A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem

2018 ◽  
Vol 29 (5) ◽  
pp. 481-488 ◽  
Author(s):  
Edouard Dessyn ◽  
Xavier Flecher ◽  
Sebastien Parratte ◽  
Matthieu Ollivier ◽  
Jean-Noël Argenson
Keyword(s):  
At Risk ◽  
Aseptic Loosening ◽  
Functional Anatomy ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Continuous Series ◽  
Total Hip ◽  
Patients At Risk ◽  
The Individual

Aim: The purpose of this study is to report the 20-year follow-up of a continuous series of 232 total hip arthroplasties (THAs) performed in patients aged less than 50 at the index surgery. Patients and methods: This is a retrospective monocentric study which reports the clinical, radiographical and survival results of 232 THAs performed with a custom cementless femoral stem in 212 patients evaluated at follow-up ranging from 14 to 27 years. Results: At the time of follow-up, the mean Harris Hip Score was 94.1 (range 48–100). The Hip disability and Osteoarthritis Outcome Score was >80 points in all 5 categories for 146 patients (68.9%). 18 hips (8.5%) showed radiographical femoral abnormalities. 23 hips (10.8%) underwent revision of the implants. 13 were isolated cup revisions. 3 more hips had bipolar revisions for aseptic loosening at 15, 20 and 21 years. Taking stem revision for aseptic loosening as an endpoint, survivorship was 96.8% at 20 years (95% confidence interval, 95.1–98.5; patients at risk 76) and 94.5% at 25 years (91.7–97.3; patients at risk 12). Conclusions: The results of this study confirm that THA using this custom-designed stem can provide excellent clinical and radiographical outcomes at a mean follow-up of 20 years in patients younger than 50. The individual 3D femoral stem and prosthetic neck has been able to restore extra- and intramedullary functional anatomy in this young and active cohort of patients.

scholarly journals Implant Breakage Risk for Modular Fluted Tapered Stems in Revision Total Hip Arthroplasty at 5-Year Follow-Up

2020 ◽  
Author(s):  
Thibaut Lucena ◽  
Etienne Cavaignac ◽  
Philippe Chiron ◽  
Nicolas Reina
Keyword(s):  
Aseptic Loosening ◽  
Clinical Outcomes ◽  
Joint Infection ◽  
Case Series ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Total Hip ◽  
Huge Impact ◽  
Implant Breakage

Abstract Background: Modular stems in revision total hip arthroplasties allow diaphyseal fixation and optimal restoration of the architecture of the proximal femur. Several studies report metaphyseal implant breakage in the mid- to long-term and therefore a huge impact on survivorship. We aimed to evaluate a specific design of uncemented modular fluted tapered stems (MFT) to analyze survivorship and clinical and radiological outcomes.Methods: In a retrospective study, we identified 99 patients who had surgery using the same design of MFT implant between 2012 and 2014. Patients were mainly male in 53% and mean age was 73 years. Indications were 33 aseptic loosening, 24 periprosthetic fractures, 23 periprosthetic joint infection, 1 instability and 18 were complex primary arthroplasties. Survivorship, complications and clinical outcomes, were assessed. Mean follow-up was 5 years.Results: There was no implant breakage. At 5-year follow-up, the survivorship free of revision for aseptic loosening and free of revision for any reason of the femoral stem were 100% and 99%, respectively. At last follow-up, they were 94% and 81%, respectively. Six implants were revised. A mean stem subsidence of 6 mm was noted in 9 cases; 1 was revised for aseptic loosening. The Harris hip score was 89. The risk of revision was significantly higher for shorter diaphyseal implants (p=0.026).Conclusion: At mid-term follow-up of 5 years, the MFT studied reported an excellent survivorship and clinical outcomes with no specific complications. Unlike literature reports, no specific complications occurred with this design. Satisfying clinical outcomes and limited subsidence are consistent with previous reports though.Level of evidence: IV – Case series

