High failure rate of a modern, proximally roughened, cemented stem for total hip arthroplasty

Introduction: Total Hip Arthroplasty (THA) in the treatment of primary osteoarthritis of the hip has evolved to a very safe and cost-effective intervention with revision rates below 5% after 10 years. To this day, however, controversy remains on whether or not to cement the acetabular cup. Methods: A comprehensive PubMed search of the English literature for studies published between 2007 and 2018 was performed. Studies comparing the clinical (revision rate, functionality), radiological (wear) or economic (cost) differences between cemented (cemented stem with cemented cup) and hybrid (cemented stem with uncemented cup) prostheses for primary osteoarthritis of the hip were identified as eligible. Results: A total of 1032 studies were identified whereof twelve were included for qualitative synthesis. All studies concerning the risk of revision were based on registry data, covering a total of 365,693 cups. Cemented prostheses had a similar or lower risk of revision compared to hybrid prostheses in every study, but performed slightly worse on functionality and quality of life. While cemented prostheses were the cheapest option, hybrids were the most cost-effective. Discussion: The widespread preference for cementless fixation of the acetabulum cannot be explained by a superior survival of cementless or hybrid models. Irrespective of age, cemented fixation of the acetabulum remains the gold standard to which other techniques should be compared.

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Revision of failed total hip arthroplasty with a proximal femoral modular cemented stem

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.82b5.0820684 ◽

2000 ◽

Vol 82-B (5) ◽

pp. 684-688 ◽

Cited By ~ 4

Author(s):

S. A. Crawford ◽

P. D. Siney ◽

B. M. Wroblewski

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Total Hip ◽

Cemented Stem

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Freedom Constrained Liner for the Treatment and Prevention of Dislocation in Total Hip Arthroplasty

Scandinavian Journal of Surgery ◽

10.1177/1457496916660035 ◽

2016 ◽

Vol 106 (2) ◽

pp. 165-172 ◽

Cited By ~ 9

Author(s):

M. Karvonen ◽

H. Karvonen ◽

M. Seppänen ◽

A. Liukas ◽

M. Koivisto ◽

...

Keyword(s):

Risk Factors ◽

Total Hip Arthroplasty ◽

Failure Rate ◽

Hip Arthroplasty ◽

Mechanical Failure ◽

University Hospital ◽

Revision Thas ◽

Total Hip ◽

Locking Mechanism ◽

Constrained Liner

Background and Purpose: Dislocation is one of the most common complications following total hip arthroplasty. The aim of our study was to assess failure rate of the Biomet Freedom constrained liner (Biomet, Warsaw, IN, USA) either in revision surgery for recurrent dislocation, or as a preventive method in high dislocation risk patients. Patients and Methods: We assessed retrospectively 105 consecutive surgical procedures in 103 patients where a Freedom constrained liner or cup was used in Turku University Hospital over a 7-year period from 2007 to 2014. The mechanical failure rate of the device was assessed based on medical records. The average age of the patients was 73.4 years. The number of male patients was 53 (51%). Mean follow-up time was 2.5 years. The association between failure of the device and potential risk factors—age, gender, indication, and approach—was analyzed with logistic regression. Results were expressed by odd ratios and 95% confidence intervals. Results: The mechanical failure rate of the Freedom device was 6 out of 105 (5.7%). None of the 11 preventive primary THAs against dislocation failed, 4 out of 52 (7.7%) preventive revision THAs against dislocation failed, and 2 out of 42 (4.8%) of the treated dislocation cases failed. Four out of six failures were dislocations due to impingement and failure of the locking mechanism. Two liners failed because of loosening. The risk factors assessed were not associated with failure of the device. Interpretation: We found out that the mechanical failure rate of a Freedom constrained device was low. These results encourage us to continue using the device.

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Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia

10.21203/rs.3.rs-745383/v1 ◽

2021 ◽

Author(s):

Zhe-Yu Huang ◽

Jing Ling ◽

Zhi-Min Zeng ◽

Zheng-Lin Di ◽

Jun-Hui Zhang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Cement Leakage ◽

Developmental Dysplasia ◽

Harris Hip Score ◽

Total Hip ◽

Derotational Osteotomy ◽

Femoral Shortening ◽

Cemented Stem ◽

The Mean

Abstract Background Performing total hip arthroplasty (THA) in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging. Subtrochanteric shortening osteotomy is typically required for placing the acetabular component within the anatomic hip center. However, the outcomes of subtrochanteric osteotomy using cemented components are not widely reported. This study aimed to evaluate the outcomes of cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH.Methods We retrospectively evaluated data of patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018. Patients who underwent surgery at the hip joint were excluded. Data regarding pre- and postoperative clinical and radiological parameters were collected and reviewed.Results Among 14 patients included (14 hips), the mean age was 60.4 (range, 47–73) years. The mean Harris hip score improved from 40.7 to 87.7. The mean limb length discrepancy reduced from 52 mm to 12.7 mm. No neurologic deficits were noted. The mean osteotomy union time was 10.6 months. Delayed union and postoperative dislocation were observed in one and two patients, respectively. Cement leakage into the osteotomy gap was observed in one patient. No revisions were required. No signs of loosening or migration were observed. Conclusions Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective for the treatment of patients with Crowe IV DDH. The cemented femoral component showed promising mid-term follow up results. However, cement leakage affects bone healing. Osteotomy and cementing should be performed meticulously.Trial Registration: Retrospectively registered

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