The fate of sagittal alignment in tapered uncemented femoral components in total hip arthroplasty: 889 hips followed for a minimum of 10 years

2020 ◽  
pp. 112070001989598
Author(s):  
Eduardo García-Rey
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Sagittal Alignment ◽  
Posterolateral Approach ◽  
Harris Hip Score ◽  
Anterolateral Approach ◽  
Total Hip ◽  
Group 3

Purpose: Aseptic loosening is rare after primary total hip arthroplasty (THA) with mostly uncemented tapered stems; however, different factors can modify the results. We question whether 3 different current femoral components and/or the surgical technique affect the clinical and radiological outcome after a minimum follow-up of 10 years. Methods: 889 uncemented tapered stems implanted from 1999 to 2007 were evaluated for a minimum follow-up of 10 years. Group 1 (273 hips) shared a conical shape and a porous-coated surface, group 2 (286 hips) a conical splined shape and group 3 (330 hips) a rectangular grit-blasted stem. Groups 1 and 2 were implanted through a posterolateral approach and group 3 using an anterolateral approach. Clinical outcomes and anteroposterior and sagittal radiographic analyses were compared. Results: No thigh pain was reported in unrevised patients. Mean Harris Hip score was lower for patients in group 3 for pain and function at all intervals. 14-year implant survival for aseptic loosening was 98.2% (95% confidence interval [CI] 96.2–100) in group 3. No revision for aseptic loosening was found with the other designs. A stem position outside neutral limits in the sagittal alignment ( p = 0.001, hazard ratio: 6.17, 95% CI, 2.05–18.61) was associated with aseptic loosening in group 3. Conclusions: Most current uncemented straight tapered femoral components can provide adequate bone fixation in primary THA after 10 years. Conical stems inserted through a posterolateral approach are more reliable than rectangular ones inserted through an anterolateral approach.

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.

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 Heterotopic ossification in primary total hip arthroplasty using the posterolateral compared to the direct lateral approach

2021 ◽  
Author(s):  
J. H. J. van Erp ◽  
J. R. A. Massier ◽  
S. Truijen ◽  
J. E. J. Bekkers ◽  
T. E. Snijders ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Rating Scale ◽  
Lateral Approach ◽  
Posterolateral Approach ◽  
Harris Hip Score ◽  
Total Hip ◽  
Direct Lateral Approach

Abstract Purpose Total hip arthroplasty (THA) is a successful procedure. However, in time, heterotopic ossification (HO) can form due to, amongst others, soft tissue damage. This can lead to pain and impairment. This study compares the formations of HO between patients who underwent either THA with the posterolateral approach (PA) or with the direct lateral approach (DLA). Our hypothesis is that patients who underwent THA with a PA form less HO compared to THA patients who underwent DLA. Methods In this prospective cohort study, 296 consecutive patients were included who underwent THA. A total of 127 patients underwent THA with the PA and 169 with the DLA. This was dependent on the surgeon’s preference and experience. More than 95% of patients had primary osteoarthritis as the primary diagnosis. Clinical outcomes were scored using the Numeric Rating Scale (NRS) and Harris Hip Score (HHS), radiological HO were scored using the Brooker classification. Follow-up was performed at 1 and 6 years postoperatively. Results Two hundred and fifty-eight patients (87%) completed the 6-year follow-up. HO formation occurred more in patients who underwent DLA, compared to PA (43(30%) vs. 21(18%), p = 0.024) after 6 years. However, the presence of severe HO (Brooker 3–4) was equal between the DLA and PA (7 vs. 5,p = 0.551). After 6 years the HHS and NRS for patient satisfaction were statistically significant higher after the PA (95.2 and 8.9, respectively) compared to the DLA (91.6 and 8.5, respectively) (p < 0.001 and p = 0.003, respectively). The NRS for load pain was statistically significant lower in the PA group (0.5) compared to the DLA group (1.2) (p = 0.004). The NRS for rest pain was equal: 0.3 in the PA group and 0.5 in the DLA group. Conclusion THA with the PA causes less HO formation than the DLA. Trial registration Registrated as HipVit trial, NL 32832.100.10, R-10.17D/HIPVIT 1. Central Commission Human-Related research (CCMO) Registry.

scholarly journals Anterolateral Approach Might Be Superior to Posterolateral Approach in Controlling Lower Limb Discrepancy for Special Total Hip Arthroplasty Patients

2021 ◽  
Author(s):  
Ao Xiong ◽  
Guoqing Li ◽  
Su Liu ◽  
Chang Xu ◽  
Deli Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lower Limb ◽  
Univariate Analysis ◽  
Hospital Costs ◽  
Developmental Dysplasia ◽  
Posterolateral Approach ◽  
Anterolateral Approach ◽  
Total Hip

