scholarly journals Midterm outcome of fourth-generation ceramic-on-ceramic bearing surfaces in revision total hip arthroplasty

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878391 ◽  
Author(s):  
Jun-Dong Chang ◽  
In-Sung Kim ◽  
Sameer Ajit Mansukhani ◽  
Vishwas Sharma ◽  
Sang-Soo Lee ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Fourth Generation ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Revision Tha ◽  
Ceramic On Ceramic

Purpose: The purpose of this study is to evaluate the clinical and radiologic outcomes after revision total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) bearing surfaces. Methods: A total of 52 revision THAs (28 men and 19 women) using the fourth-generation CoC bearing surfaces were retrospectively evaluated. Both acetabular cup and femoral stem were revised in all cases. The mean follow-up period was 7.3 years (range, 4.0–9.9 years). The clinical results with Harris hip score (HHS), Western Ontario McMaster Osteoarthritis Index (WOMAC), and radiologic outcomes were evaluated. Results: At the final follow-up examination, the average HHS was 90.4 (range, 67–100). The average WOMAC pain and physical function score were 2.8 (range, 0–12) and 16.4 (range, 0–42), respectively. Complications were observed in 10 hips (19.2%). However, there were no bearing surface-related complications, and no cases of dislocation and squeaking. Retroacetabular pelvic osteolysis without cup loosening was observed in one hip at the final follow-up. However, no hip showed radiographic signs of cup loosening, vertical or horizontal acetabular cup migrations, and changes of inclinations during the follow-up period. Conclusion: Our data showed that clinical and radiologic outcomes after revision THA using fourth-generation CoC bearing were favorable. Hence, revision THA with the use of CoC bearing surfaces can be preferentially considered. Further studies with long-term follow-up data are warranted.

scholarly journals 32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

2018 ◽  
Vol 29 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Yoshitoshi Higuchi ◽  
Taisuke Seki ◽  
Yukiharu Hasegawa ◽  
Yasuhiko Takegami ◽  
Daigo Morita ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Total Hip ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Average Patient ◽  
The Mean ◽  
Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty

2019 ◽  
pp. 112070001987361 ◽  
Author(s):  
Jesús Moreta ◽  
Iker Uriarte ◽  
Xabier Foruria ◽  
Ioar Urra ◽  
Urko Aguirre ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Revision Total Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Revision Tha

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

scholarly journals Cement Removal from the Femur Using the ROBODOC System in Revision Total Hip Arthroplasty

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Mitsuyoshi Yamamura ◽  
Nobuo Nakamura ◽  
Hidenobu Miki ◽  
Takashi Nishii ◽  
Nobuhiko Sugano
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Cement ◽  
Hip Arthroplasty ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Revision Tha ◽  
Cement Removal

Introduction. The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal.Materials and Methods. The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated.Results. The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered.Conclusions. Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.

scholarly journals Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hou-Tsung Chen ◽  
Cheng-Ta Wu ◽  
Tsan-Wen Huang ◽  
Hsin-Nung Shih ◽  
Jun-Wen Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Type Ii ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Press Fit ◽  
Cementless Cup ◽  
Revision Tha ◽  
Acetabular Defects

Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.

Do Cemented Dual-Mobility Cups Confer Stability for Patients at High Risk of Dislocation in Revision Total Hip Arthroplasty?

2018 ◽  
Vol 02 (02) ◽  
pp. 088-091 ◽  
Author(s):  
Perry Evangelista ◽  
Kamil Okroj ◽  
Darren Plummer ◽  
Craig Della Valle ◽  
Ran Schwarzkopf
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Revision Total Hip Arthroplasty ◽  
Acetabular Cup ◽  
Metal Shell ◽  
Dual Mobility ◽  
Total Hip

