Early Femoral Loosening of the Titanium 3M Capital Cemented Hip: A Lesson Relearned

2002 ◽  
Vol 12 (1) ◽  
pp. 17-22 ◽  
Author(s):  
A.R. Harvey ◽  
I.W. Barlow ◽  
N.M.P. Clarke
Keyword(s):  
Hip Replacement ◽  
Operative Technique ◽  
Femoral Stem ◽  
Cementing Technique ◽  
Radiological Criteria ◽  
Stem Loosening ◽  
Capital Cases ◽  
Hip Replacements ◽  
Early Failures

A 4-year follow-up study is presented comparing 3M Capital cemented hip replacements with Charnley low friction arthroplasty controls. The mean radiological follow-up in the Capital and Charnley groups was 47 months (25 to 61) and 47 months (23 to 66) respectively. All cases were performed by the same surgical team over the same period (April 1991-October 1993). The operative technique including femoral preparation and cementing technique was identical in each group. Charnley broaches were used for femoral preparation in both groups and Charnley cups were used in all cases. In all of the 3M Capital cases cobalt-chrome femoral heads were used. There was no case selection for either group. Six of the 21 Capital femoral components were deemed to be loose on radiological criteria. None of the Charnley hips was loose. This represents an unacceptably high incidence of radiological femoral stem loosening in the Capital hip replacement. A previous uncontrolled study has attributed early failures to deficient femoral preparation and/or cementing technique. We suggest that early femoral stem loosening in the Capital hip occurs despite satisfactory operative technique in contrast with the results using the Charnley total hip replacement.

Short-Term Clinical Assessment of Hip Hemi-Arthroplasty in 11 Dogs

2021 ◽  
Author(s):  
Renée Huggard ◽  
Grace Wicks ◽  
Gordon Corfield
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Salvage Procedure ◽  
Short Term ◽  
Total Hip ◽  
Pelvic Radiography ◽  
Hemi Arthroplasty

Abstract Objective The aim of this study was to assess the short-term clinical outcome in dogs following a hip hemi-arthroplasty for the treatment of primary pathological disorders of the hip and as a salvage procedure following failure of the cup component of a total hip replacement. Materials and Methods Medical records of dogs that had a unilateral hip hemi-arthroplasty performed between 2015 and 2020 were reviewed. Data collected included follow-up orthopaedic examinations performed at 0, 2, 8 and 52 weeks postoperatively, pelvic radiography at 0, 8 and 52 weeks postoperatively and an owner questionnaire (Helsinki chronic pain index [HCPI]). Results Eleven unilateral hip hemi-arthroplasty procedures were identified. The median age at time of surgery was 3.6 years (8 months–10 years) and the median follow-up time was 13 months (range: 2 months–3 years). The HCPI for all dogs at follow-up was median 8 ± 7.30 (range: 5–25). Total HCPI was < 12 for 7/10 dogs and ≥ 12 for 3 dogs. Pelvic radiographs at 1 year confirmed osteointergration of the femoral stem implant and no evidence of implant subsidence or progression of osteoarthritis. However, there was some evidence of mild lucency of the acetabular bed around the prosthetic femoral head and mild peri-acetabular sclerosis in four cases. Conclusion Hip hemi-arthroplasty provides a clinically acceptable treatment for disabling disease of the coxofemoral joint with 10/11 patients achieving acceptable short-term clinical function. Long-term assessment of the hip hemi-arthroplasty and comparison with total hip replacement is indicated.

scholarly journals Our Experience with Short Stem Hip Replacement Surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Sumeet Rastogi ◽  
Sanjiv K S Marya
Keyword(s):  
Soft Tissue ◽  
Hip Replacement ◽  
Stress Shielding ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Hip Implant ◽  
Excellent Outcome ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

Context-A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips.Materials and methods-50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009). Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw) with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter.Statiscal analysis used-VAS and Harris hip score formed the basis of evaluationResults-These patients were followed up for a mean period of 49 months (Range 36-72 months). The average incision size was 14.38 cm (10-18 cm) and blood loss was 269 ml (175-450 ml). There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 %) had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41) patients had an excellent outcome at last follow-up.Conclusion-We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit initially followed by bone in-growth and was ideally suited to satisfy the requirements of a conservative hip implant. Unfortunately, due to unknown reasons, the implant has been recently withdrawn from the market by DePuy and is no longer available for use.Key MessageConservative hip stems that preserve bone and soft tissue at the time of surgery, prevent femoral stress shielding by circumferential loading, promote positive bone remodeling and help to make revision surgeries easier are ideally suited as hip implants for young active adults with end stage hip disease requiring hip replacement surgery.