Long-term results of acetabular reconstruction using irradiated allograft bone

2018 ◽  
Vol 100-B (11) ◽  
pp. 1449-1454 ◽  
Author(s):  
C. M. Green ◽  
S. C. Buckley ◽  
A. J. Hamer ◽  
R. M. Kerry ◽  
T. P. Harrison
Keyword(s):  
At Risk ◽  
Aseptic Loosening ◽  
Acetabular Component ◽  
Long Term Results ◽  
Acetabular Reconstruction ◽  
Allograft Bone ◽  
Patients At Risk ◽  
Irradiated Allograft

Aims The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Patients and Methods Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. Results At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). Conclusion Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449–54.

Midterm outcomes of total hip arthroplasty with a modular Birmingham head

2019 ◽  
pp. 112070001987738 ◽  
Author(s):  
Duncan W Cushnie ◽  
Brent A Lanting ◽  
Richard McCalden ◽  
Douglas DR Naudie ◽  
James L Howard
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Tissue Reaction ◽  
Harris Hip Score ◽  
Total Hip ◽  
Tissue Reactions ◽  
Clinical Records

Introduction: Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). Methods: A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. Results: 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls ( p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. Discussion: BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.

The Wagner SL-Revision Stem for Aseptic Loosening: Clinical and Radiological Results 5 to 7 Years after Femoral Revision

2003 ◽  
Vol 13 (2) ◽  
pp. 94-100
Author(s):  
M.J.F. Diks ◽  
M. Spruit ◽  
J.J. Reimering ◽  
F. Den Boer ◽  
P.G. Anderson
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Primary Stability ◽  
Harris Hip Score ◽  
Radiological Evaluation ◽  
Total Hip ◽  
Revision Stem

Aseptic loosening in total hip arthroplasty can lead to proximal femoral periprosthetic bone loss. The non-cemented Wagner revision stem achieves primary fixation in the diaphysis. The purpose of this study is to evaluate the results after medium- to long-term follow-up of the Wagner prosthesis for revision of the femoral component for aseptic loosening in total hip arthroplasty with proximal femoral bone loss. We performed 53 femoral revisions for aseptic loosening with the non-cemented Wagner revision stem. Clinical assessment included a modified Harris Hip Score and a radiological evaluation. The mean follow-up was 65 months. The Harris Hip Score improved significantly (42.9 to 72.3). Radiological evaluation revealed 24.5% subsidence (>5 mm) in our population. Nine re-revisions were done, eight in the first post-operative year. The re-revisions were performed for progressive subsidence (five), recurrent dislocations (one), subsidence with low-grade infection (one), false route (one), and aseptic loosening after 75 months (one). The cumulative survival rate of the Wagner stem after 12 months was 85% and 76% after 75 months. A relatively high re-revision rate was observed during the first post-operative year. Analysis of these failures has shown that subsidence may be the result of insufficient primary stability. Adequate pre-operative planning and intra-operative radiological assistance is necessary for perfect primary stability and fixation of the Wagner stem. The re-revision incidence after the first 12 months is 0.45 per 100 implants per year. The prosthesis has good survival potential after proper introduction.

Perioperative Fracture Risk and Two-Year Survivorship of a Short Tapered Femoral Stem following Direct Anterior Approach Cementless Total Hip Arthroplasty with a Fracture Table

2020 ◽  
Vol 04 (01) ◽  
pp. 033-037
Author(s):  
Samantha Andrews ◽  
Gregory J. Harbison ◽  
Ian Hasegawa ◽  
Emily Unebasami ◽  
Cass Nakasone
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Femoral Stem ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Fracture Table ◽  
Short Femoral Stem

