our series, the Bicontact uncemented total hip arthroplasty stem without hydroxyapatite coating showed excellent survival and the cup survival was comparable to other leading series.     

Total hip arthroplasty with a collarless, tapered, fiber metal proximally coated femoral stem: minimum 5-year follow-up

The purpose of this study was to evaluate the midterm results, osteointegration potential, and implant-related complications of a cementless, collarless, proximally coated, distally tapered femoral hip prosthesis. The clinical and radiographic results for 129 hips in 116 patients after total hip arthroplasty with a Fiber Metal Taper (Zimmer, Inc ,Warsaw, Ind) femoral stem are reported. One hundred twenty-two (95%) hips were available for the minimum of 5 years clinical and radiographic follow-up. The mean duration of follow-up was 81 months (range, 60-104 months). The mean Harris hip score improved from 44 to 92 at the most recent follow-up. All femoral components were clinically stable with radiographic evidence of bone ingrowth. There has been no evidence of subsidence greater than 2 mm, no significant thigh pain, and no femoral revisions for any reason. Total hip arthroplasty with the Fiber Metal Taper stem demonstrates good clinical and radiographic results at midterm follow-up.     

应用羟基磷灰石喷涂解剖型股骨假体的中期随访结果

目的 探讨使用羟基磷灰石喷涂解剖型股骨假体的全髋关节置换术的中期随访结果 .方法 对2001年1月至2003年12月使用羟基磷灰石喷涂解剖型股骨假体的全髋关节置换术患者75例90髋进行中期随访,男49例61髋,女26例29髋;患者年龄42～68岁,平均58.4岁.以Harris评分系统进行临床结果 评估,采用配对t检验分别比较未次随访Harris评分与术前Harris评分、术后早期Harris评分之间的差异;拍摄髋关节正、侧位X线片对影像学结果 进行评估.结果 48例56髋获得随访,男29例35髋,女19例21髋;随访时间5～8年,平均7.2年.随访中无翻修病例.术前Harris评分平均(28.2±6.3)分,术后早期(平均1年)平均(93.2±4.8)分,末次随访平均(91.6±4.5)分,优良率100%.末次随访Harris评分与术前比较差异有统计学意义(P<0.05),与术后早期比较差异无统计学意义(P>0.05).随访期间出现人腿痛3例.X线片显示全部假体均获得稳定的骨长入,出现股骨近端局限性骨溶解2例、假体柄远端骨质硬化3例、假体刷围间断透光线6例,无一例出现假体下沉和假体内外翻.结论 羟基磷灰石喷涂解剖犁股骨假体应用于全髋关节置换术的中期随访结果 满意,假体可以获得稳定的骨长入,但远期疗效有待进一步观察.     

Cementless Modular Total Hip Arthroplasty in Patients Younger than Fifty with Femoral Head Osteonecrosis: Minimum Fifteen-Year Follow-Up

This study aimed to report the outcome of total hip arthroplasty (THA) with a modular femoral component in patients younger than fifty years with osteonecrosis of femoral head. Sixty-four osteonecrotic hips in fifty-five patients were available for clinical and radiographic analyses at minimum follow-up of fifteen-years. The mean Harris hip score improved from 36 points preoperatively to 92.7 points at final follow-up. Sixty-two (95.3%) hips demonstrated stable bone ingrowth. No hips showed loosening or required revision for aseptic loosening. Survivorship with an end point of stem revision for any reason was 93.8% and for aseptic loosening was 100% at 16.8 years. We believe that cementless THA with a modular stem is a promising procedure for young and active patients with osteonecrosis of the femoral head.     

Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head: a concise follow-up, at an average of seventeen years, of a previous report

We previously evaluated ninety-eight consecutive patients (148 hips) at mean of 9.3 years after total hip arthroplasty; the mean age at the time of the index surgical procedure was 47.3 years. Fifty patients (100 hips) had simultaneous bilateral arthroplasty with a cemented stem in one hip and a cementless stem in the contralateral hip. Forty-eight patients (forty-eight hips) had unilateral hip arthroplasty with a cementless stem. All patients had a cementless acetabular component. In our first report, we found no difference in clinical results, as measured with the Harris hip score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), between the cementless and cemented stems. One hip (2%) in the hybrid group (a cementless cup and a cemented stem) had revision because of infection and two hips (2%) in the fully cementless group had revision of the femoral component because of a periprosthetic fracture. Between the time of follow-up in that study (at a mean of 9.3 years) and the time of follow-up in the present study (at a mean of 17.3 years), twenty-two revisions of acetabular components were performed, with eight in the hybrid group and fourteen in the fully cementless group. There was no difference in clinical results, as measured with the Harris hip score and the WOMAC, between the hybrid and fully cementless groups. At the time of the present review, forty (83%) of forty-eight acetabular components in the hybrid group and eighty (85%) of ninety-four acetabular components in the fully cementless group were intact. Most of the femoral components (98%) in both groups were intact. Wear and periacetabular osteolysis were the causes of failure in the hips requiring revision.     