Abstract Objectives: Variable approaches for total hip arthroplasty (THA) are promoted but investigations of associations between the approaches and the postoperative lower limb discrepancy (LLD) are limited. We intended to compare the efficacy between the anterolateral approach (ALA) and posterolateral approach (PLA) in controlling of postoperative LLD. Methods: Two retrospective cohorts were established including patients undergone unilateral primary THA. Preoperative and latest follow-up radiographs were compared and evaluated. Two hundred and sixty patients (140 females and 126 males; aged 46.70 ± 13.62 years) were recruited with around 20 months follow-up postoperatively. Results: Univariate analysis identified lower postoperative LLD, lower postoperative acetabular offset and lower hospital costs in the ALA group than in the PLA group (p＜0.01), however, the femoral and global offset and length of stay (LOS) are comparable between (p > 0.05). Multivariable liner regression revealed that PLA, preoperative LLD, developmental dysplasia of the hip and aseptic avascular necrosis are major contributors to the postoperative LLD (p<0.05). Conclusions: This study illustrates that the ALA might be superior to the PLA in controlling the postoperative LLD among some of the THA patients. Both ALA and PLA are comparable in regard to femoral and offset and LOS.

scholarly journals Long-Term Results of Total Hip Arthroplasty with RM Classic Cups

2019 ◽  
Vol 25 (3) ◽  
pp. 25-33
Author(s):  
V. V. Danilyak ◽  
V. V. Klyuchevsky ◽  
M. A. Molodov ◽  
E. V. Goryunov ◽  
K. V. Marchenkova
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Polyethylene Wear ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Pelvic Bone ◽  
Total Hip

Relevance. The RM Classic monoblock titanium-coated polyethylene cup is widely used in the total hip arthroplasty. However, so far in Russia there has been no analysis of follow-up over 10 years for a limited number of patients in a single hospital. The aim of the study was to evaluate the long-term outcomes of total hip replacement with RM Classic acetabular component. Materials and Methods. The outcomes of 328 total hip arthroplasties (289 patients operated in the period from 1997 to 2007) with RM Classic cups were evaluated in a monocentral retrospective clinical study. The average follow-up period was 14.4 years. Revision procedure due to aseptic loosening, polyethylene wear or osteolysis was considered as the end point of the study. Results. 9 revisions during the short and medium follow-up periods (up to 10 years) were associated with malpositioning of RM Classic components and errors in surgical technique. The indications for later revision THA (19 cases) were polyethylene wear and aseptic loosening. Only in one case they were combined with pelvic bone osteolysis with the formation of III a defect according to W.G. Paprosky classification. Within 15 years the Kaplan-Meier survivorship of RM Classic cup was 92.5%. There was a statistically significant difference of the survival curves in the ceramic-on-poly against metal-on-poly bearings: 94.9% and 79.4%, respectively. The average Harris Hip Score was 88.6. Conclusion. RM Classic uncemented monoblock cup has proven its high efficiency and survival in 15 years follow-up period and over.

scholarly journals LONG-TERM RESULTS OF ENHANCED TAPERED STEM VerSys ET USE IN PRIMARY TOTAL HIP ARTHROPLASTY

2010 ◽  
Vol 16 (3) ◽  
pp. 7-15
Author(s):  
R. M. Tikhilov ◽  
V. M. Shapovalov ◽  
I. I. Artyukh ◽  
V. A. Shubnyakov
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
High Efficiency ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Total Hip ◽  
The Mean ◽  
Primary Total Hip Arthroplasty

The authors reported the outcome at a minimum of five years of 130 consecutive arthroplasties of VerSys ET (Zimmer) in 111 patients. The procedures were performed between 2001 and 2004. In 129 cases (99.2%) Trilogy cup (Zimmer) was used in one case - Muller's acetabular cage (Mathys). The mean age of patients was 49.5 (SD 11.5) (23 to 73), male 76 (58.5%), female - 54 (41.5%), overweight patients 109 (83.8%). Majority of patients had activity in Charnley class A. The most frequent was femur Dorr type A (27,0%) and Dorr type В (66,1%). The mean follow-up was 76 months (60 to 96). The outcomes assessed in 103 patients (120 hips) (92.3%). Outcomes of ten cases were not determined. The mean Harris Hip score improves from 35.1 (SD 8.3) preoperatively to 94.3 (SD 8.5) post-operatively. Kaplan-Meier analysis with revision of the stem as the end-point demonstrated 97,7% survival in term 60 to 96 months, for aseptic loosening - 99,2%. Subsidence of the implants in 61 (50.8%) patients was fixed at a mean follow-up 18.3 (SD3.7) months after surgery and did not progress further. After surgery stem position was neutral 91(75.8%) patients, varus - 14 (12.1%) and valgus - 14 (12.1%). Complications were observed in 8 (6.7%) cases: among them - periprosthetic fractures 6 (5.0%), stem aseptic loosening - 1 (0.8%), recurrent dislocation - 1 (0.8%). Four patients undergone revision surgery We consider the high efficiency of VerSys ET stem use for primary total hip arthroplasty.

