Systematic Review of Literature of Cemented Femoral Components: What Is the Durability at Minimum 20 Years Followup?

Background

Cemented femoral total hip arthroplasty may be one of the most successful surgical interventions of all time. However, although results are very encouraging over the early to mid-term followup, relatively few studies have analyzed the durability of these implants beyond 20 years followup. To evaluate the performance of contemporary implants, it is important to understand how previous implants perform at 20 or more years of followup; one way to do this is to aggregate the available data in the form of a systematic review.

Questions/purposes

(1) How durable is cemented femoral fixation in the long term (minimum 20-year followup) with respect to aseptic loosening? (2) Is the durability of cemented femoral fixation dependent on age of the patient? (3) Are the long-term results of the cemented femoral fixation dependent on any identifiable characteristics of the prosthesis such as surface finish?

Methods

A systematic review was performed to identify long-term studies of cemented femoral components. After application of inclusion and exclusion criteria to 1228 articles found with a search in PubMed and EMBASE, 17 studies with a minimum of 20-year followup on cemented femoral components were thoroughly analyzed in an attempt to answer the questions of this review. The quality of the studies reviewed was assessed with the Methodological Index for Nonrandomized Studies (MINORS) instrument. All studies were case series and cohort sizes ranged from 110 to 2000 hips for patients older than 50 years of age and 41 to 93 hips for patients younger than 50 years at the time of surgery.

Results

Among the six case series performed in patients older than 50 years of age, survivorship for aseptic loosening of the femoral component ranged from 86% to 98% at 20 years followup. There were no obvious differences for younger patients when analyzing the five studies in patients younger than age 50 years in which survivorship free from aseptic loosening for these studies ranged from 77% at 20 years in one study and 68% to 94% at 25 years in the other studies. Although data pooling could not be performed because of heterogeneity of the studies included here, it appeared that stems with a rougher surface finish did not perform as well as polished stems; survivorship of stems with rougher surface finishes varied between 86% and 87%, whereas those with smoother finishes ranged between 93.5% and 98% at 20 years.

Conclusions

Excellent long-term fixation in both older and younger patients can be obtained with cemented, polished femoral stems. These results provide material for comparison with procedures performed with newer cementing techniques and newer designs, both cemented and cementless, at this extended duration of followup.     

Community surveys in local needs assessment projects: Lessons from a case study

Drawing on the author's experience with a low budget mental health needs assessment project, guidelines are offered to administrators of individual mental health centers contemplating field surveys. Throughout, the emphasis is on methods that maintain the integrity and quality of the data collected but still minimize costs. Consequently, the types of existing resources available to local agencies are detailed. The article does not attempt to minimize the complexities involved with survey projects, but rather strives to demonstrate that they are feasible for small agencies.Mary E. Stefl, Ph.D., is associated with the Health Care Administration Department, Trinity University, San Antonio, Texas.The author wishes to acknowledge A. James Ellis, executive director of the Warren County Community Mental Health Board, and Gordon Roberts, advisory board member and overall director of the needs assessment project, whose foresight, initiative, and hard work made this project possible. Similarly, thanks is due to Rex M. Rogers, Ph.D. (now at Cedarville College), who provided assistance on the project and helped with the initial draft of this paper.     

Tourette Syndrome in the Classroom: Special Problems, Special Needs

Tourette Syndrome (TS) is an uncommon developmental disability characterized by repetitive and involuntary verbal and motor tics. A survey of all known affiliates of the Tourette Syndrome Association of Ohio was conducted to document the special problems and needs of the TS student. A total of 431 questionnaires was returned, and the types and frequency of interpersonal and academic school problems were found to be pervasive. Problems did not differ by grade level, but students medicating their TS symptoms experienced more problems. In most cases, current students described similar problems to adults, suggesting that recent attempts to provide optimal educational opportunities to all handicapped children have not been successful where TS is involved. The presence of a behavioral or learning disability diagnosis indicated that substantial percentages of respondents were in need of specialized educational services, but not all those in need were receiving them. Parents were generally satisfied with their child's education, but less satisfied when specialized education was involved. Suggestions are offered for more effectively dealing with the TS child in the classroom.     

Thermogenic response to adrenaline during restricted blood flow in the forearm.

To elucidate the underlying mechanism behind the thermogenic effect of adrenaline in human skeletal muscle, nine healthy subjects were studied during intravenous infusion of adrenaline. Restriction of blood flow to one forearm was obtained by external compression of the brachial artery, to separate a direct metabolic effect of adrenaline from an effect dependent on increased blood flow. The other arm served as the control arm. In the control arm, the forearm blood flow increased 4.7-fold (from 2.0 +/- 0.3 to 9.3 +/- 1.5 mL 100 g(-1) min(-1), P < 0.001) during the adrenaline infusion. Adrenaline significantly increased forearm oxygen consumption (from 4.7 +/- 2.1 to 7.0 +/- 3.6 micromol 100 g(-1) min(-1), P < 0.025). In the arm with restricted blood flow, the forearm blood flow increased 2.9-fold (from 1.6 +/- 0.3 to 4.6 +/- 0.8 mL 100 g(-1) min(-1), P < 0.002) but the forearm oxygen consumption did not increase (baseline period: 5.6 +/- 2.3 micromol 100 g(-1) min(-1), adrenaline period: 6.1 +/- 2.1 micromol 100 g(-1) min(-1), P = 0.54). The experimental design and the difficulties in interpretation of the result are discussed. The results give evidence for the hypothesis that the vascular system plays a key role in the thermogenic effect of adrenaline in skeletal muscle in vivo.     

Summer camps for juveniles with rheumatic disease: Do they make a difference?

Summer camps for juveniles with rheumatic disease are being offered increasingly as components of comprehensive treatment approaches, but the therapeutic value of these sessions is largely undetermined. This study attempted to judge the impact of a summer camping experience on two aspects of participants' psychosocial functioning, self-concept, and locus of control. Both of these constructs have been related to effective disease management. On both measures, the mean scores of 36 campers improved significantly following a week-long camp session, and these positive effects were maintained over a 6-month follow-up period. Campers who had attended previous camping sessions appeared to obtain maximal benefit, and male campers with rheumatic disease were identified as needing special attention. The study's limitations are discussed, and future research directions are outlined.     

Antibiotic therapy intervention at a community hospital. Opportunities for cost and quality improvements

In a one-year study, thirty-two physicians' antibiotic costs decreased significantly and were lower than those in a comparison group. The quality of patient care was not adversely affected, and the hospital's overall rate of nosocomial infection decreased. The success of the program led to its being adopted throughout the hospital. The dynamics of pharmacies' implementing cost-reduction strategies with voluntary medical staffs are discussed throughout the article.