AbstractThe cementless, tapered wedge, short femoral stem implant is commonly used in direct anterior approach (DAA) total hip arthroplasty (THA). The lack of access and visualization, however, may increase the risk of perioperative fracture and early failure. Therefore, the current study examined perioperative complications and 2-year implant survivorship following DAA THA performed using a fracture table and short, tapered wedge femoral stem. A retrospective analysis was conducted on patients having undergone DAA THA with a cementless, tapered wedge, short femoral stem. Perioperative fractures were noted and survivorship was determined by the incidence of revision surgery within a minimum 2-year follow-up period. A total 366 consecutive patients (441 hips) were identified in the cohort. Four patients (6 hips; 1.4%) were lost to follow-up and three patients died from unrelated causes. Average follow-up time for the remaining 359 patients (435 hips) was 32.9 ± 10.2 months. There were no intraoperative factures but three perioperative fractures within two weeks. Aseptic loosening occurred in one stem at 13 months, resulting in a 99.1% survival rate with a mean survival time of 23.8 ± 0.1 months (95% confidence interval: 23.6–24.0 months). The use of a short, tapered wedge femoral stem and a fracture table for DAA THA resulted in 0.7% periprosthetic fractures and only one aseptic loosening within 2 years. These results suggest that proper femoral exposure with the use of a fracture table and a short, tapered wedge femoral stem does not appear to increase the risk of periprosthetic femoral fracture.

scholarly journals Catastrophic Failure and Metallosis of the Acetabular Component in Total Hip Arthroplasty

2021 ◽  
Author(s):  
FIRAT OZAN ◽  
Murat Kahraman ◽  
Ali Baktır ◽  
Kürşat Gençer
Keyword(s):  
Revision Arthroplasty ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Catastrophic Failure ◽  
Total Hip ◽  
Catastrophic Failures ◽  
Revision Tha ◽  
The Mean ◽  
Hip Arthroplasties

Abstract Background: To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods: Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results: The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions: Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.

Use of telephone interviews to follow up patients after total hip replacement

2005 ◽  
Vol 11 (4) ◽  
pp. 211-214 ◽  
Author(s):  
Sanjeev Sharma ◽  
Ravi Shah ◽  
Kingsley Paul Draviraj ◽  
M S Bhamra
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Harris Hip Score ◽  
Face To Face ◽  
Total Hip ◽  
Telephone Interviews ◽  
Significant Difference ◽  
The Mean ◽  
The Individual

We studied the feasibility of telephone interviews to assess hip function in patients who had had a total hip replacement. One hundred patients attending the orthopaedic clinic for follow-up after undergoing total hip replacement were studied. A modified Harris hip score was used. Since range of motion and deformity cannot be assessed by telephone, only pain and function were assessed. The maximum possible score was 100. Patients attending follow-up clinics were contacted by telephone one to two weeks prior to their appointment and a telephone assessment was completed. This was then compared with a face-to-face assessment in the subsequent clinic. The mean hip score obtained with the telephone interview was 85.2 and the mean hip score at face-to-face assessment was 86.1. The mean of the differences between the individual scores was −0.9 (SD 5.5). This difference was not significant ( P=0.11). Only three patients had a clinically significant difference (>20 points) between the two methods. Telephone questionnaires may be a useful adjunct to face-to-face assessment for patient follow-up after total hip replacement.

Does hydroxyapatite coating enhance ingrowth and improve longevity of a Zweymuller type stem? A double-blinded randomised RSA trial

2017 ◽  
Vol 28 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Daniel Hoornenborg ◽  
Inger N. Sierevelt ◽  
Joost A. Spuijbroek ◽  
John Cheung ◽  
Harm M. van der Vis ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Femoral Stem ◽  
Hydroxyapatite Coating ◽  
Harris Hip Score ◽  
Double Blind ◽  
Long Term Outcome ◽  
Total Hip ◽  
Early Migration ◽  
Significant Difference