A prospective randomised comparison of earlier function after total hip arthroplasty with a mini posterior approach or supercapsular percutaneously-assisted total hip approach: a gait analysis study

2021 ◽  
pp. 112070002110184
Author(s):  
Andrey A Korytkin ◽  
Younes M El Moudni ◽  
Yana S Novikova ◽  
Kirill A Kovaldov ◽  
Ekaterina A Morozova
Keyword(s):  
Total Hip Arthroplasty ◽  
Gait Analysis ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Gait Velocity ◽  
Harris Hip Score ◽  
Kinematic Parameters ◽  
Gait Patterns ◽  
Total Hip

Background: The supercapsular percutaneously-assisted total hip (SuperPATH) approach is a muscle sparing surgical technique for total hip arthroplasty (THA). The literature reports good clinical and functional results of the SuperPATH technique in the short term. We aimed to compare early outcomes and gait analysis of THA using the mini posterior approach (MPA) and supercapsular percutaneously-assisted total hip (SuperPATH) approach. Methods: 44 patients who underwent THA, were randomly allocated to either MPA or SuperPATH. The data were then collected prospectively (preoperatively and postoperatively at 6 weeks). Plain anteroposterior radiographs of the pelvis and instrumental gait analysis were obtained. The visual analogue scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were used to assess functional and clinical outcomes. Results: No significant difference was found in patients’ surgical outcomes. Patients in the SuperPATH group had less pain according to the VAS score at follow-up than the MPA group ( p < 0.01). There was also a significant improvement in HHS and HOOS scores for all patients ( p < 0.001) with the SuperPATH group showing superior changes. The comparison of mean differences in gait velocity between preoperative and 6 weeks postoperative result, revealed improvement in the SuperPATH group over the MPA group ( p = 0.06). Limping was more persistent in the MPA group. Kinematic parameters demonstrated improved hip joint excursion slightly higher in the MPA group. There was no significant improvement in kinetic and kinematic parameters at different walking moments for all patients at 6 weeks compared to preoperative gait patterns. Conclusions: SuperPATH and MPA both show excellent results. This study reveals that the SuperPATH technique was associated with lower postoperative pain levels, and higher physical function and quality of life. Improved functional outcomes allowed earlier postoperative rehabilitation and faster recovery. Specific improvement in gait patterns were identified with nonsignificant differences between the 2 approaches at 6 weeks follow-up.

Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up

2021 ◽  
Author(s):  
Moritz Sharabianlou ◽  
Prerna Arora ◽  
Derek Amanatullah
Keyword(s):  
Total Hip Arthroplasty ◽  
Functional Recovery ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Harris Hip Score ◽  
Timed Up And Go ◽  
Total Hip ◽  
Radiologic Evaluation ◽  
Superior Approach

This study aims to establish the midterm safety and performance for the direct superior approach to minimally invasive surgery total hip arthroplasty (MIS-THA). We used a unicentric, single-surgeon, retrospective, consecutive case series analysis of the first 40 patients who received primary unilateral direct superior MIS-THA. Special attention was given to functional recovery by measuring Harris Hip Score (HHS) and timed-up-and-go (TUG) with a mean follow up of 2.2 ± 0.4 years. A radiologic evaluation was performed. HHS and TUG improved significantly at three months and one year (p < 0.001). All components were placed within the Lewinnek safe zone with no change position or signs of loosening at two years. With a minimum of two years of follow up, the direct superior approach appears to be safe without any obvious or consistent postoperative complications—clinically or radiographically—with excellent functional recovery. Additionally, our subgroup analysis supported no late learning curve effect.

scholarly journals A 10-Year Follow-Up of Two-Incision and Modified Watson-Jones Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Shih-Jie Lin ◽  
Tsan-Wen Huang ◽  
Po-Chun Lin ◽  
Feng-Chih Kuo ◽  
Kuo-Ti Peng ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Large Scale ◽  
Operation Time ◽  
Harris Hip Score ◽  
Total Hip ◽  
Radiographic Parameters

Long-term data and information indicating whether minimally invasive surgery (MIS) approaches are safe and effective with total hip arthroplasty (THA) are lacking. Between 2004 and 2006, 75 patients with alcohol-related osteonecrosis of the femoral head (ONFH) who underwent 75 THAs with the two-incision approach were studied. The medical records, radiographic parameters, and functional outcomes were collected prospectively. All data were compared with those for matched patients who underwent a modified Watson-Jones (WJ) approach. THA using the two-incision approach was associated with longer operation time, more blood loss, more lateral femoral cutaneous nerve injury, and more periprosthetic femoral fractures (p<0.05for all four) than the modified WJ approach. The Harris Hip Score (HHS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) increased significantly from the period preoperatively to 6 weeks postoperatively and thereafter up to the last follow-up in both groups. However, there were no significant differences in terms of radiographic parameters and functional outcomes between the two groups throughout the study period. Both the two-incision and the modified WJ approach provided satisfactory results and survival rates at a mean follow-up of 10.8 years. A prospective, randomized, large-scale cohort study is still warranted for evidence-based recommendations.

scholarly journals Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

2021 ◽  
Vol 2 (12) ◽  
pp. 1035-1042
Author(s):  
Maciej Okowinski ◽  
Mette Holm Hjorth ◽  
Sebastian Breddam Mosegaard ◽  
Jonathan Hugo Jürgens-Lahnstein ◽  
Stig Storgaard Jakobsen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Femoral Bone ◽  
Total Hip ◽  
Stem Subsidence ◽  
Femur Fractures

Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.

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