Multi-centre study of cement-in-cement and in-cement femoral revision total hip arthroplasty using polished,stainless steel stems

BackgroundExposure of the acetabular component during revision total hip arthroplasty is often difficult and stems are often difficult to remove. Polished and tapered cemented stems are easily removed and can be easily reconstructed by either cement-in-cement or in-cement technique. This study was a retrospective review of the medium-term outcomes of revision total hip arthroplasty conducted with the Exeter stem fixed by cement-in-cement or in-cement method in four institutions.MethodsThis study included hips (n = 103) reconstructed by cement-in-cement or in-cement technique on the femoral side during revision total hip arthroplasty in four institutions between 2003 and 2015. The mean age at surgery was 71.1 years (range, 43–86 years), and the mean follow-up period was 5.6 years (range, 0–13 years).ResultsRevision arthroplasty was required for acetabular component complications in 69 hips, for dislocation in 25, for infection in eight, and for stem fracture in one hip. Re-revision was required in 10 hips for: infection (n = 6), acetabular component complications (n = 3), and dislocation (n = 1). No radiographic loosening, cement fractures, or osteolysis of the femoral components were observed. Ten-year survival rate was 99% with the endpoint of femoral revision surgery, and 100% with the endpoint of femoral aseptic loosening.ConclusionsThe medium-term outcomes of revision total hip arthroplasty on the femoral side conducted using the cement-in-cement or in-cement technique were favourable, with no cases of aseptic loosening. As long as the bone-cement interface remains robust, there is no need to remove all the cement, and the cement-in-cement or in-cement technique should be used for reconstruction.     

Modular cementless total hip arthroplasty for multiple epiphyseal dysplasia

We analyzed a consecutive series of 23 total hip arthroplasties that had been performed using modular cementless prostheses in 13 patients with a confirmed diagnosis of multiple epiphyseal dysplasia and end-stage osteoarthritis of the hip. The average Harris hip score improved from 40.6 to 93.8 points. Postoperatively, all hips demonstrated favorable alterations in the biomechanical parameters including hip center of rotation, femoral offset, femoral neck length, and limb length. At a mean follow-up of 4.8 years, no hip required revision because of aseptic loosening of the acetabular or femoral component. One patient (1 hip, 4.3%) underwent reoperation for polyethylene wear and osteolysis 8 years after index arthroplasty. This study shows encouraging clinical and radiographic outcomes of modular cementless total hip arthroplasties for this technically difficult condition.     

Uncemented femoral revision arthroplasty using a modular tapered,fluted titanium stem

Background and purpose — Due to the relative lack of reports on the medium- to long-term clinical and radiographic results of modular femoral cementless revision, we conducted this study to evaluate the medium- to long-term results of uncemented femoral stem revisions using the modular MRP-TITAN stem with distal diaphyseal fixation in a consecutive patient series.

Patients and methods — We retrospectively analyzed 163 femoral stem revisions performed between 1993 and 2001 with a mean follow-up of 10 (5–16) years. Clinical assessment included the Harris hip score (HHS) with reference to comorbidities and femoral defect sizes classified by Charnley and Paprosky. Intraoperative and postoperative complications were analyzed and the failure rate of the MRP stem for any reason was examined.

Results — Mean HHS improved up to the last follow-up (37 (SD 24) vs. 79 (SD 19); p < 0.001). 99 cases (61%) had extensive bone defects (Paprosky IIB–III). Radiographic evaluation showed stable stem anchorage in 151 cases (93%) at the last follow-up. 10 implants (6%) failed for various reasons. Neither a breakage of a stem nor loosening of the morse taper junction was recorded. Kaplan-Meier survival analysis revealed a 10-year survival probability of 97% (95% CI: 95–100).

Interpretation — This is one of the largest medium- to long-term analyses of cementless modular revision stems with distal diaphyseal anchorage. The modular MRP-TITAN was reliable, with a Kaplan-Meier survival probability of 97% at 10 years.     