Outcomes of Total Hip Replacement in Limbs Affected by Poliomyelitis

2016 ◽  
Vol 27 (2) ◽  
pp. 198-204
Author(s):  
Cesare Faldini ◽  
Marcello De Fine ◽  
Alberto Di Martino ◽  
Daniele Fabbri ◽  
Raffaele Borghi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Hip Osteoarthritis ◽  
Lateral Approach ◽  
Harris Hip Score ◽  
Total Hip ◽  
Hip Replacements ◽  
Hip Diseases

Introduction The outcomes of total hip replacement in patients suffering from residual poliomyelitis are poorly covered in the literature. In this retrospective study we posed the question of whether total hip replacement performed for degenerative hip diseases in limbs with residual poliomyelitis could determine satisfactory mid-term clinical and radiographic results, with a reasonable complication rate. Methods A retrospective study was carried out to assess the results of 14 total hip replacements performed on 14 patients with residual poliomyelitis on the involved limb from June 1999 to September 2011. Average age at the time of surgery was 51 years (range 26-66 years). Mean duration of follow-up was 92 months (range 52-156 months). Surgery was performed through a direct lateral approach on all hips. All but one were cementless implants. Results 2 implants failed, 1 due to traumatic acetabular fracture 6 days after surgery, and 1 due to aseptic cup loosening 13 years after surgery. Surgery was uneventful in all patients except 1 (7%), who experienced a transient sensory sciatic nerve palsy. At the latest follow up Harris Hip Score was 83.3 (range 72-91) with a marked improvement when compared to preoperative score (average 52, range 32-78). No dislocations had occurred. Conclusions Total hip replacement can be considered a feasible option for hip osteoarthritis in patients with limbs affected by residual poliomyelitis. Longer follow-up studies are needed to assess the effectiveness of unconstrained total hip replacement in polio patients.

scholarly journals Proximally porous coated femoral stem in total hip replacement - 5- to 13-year follow-up report

2000 ◽  
Vol 24 (2) ◽  
pp. 97-100 ◽  
Author(s):  
D. Weber ◽  
D. L. Pomeroy ◽  
R. Brown ◽  
L. A. Schaper ◽  
W. E. Badenhausen, Jr. ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Total Hip

scholarly journals Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Alain Cypres ◽  
Arnaud Fiquet ◽  
Philippe Girardin ◽  
David Fitch ◽  
Philippe Bauchu ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Total Hip ◽  
Cementless Femoral Stem

Abstract Background The separate design concepts of dual-mobility cups and triple-taper femoral stems were developed to improve survivorship following total hip replacement (THR) by reducing instability/dislocation and enabling enhanced fixation. Successful outcomes at over two decades have been reported with earlier-generation devices based on these concepts. The current study aimed to provide the first long-term results with a unique pairing of later-generation dual-mobility cup and triple-taper cementless femoral stem after a decade of use in patients undergoing THR. Methods In this retrospective analysis, records were reviewed for all subjects implanted with this dual-mobility cup/cementless femoral stem combination at three centers between 2002 and 2005. Any subject who had not already had follow-up visit beyond 10 years, was not previously revised, and still living were invited for a single follow-up visit consisting of Merle d’Aubgine Scores, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and standard radiographs. Results There were 244 THRs available for analysis. At a mean follow-up of 11.9 years, the Kaplan-Meier survivorship (endpoint: revision for any reason) was 99.1% (95% CI, 97.6–99.7) for the stem and 95.9% (95% CI, 93.1–97.6) for the cup. Merle d’Aubigne Scores were significantly improved from baseline and WOMAC scores were in the satisfactory range at the final follow-up. Radiographic analysis revealed no cases of stem subsidence, no cases of bone hypertrophy, 1 (0.4%) case of bone atrophy, and 3 (1.2%) cases of osteolysis around the stem. No subjects had radiolucent lines greater than 1 mm in any femoral Gruen zone. Evidence of cup migration was seen in 1 (0.4%) subject and 1 (0.4%) subject had evidence of osteolysis that was seen in Gruen zones I, II, IV, and V. Conclusions This combination of a later-generation dual-mobility cup and cementless triple-taper stem was associated with excellent survivorship and satisfactory functional outcomes at over 10 years follow-up. Trial registration ClinicalTrials.gov, NCT02648152. Date of registration: January 6, 2016. Retrospectively registered.

The Cemented Custom Femoral Stem - a 10 Year Review

2007 ◽  
Vol 17 (4) ◽  
pp. 194-204 ◽  
Author(s):  
S. O'brien ◽  
R.K. Wilson ◽  
B.M. Hanratty ◽  
N.W. Thompson ◽  
M.E. Wallace ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Median Survival ◽  
Revision Surgery ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Kaplan Meier ◽  
Custom Made ◽  
Titanium Stem

We report a series of 706 patients (759 hip implants) with an average follow up of 10.5 years (range, 10 - 11 years) following total hip replacement (THR) using a cemented custom-made femoral stem and a cemented HDP acetabular component. The fate of every implant is known. One hundred and seventy-four patients (23%) were deceased at the time of their 10-year review - all died with a functioning THR in situ. Four hundred and sixty-two patients (61%) were subsequently reviewed. One hundred and twenty three patients (16%) were assessed by telephone review, as they were too ill or unwilling to attend. Kaplan-Meier survival analysis (all components) demonstrated a median survival at 10 years of 96.05% or 95% Confidence Intervals (CI) for median survival of (94.41% to 97.22%). Revision surgery occurred in 30 cases (3.9%). Seventeen had full revisions (2.2%) and 13 (1.7%) socket revisions only. Twenty-one out of 30 revisions were for infection or dislocation. There were 2 cases (0.3%) of revision for aseptic loosening of the stem. The 10-year results of the custom femoral titanium stem are encouraging and compare well with other cemented systems.