Introduction: An ongoing discussion is whether using a hydroxyapatite coating enhances the ingrowth and longevity of a femoral stem in total hip arthroplasty. The best way to predict speed of ingrowth and long-term outcome is by evaluating micromotion by radiostereometric analysis. To study the effect of hydroxyapatite (HA) coating on the migration of the SL-PLUS hip stem, we performed a prospective double blind randomised controlled trial comparing the early migration of the hydroxyapatite (HA)-coated SL-PLUS stem compared to the Standard (non-coated) SL-PLUS stem. Patients and methods: 51 patients were randomly assigned to receive either an uncoated or a HA-coated femoral component during total hip replacement. RSA images were obtained direct postoperatively and at 6 weeks, 12 weeks, 6 months, 12 months and 24 months. HOOS scores were obtained preoperative and at final follow-up. Results: RSA evaluation demonstrated significant migration up to 3 months postoperatively in both groups. After initial setting no significant migration was observed. There was no significant difference in migration between the HA-coated group and the uncoated group. Both Harris Hip Score (HHS) and HOOS domain scores (pain and ADL) significantly improved compared to baseline at 24 months after surgery in both treatment groups (p<0.001 for all comparisons). Improvement did not differ significantly between the 2 groups. Conclusions: At 2 years follow-up, the HA-coated and uncoated Zweymuller type, distal fitting stem do not show different migration patterns.

scholarly journals Primary total hip arthroplasty in patients with rheumatoid arthritis

2006 ◽  
Vol 53 (4) ◽  
pp. 117-120 ◽  
Author(s):  
B.M. Gluscevic ◽  
B.D. Kraljevic ◽  
V.A. Jovanovic ◽  
P.B. Stosic ◽  
D.M. Milosavljevic ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Fixation Method ◽  
Harris Hip Score ◽  
Total Hip ◽  
And Function

Total hip arthroplasty has become a successful way of treating the painful and destroyed hip joint in the patient with rheumatoid arthritis( RA). Two hundred twenty(135 cemented and 85 noncemented) total hip arthroplasties we were performed in 180 patients with rheumatoid arthritis. The average age was 48,61 years and the average follow-up was 8,4 years. Clinical evaluation was based on a Harris hip score that showed significant improvement in pain and function preoperatively compared with pain and function at follow-up. There were two deep infections requiring removal of the prosthesis. Four cemented acetabular cups and one cemented femoral component were revised due to aseptic loosening. Three acetabular rings were revised due to aseptic loosening. The relatively inferior results of total hip arthroplasty among RA patients is due not only to fixation method, but also to the poorer bone quality and weakening musculature. The results in these patients suggest that cement less total hip arthroplasty might become a successful way of treating the destroyed hip joint in the patient with rheumatoid arthritis.

scholarly journals EVALUATION OF THE RESULTS OF CEMENTLESS TOTAL HIP ARTHROPLASTY IN PATIENTS WITH STAGES IV, V AND VI OSTEONECROSIS OF THE FEMORAL HEAD

2020 ◽  
Vol 62 (1) ◽  
Author(s):  
Đắc Việt Mai ◽  
Thu Thủy Nguyễn
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Ingrowth ◽  
Femoral Stem ◽  
Stage Iv ◽  
Harris Hip Score ◽  
Total Hip ◽  
The Mean

This study aimed to report the outcome of total hip arthroplasty (THA) with an extensive hydroxyapatite (HA) coating for the fixation of a tapered femoral stem (Corail) in patients aged 60 or younger than sixty years with stage IV, V và VI osteonecrosis of femoral head. Subject and method: Descriptive prospective research of ninety osteonecrotic hips in ninety patients were available for clinical and radiographic analyses at minimum follow-up of 5 years. Results and Conclusion: The mean Harris hip score improved from 43.74 ± 9,25points preoperatively to 96.67 ± 3.82points at final follow-up. Seventy-four (100%) hips demonstrated stable bone ingrowth. No hips showed acetabular or femoral osteolysis radiolucency and loosening, or required revision for aseptic loosening. We believe that cementless THA with a Corail stem is a promising procedure for patients with osteonecrosis of the femoral head.

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