Mid-Term Clinical and Radiographic Outcomes of a Long Cementless Monobloc Stem for Revision Total Hip Arthroplasty

BackgroundFor the past 2 decades, the authors have been using a long tapered cementless stem made of titanium and fully coated with hydroxyapatite for revision total hip arthroplasty. The purpose of this multicentric study is to assess clinical outcomes, radiographic outcomes, re-revision rates, and survival rates of this revision stem at a minimum 5-year follow-up.MethodsThe records of a multicentric continuous series of 335 adults undergoing revision total hip arthroplasty using the Corail revision stem (DePuy, Leeds, UK) between 2000 and 2012 were retrospectively reviewed. The Harris Hip Score, Oxford Hip Score, and Engh score were recorded. Survival was assessed using the Kaplan-Meier method and cumulative incidence function.ResultsSeventy-seven patients died with their revision stem in place, 47 could not be contacted, and 22 had stem re-revisions. This left a final cohort of 201 patients, aged 70 ± 12 years at revision surgery, with a body mass index of 26 ± 4. The Kaplan-Meier survival was 93.9% for re-revision of any component for any reason, 96.7% for re-revision of the stem for any reason, and 99.3% for re-revision of the stem for aseptic reasons. At last follow-up, the Harris Hip Score was 84.8 ± 13.1, the Oxford Hip Score was 21.0 ± 7.8, and the Engh score was 16.4 ± 6.7.ConclusionThe long tapered cementless revision stem had excellent clinical and radiographic outcomes at a minimum follow-up of 5 years. The revision stem enabled restoration of bone stock in femurs with pre-revision bone defects, confirming that the hydroxyapatite coating promotes osseointegration, even in femurs with extensive bone loss.Level of EvidenceLevel IV, retrospective cohort study.     

无柄人工髋关节置换术的初步临床应用

目的 评价无柄人工髋关节置换术的早期随访结果,探讨其临床应用的安全性及可行性.方法 2002年2月至2007年3月,对51例56髋施行无柄人工髋关节置换术.男31例34髋,女20例22髋;年龄25～87岁,平均56.2岁.术前髋关节Harris评分平均(72.4±8.4)分.新鲜股骨颈骨折6例6髋,股骨颈骨折继发股骨头坏死4例4髋,股骨头缺血性坏死(FicatⅢ-Ⅳ期)34例37髋,强直性脊柱炎髋关节强直2例3髋,类风湿髋关节炎2例3髋,髋关节结核3例3髋.全髋关节置换50髋,半髋关节置换6髋.以Harris评分评价术后疗效,用Amstutz分区方法对X线片进行分区评价,观察假体位置及并发症情况.结果 全部病例随访2～7年,平均4.8年.髋关节Harris评分平均(92.8+3.2)分,其中优44髋、良7髋、可4髋、差1例,优良率91%.术后第2,3天发生关节脱位2例,经手法复位成功;术后40天发生感染1例,行关节腔病灶清除及持续关节腔冲洗后治愈;术后半年髋区疼痛1例,行有柄全髋关节翻修.随访期间X线片未见关节松动、脱位及螺钉松动、断裂等情况.结论 无柄人工髋关节置换术可保留股骨颈,创伤小、出血少易于于翻修,适合高龄体弱及年轻患者.早期疗效可靠,远期疗效有待进一步观察.     

Results of a Tapered Proximally-Coated Primary Cementless Stem for Revision Hip Surgery

Nineteen patients (nineteen hips) who had undergone revision total hip arthroplasties using a proximally-coated primary cementless stem were evaluated to determine if a subset of revision arthroplasty patients could be identified where the use of this stem would be appropriate. Of these 19 revisions, 15 were performed for the second stage treatment of infection. The femoral bone deficiency was classified as Paprosky Type I in 6 hips and Type II in 13 hips. At a mean follow-up of 49 months, aseptic stem survivorship was 95% with one revision due to aseptic stem failure. The mean Harris hip scores had improved from a mean of 44 points pre-operatively to 89 points post-operatively. Intra-operatively, there was one complication which included a peri-prosthetic fracture distal to the stem which was treated with an allograft strut with cerclage wires. The authors believe that in type I or II femoral defects, the use of this specific cementless stem may be beneficial in the setting of a revision total hip arthroplasty.     