AbstractDislocation is among the most commonly reported complications following revision total hip arthroplasty. Dual-mobility bearings may lower the risk of dislocation. The authors report the results of a multicenter study evaluating the use of a dual-mobility acetabular cup design that was cemented into a metal shell as part of complex acetabular reconstructions or in cases where the risk of dislocation was felt to be high, such as isolated bearing exchanges. Eighteen patients were identified for being at high risk of dislocation who underwent cementation of a dual-mobility shell that is specifically made for cementation, into a fully porous metal revision acetabular cup (10 patients) or into a well-fixed cup at the time of revision without removal of the existing acetabular component (eight patients). Patients were assessed clinically and radiographically at a minimum of 2 years for the evidence of dislocation, revision surgery, and implant loosening. At a mean of 36 months (range, 25–56 months), one patient died and one was lost to follow-up. There were no known cases of hip dislocation. There was one repeat revision, for a deep infection treated with irrigation and debridement. The mean preoperative Harris Hip Score of 46 (range, 40–79) improved to a mean of 65 points (range, 41–97) at the most recent evaluation. Acetabular components were retained in 8 out of 18 cases and the dual-mobility shell was cemented into it. Cementation of a dual-mobility cup into a shell at the time of a revision surgery is a safe and reliable construct at minimum of 2 years for patients at high risk of dislocation. There were no complications related to the cementation of the cup into the metal shell. Longer follow-up is required to further assess the durability of this construct.

scholarly journals Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

2019 ◽  
Author(s):  
Hao Tang ◽  
Yixin Zhou ◽  
Zhuyi Ma ◽  
Yong Huang ◽  
Shengjie Guo
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Porous Metal ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Fixation Group ◽  
Acetabular Defects ◽  
Type 3

Abstract Background: We proposed a new concept of “iliac extended fixation” in revision total hip arthroplasty (THA) as fixation extending superiorly 2 cm beyond the original acetabular rim with porous metal augments, which was further classified into intracavitary and extracavitary fixation. This study reports the minimum 2 years outcome of the iliac extended fixation technique in patients with Paprosky type 3 acetabular defects. Methods: Thirty two revision THA patients were retrospectively reviewed who underwent reconstruction with the concept of iliac extended fixation from 2014 to 2016 in our hospital. Patients were assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). In addition, radiographs were assessed and patient reported satisfaction was collected. Results: At an average follow-up of 40 months (range 25 – 64 months), the postoperative HHS and WOMAC scores were significantly improved at the last follow-up (p < 0.001). The postoperative horizontal and vertical locations of the COR were significantly improved from the preoperative measurements (p < 0.05). Two (6.3 %) patients were dissatisfied with the outcome. The extracavitary iliac extended fixation group had significantly more horizontal screws fixation (4.6 ± 25.7° vs 41.9 ± 37.8°, p < 0.001) and higher rate of osteointegration in zone 1A (91.7% vs 50.0%, p = 0.023) than the intracavitary iliac extended fixation group. Conclusions: Intracavitary and extracavitary iliac extended fixation with porous metal augments and cementless cups are effective in reconstructing severe superior acetabular bone defects, with promising short-term clinical and radiographic outcome.

scholarly journals Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

2020 ◽  
Vol 30 (1_suppl) ◽  
pp. 7-11
Author(s):  
Massimo Franceschini ◽  
N Amir Sandiford ◽  
Vincenzo Cerbone ◽  
Lucio Cappelli Toledo de Araujo ◽  
Daniel Kendoff
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Short Term ◽  
Total Hip ◽  
Antibacterial Coating ◽  
Revision Tha ◽  
Detailed Function ◽  
New Strategies

Background: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. Scope: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up. Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. Conclusion: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

scholarly journals Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

2019 ◽  
Author(s):  
Hao Tang ◽  
Yixin Zhou ◽  
Zhuyi Ma ◽  
Yong Huang ◽  
Shengjie Guo
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Porous Metal ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Fixation Group ◽  
Acetabular Defects ◽  
Type 3

Abstract Background: We proposed a new concept of “iliac extended fixation” in revision total hip arthroplasty (THA) as fixation extending superiorly 2 cm beyond the original acetabular rim with porous metal augments, which was further classified into intracavitary and extracavitary fixation. This study reports the minimum 2 years outcome of the iliac extended fixation technique in patients with Paprosky type 3 acetabular defects. Methods: Thirty two revision THA patients were retrospectively reviewed who underwent reconstruction with the concept of iliac extended fixation from 2014 to 2016 in our hospital. Patients were assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). In addition, radiographs were assessed and patient reported satisfaction was collected. Results: At an average follow-up of 40 months (range 25 – 64 months), the postoperative HHS and WOMAC scores were significantly improved at the last follow-up (p < 0.001). The postoperative horizontal and vertical locations of the COR were significantly improved from the preoperative measurements (p < 0.05). Two (6.3 %) patients were dissatisfied with the outcome. The extracavitary iliac extended fixation group had significantly more horizontal screws fixation (4.6 ± 25.7° vs 41.9 ± 37.8°, p < 0.001) and higher rate of osteointegration in zone 1A (91.7% vs 50.0%, p = 0.023) than the intracavitary iliac extended fixation group. Conclusions: Intracavitary and extracavitary iliac extended fixation with porous metal augments and cementless cups are effective in reconstructing severe superior acetabular bone defects, with promising short-term clinical and radiographic outcome.