Hip replacement in patients younger than 65 years: Results of the CLS prosthesis

2003 ◽  
Vol 13 (3) ◽  
pp. 133-141 ◽  
Author(s):  
G.S. Radcliffe ◽  
J.I. Wilson ◽  
R.U. Ashford ◽  
P.G. De Boer
Keyword(s):  
Patient Satisfaction ◽  
Confidence Interval ◽  
Hip Replacement ◽  
Clinical Results ◽  
Total Hip Replacements ◽  
Hip Replacements ◽  
Show Evidence ◽  
The Mean ◽  
Lost To Follow Up

We present the results of a retrospective review of 65 CLS uncemented total hip replacements in 47 patients all of whom were less than 65 years of age at the time of surgery. The mean follow-up was 6.5 years and only one case was lost to follow-up. The clinical results were good. The mean (95% confidence interval) Merle d'Aubigne Postel score for pain (max. 6) was 5.42 ± 1.13 (5.13 – 5.71) and for mobility (max. 6) 5.55 ± 0.71 (5.37 – 5.73). The mean score for patient satisfaction (max. 5) was 4.89 ± 0.46 (4.77 – 5.00). The mean total score was therefore 15.97 ± 1.70 (95% confidence interval 15.54 - 16.40) from a maximum of 17 points. There were three revisions over the study period giving a mean (95% confidence interval) survivorship of 96.5% (91.9% - 100%) at five years. We present the results of a radiological review, which show that the surviving implants show evidence of osseointegration. This was achieved despite the lack of a porous or hydroxyapatite coating.

scholarly journals The hidden costs of metal-on-metal hip resurfacing: the financial and logistical implications of a change in hospital follow-up policy

2013 ◽  
Vol 95 (3) ◽  
pp. 88-91
Author(s):  
J Lloyd ◽  
I Starks ◽  
T Wainwright ◽  
R Middleton
Keyword(s):  
Hip Replacement ◽  
Hip Resurfacing ◽  
Surface Wear ◽  
Bearing Surface ◽  
Total Hip ◽  
Total Hip Replacements ◽  
Large Head ◽  
Metal On Metal ◽  
Hip Replacements

Metal-on-metal (MoM) hip resurfacings (HRs) and large head total hip replacements (LHTHRs) were perceived by many as a surgical revolution, with clear advantages over the traditional metal-on-polyethylene total hip replacement (THR). This is especially the case for younger, active individuals in whom conventional THR has been associated with higher rates of aseptic loosening. In addition to less bearing surface wear, frequently cited advantages for HR include the preservation of femoral bone stock, lower dislocation rates, and superior function and activity scores.

Cemented femoral stem fixation through the anterior approach has fewer early complications than cementless fixation

2021 ◽  
Vol 103-B (7 Supple B) ◽  
pp. 33-37 ◽  
Author(s):  
Kwame A. Ennin ◽  
Karim A. Elsharkawy ◽  
Shuvalaxmi Dasgupta ◽  
Roger H. Emerson
Keyword(s):  
Anterior Approach ◽  
Older Patients ◽  
Femoral Stem ◽  
Consecutive Series ◽  
Cementing Technique ◽  
Cementless Fixation ◽  
Early Complications ◽  
Surgical Complexity ◽  
Cemented Stem

Aims To achieve the functional benefits of the direct anterior (DA) approach and the fixation benefits of cemented replacement, this study combined the two techniques posing the following questions: does the limited access of the DA approach adversely affect the cement technique?; and does such a cementing technique reduce the incidence of cementless complications? Methods A consecutive series of 341 patients (360 hips) receiving the DA approach between 2016 and 2018 were reviewed. There were 203 cementless stems and 157 cemented stems. Mean age was 75 years (70 to 86) in the cementless group and 76 years (52 to 94) in the cemented group, with 239 (70%) females in the whole series. Femoral complications were compared between the two groups. Mean follow-up was 1.5 years (0.1 to 4.4) for patients in the cementless group and 1.3 years (0.0 to 3.9) for patients in the cemented group. Results The cementless group had a higher rate of femoral complications (8 vs 0; p = 0.011). There were two loose stems and six fractures, all requiring revision. Fractures occurred a mean 14.5 days (2 to 31) postoperatively and loosening at 189 days and 422 days postoperatively. Femoral cementing can be done using the DA approach safely and reduces the number of complications compared with a contemporary cementless series. Conclusion A higher rate of early fractures and loosening occurred with cementless stems. This was not observed in our cemented stem cohort and cementing was safely accomplished through the DA approach. The modern femoral cementing process with the DA approach does not add to surgical complexity or time, has fewer early complications, and is a safer option for older patients compared to cementless femoral arthroplasties. Cite this article: Bone Joint J 2021;103-B(7 Supple B):33–37.

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