Cementless total hip arthroplasty in Chinese patients with osteonecrosis of the femoral head

This study was designed to evaluate the midterm (> or = 5 years) clinical and radiographic outcomes of the cementless total hip arthroplasty in 64 Chinese patients (72 hips), which revealed that the mean Harris hip score increased from an average of 44.0 points before operation to 92.4 points at the last follow-up. Excellent results were achieved in 60 hips (83%). No loosening of the components was observed radiographically. No revision of the femoral components was required. Only one focal area of pelvic osteolysis in 1 hip (1%), which requires a revision, and some small focal areas of femoral osteolysis in 12 hips (17%) were observed. The mean linear wear rate was 0.125 mm/y. The survival rate of the acetabular and femoral components for radiographic loosening was 100% (95% confidence interval, 0.93-1.0) and for revision was 98.61% (95% confidence interval, 0.95-1.0). This study indicated that the cementless total hip arthroplasty in patients with osteonecrosis of the femoral head has a satisfactory midterm clinical and radiographic outcomes, but the long-term effect should be further studied.     

No increased stem subsidence after arthroplasty in young patients with femoral head osteonecrosis:41 patients followed for 1–9 years

Background?Poor bone stock in patients with osteonecrosis of the femoral head may be a reason for poor outcome after hip replacement. One way of studying bone quality is to measure implant migration. We thus investigated the clinical and radiographic results of cementless THR in younger patients with femoral head osteonecrosis.

Patients and methods?We studied hips in 41 patients (mean age 48 (25–63) years) with a cementless hip arthroplasty after late stage osteonecrosis. Clinical evaluation was by the Harris hip score, the WOMAC score and the SF-36 score. Stem subsidence was measured with the Ein Bild Roentgen Analyse femoral component analysis (EBRA-FCA) at 3, 12, 24, 60, and 72 months after operation. The average duration of follow-up was 7(1–9) years, with less than 2 years for 2 patients.

Results?There was no revision of any hip. No radiographic or clinical stem loosening was seen. After 60 months, the cementless stems showed a median subsidence of –0.7?mm (95% CI: –0.9 to –0.2). No femoral osteolysis occurred. Femoral radiolucent lines, all < 1?mm, were seen in 10 hips. At the latest follow-up the Harris hip score was 83 (23–100) points.

Interpretation?Our findings for porous-coated stems in patients with femoral osteonecrosis indicate no greater risk of stem subsidence and rate of osteolysis after an average of 7 years follow-up. Thus, we continue to use uncemented stems in younger patients with femoral osteonecrosis. However, continued follow-up will be necessary to evaluate the long-term outcome.     

Hydroxyapatite-coated total hip arthroplasty: the impact on thigh pain and arthroplasty survival

The purpose of this study was to evaluate the long-term clinical outcomes of primary total hip arthroplasty using an uncemented, hydroxyapatite-coated implant. We followed a consecutive series of 164 patients, who underwent total hip arthroplasty with the Furlong fully-hydroxyapatite coated implant over a mean time period of 12.8 years. Clinical and radiological analyses were performed. Roentgenographic evaluation for the femoral side of the hip was performed using the Gruen zones, for the acetabular side using the DeLee and Charnley zones. Engh's radiological score was employed to assess fixation and stability of the stem. Clinical results were evaluated by Harris Hip Score. The mean Harris hip score was 46 preoperatively and 85 at last follow-up. The mean Engh score was 23. No hips had been revised for aseptic loosening of the femoral component. Thigh pain incidence was very low (1.2%). Survival analysis showed excellent results (95.8% at end point). The Furlong hydroxyapatite-coated implant appears as a reliable and safe option for hip arthroplasty.     

Simultaneous bilateral total hip arthroplasty with hydroxyapatite-coated implants: a 20-year follow-up

Bilateral hip arthroplasty has been reported to be a safe and effective way to treat bilateral hip arthritis in a selective group of patients. We report a follow-up of 30 patients who underwent simultaneous bilateral total hip arthroplasty with hydroxyapatite implants and were followed for an average of 19.4 years. Patients had an average Harris Hip Score of 90 at the latest follow-up (range, 78-99). The average Western Ontario and McMaster Universities Arthritis Index questionnaire index score was 12 (range, 0-41), with high functional results on the 12-Item Short Form Health Survey (SF-12) and Oxford 12 questioners. Using the Kaplan-Meier survivorship analysis, with revision for any reason as an end point, survivorship was 94% at 12 years, 88% at 15 years, 74% at 18 years, and 61% at 23 years. All revisions were for the acetabular component, and the survivorship for the femoral component was 100% throughout the 23-year period. We conclude that bilateral uncemented total hip arthroplasty can provide satisfactory long-term clinical, radiological, and functional outcomes in patients even with older-generation polyethylene liners and stem designs.     

Total hip arthroplasty with step-cut subtrochanteric femoral shortening osteotomy in high riding hip dislocated patients with previous femoral osteotomy

Background

To evaluate the long-term clinical and radiological outcomes of cementless total hip arthroplasty (THA) in high riding hip dislocated patients with previous proximal femoral osteotomy.