scholarly journals Augmentation for Acetabular Deficiencies in Complex Total Hip Arthroplasty

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0007
Author(s):  
Gandhi Nathan Solayar
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Study Data ◽  
Harris Hip Score ◽  
Wound Complications ◽  
Total Hip ◽  
Early Results ◽  
Revision Tha ◽  
The Mean

Introduction: Complex and revision Total Hip Arthroplasty (THA) is a challenging prospect in patients with acetabular bone deficiencies. Augmentation using allograft and trabecular metal (TM) are among some of the options in these situations. This study report the outcomes of 14 cases of complex and revision THA using acetabular augments performed in our institution between 2015 and 2018 Materials and Methods: In this retrospective study, data included demographic features, indication for THA, type of augments and clinical outcomes using the Harris hip score were collected for the to determine early results following THA. Results: The mean cohort age was 51.3 years. Gender distribution was equal with 7 male and female patients each. 7 THAs were augmented with allograft and 7 cases with TM augments. The average duration of follow-up was 16.9 months. Most patients (11 of 14) required complex primary THA following prior traumatic hip dislocations and its subsequent complications. The mean post-operative Harris hip score for functionality was 80.84 in our cohort at final follow-up (from an average of 33.8 pre-operatively). At present, there have been no reports of wound complications, infections or dislocations in this early cohort. Discussions: Complex/revision THA using allografts for acetabular augmentation have been used for decades with good and replicable results as shown in our series. TM is relatively new but current literatures show encouraging results. Both options have resulted in good outcomes in our cohort and further long term studies would be necessary before TM augments were to replace the need for allograft. Conclusions: Both allografts and TM acetabular augments showed good early results post-operatively in our cohort. With the improved flexibility of component selection and the lower risk of allograft infection, TM augments is currently our choice of acetabular augmentation and the early results are promising.

scholarly journals High survivorship of highly cross-linked polyethylene in revision Total hip Arthroplasty: a minimum 10-year follow-up study

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Seung-Jae Lim ◽  
Ingwon Yeo ◽  
Chan-Woo Park ◽  
Kyung-Jae Lee ◽  
Byung-Woo Min ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Liner ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Revision Thas ◽  
Total Hip ◽  
The Mean

Abstract Purpose Highly cross-linked polyethylene has been introduced to decrease osteolysis secondary to polyethylene wear debris generation. However, few long-term data on revision total hip arthroplasty (THA) using highly cross-linked polyethylene liners are available. The objective of this study was to determine long-term outcomes of a highly cross-linked polyethylene liner in revision THA. Materials & methods We evaluated 63 revision THAs performed in 63 patients using a highly cross-linked polyethylene liner between April 2000 and February 2005. Of these, nine died and four were lost to follow-up. Thus, the final study cohort consisted of 50 patients (50 hips), including 26 males and 24 females with a mean age of 53 years (range, 27–75 years). Mean follow-up was 11 years (range, 10–14 years). Results The mean Harris hip score improved from 44 points preoperatively to 85 points at the final follow-up. No radiographic evidence of osteolysis was found in any hip. The mean rate of polyethylene liner wear was 0.029 mm/year (range, 0.003 to 0.098 mm/year). A total of 5 hips (10%) required re-revision arthroplasty, including one cup loosening, one recurrent dislocation, and three deep infections. Kaplan-Meier survivorship with an end point of re-revision for any reason was 91.1% and for aseptic cup loosening was 97.9% at 11 years. Conclusion At a minimum of 10 years, the highly cross-linked polyethylene liners showed excellent clinical performance and implant survivorship, and were not associated with osteolysis in our patients with revision THAs.

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