Results of primary THA using 36 mm femoral heads on first-generation highly cross-linked polyethylene in patients less than 60 years of age: Minimum 10-year follow-ups

Purpose: Long-term results of total hip arthroplasty (THA) using highly cross-linked polyethylene (HXLPE) and metal femoral head with more than 10 years of follow-up have already been reported. However, most studies included results with a head size of 28 mm that could affect wear rates. The aim of this study was to evaluate the results of 36-mm metallic femoral heads on first-generation HXLPE in patients less than 60 years of age with a minimum follow-up of 10 years. Methods: Retrospective analysis included 54 cases from 47 patients. The mean age at the time of surgery was 47.22 years and the mean follow-up period was 131.04 months. Porous-coated cementless acetabular cups (Trilolgy®; Zimmer Inc., Warsaw, Indiana, USA) and HXLPE acetabular liners (Longevity®; Zimmer Inc.) were used for all cases. Acetabular cup abduction angles, anteversion angles, and wear rates of liner were measured using polyWare pro 3D distal version 5.10. Results: The average modified Harris hip score at the final follow-up was 88.48 (range 80–96). Average Merle d’Aubigne and Postel score was 15.57 (range 14–18). There was no acetabular cup or femoral stem failing due to aseptic loosening. The average steady-state wear rate determined using radiographs taken at 1 year postoperatively and at the latest follow-up was 0.053 ± 0.025 mm/year. There were no statistically significant differences in liner wear rate with respect to age, variety of the femoral stem, or liner thickness. Conclusion: Results of THA with 36-mm metallic femoral heads on first-generation HXLPE in patients less than 60 years of age were satisfactory.

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Exeter Small Femoral Stem for Patients with Small Femurs

Journal of Orthopaedic Surgery ◽

10.1177/230949901101900303 ◽

2011 ◽

Vol 19 (3) ◽

pp. 279-283 ◽

Cited By ~ 7

Author(s):

Kwok-Hing Chiu ◽

Kin-Wing Cheung ◽

Kwong-Yin Chung ◽

Wan-Yiu Shen

Keyword(s):

Femoral Stem ◽

Cement Mantle ◽

Long Term Results ◽

Harris Hip Score ◽

Ectopic Ossification ◽

Radiolucent Lines ◽

Intramedullary Reaming ◽

The Mean

Purpose. To report the long-term results of total hip arthroplasty (THA) using small size Exeter femoral stems. Methods. Eight men and 34 women aged 60 to 83 (mean, 70) years underwent 45 THAs using the Exeter small stem with offsets of 30 mm (n=3), 33 mm (n=15), and 35.5 mm (n=27). The Harris hip score was assessed pre- and post-operatively. Stem alignment and axial subsidence of the stem were measured. Radiolucent lines around the femur were recorded at 14 Gruen zones. Completeness and thickness of the cement mantle and cement fractures were also noted. Ectopic ossification, if present, was graded. Stem loosening was based on the Olsson definitions. Results. The mean follow-up was 9 (range, 5–12) years. The mean Harris hip score improved from 37 (range, 13–61) to 80 (range, 47–96) [p<0.001]. At the latest follow-up, the score was excellent (90–100) in 8 (18%) of the hips, good (80–89) in 21 (47%), fair (70–79) in 9 (20%), and poor (<70) in 7 (16%). All hips had a complete cement mantle of ≥2 mm. All stems were inserted without intramedullary reaming. 11 (24%) of the hips developed stem subsidence of <2 mm; all stabilised within 2 years. None of these patients had pain or other radiological signs of loosening. Six stems showed radiolucent lines of <1 mm in the upper zones, which were not progressive. No cement fracture or subsidence was noted. Using revision for any cause as an endpoint, the overall survival rate of Exeter small femoral stem was 100% at 10 years and 89% at 12 years. Conclusion. The results of Exeter small stems for patients with small femurs are good.

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Clinical results of the Metha short hip stem: a perspective for younger patients?

Orthopedic Reviews ◽

10.4081/or.2013.e34 ◽

2013 ◽

Vol 5 (4) ◽

pp. 34 ◽

Cited By ~ 30

Author(s):

Fritz Thorey ◽

Claudia Hoefer ◽

Nima Abdi-Tabari ◽

Matthias Lerch ◽

Stefan Budde ◽

...

Keyword(s):

Bone Ingrowth ◽

Long Term Results ◽

Harris Hip Score ◽

Femoral Revision ◽

Term Survival ◽

Younger Patients ◽

The Mean ◽

Short Stems

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

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Results at 10–24 years after single-stage revision arthroplasty of infected total hip arthroplasty in patients under 45 years of age

Hip International ◽

10.1177/1120700019888877 ◽

2019 ◽

pp. 112070001988887 ◽

Cited By ~ 3

Author(s):

Matthias Wolff ◽

Christian Lausmann ◽

Thorsten Gehrke ◽

Akos Zahar ◽

Malte Ohlmeier ◽

...

Keyword(s):

Infection Control ◽

Revision Surgery ◽

Single Stage ◽

Long Term Results ◽

Harris Hip Score ◽

Study Cohort ◽

One Stage ◽

The Mean

Introduction: The management of periprosthetic joint infection (PJI) of the hip is a challenging procedure. One-stage exchange is carried out in specialist centres with comparable infection free survival rates. However, there is a paucity of long-term results of this approach in young patients. Methods: All patients undergoing one-stage exchange due to PJI with a known causative organism ⩽45 years of age with a minimum of 10-year follow-up (mean 15 years; range 10–24 years) were enrolled in this retrospective study. Patients older than 45 years of age or patients with a two-stage procedure were excluded from the study. The primary outcome measure was failure rate with special focus on reinfection at latest follow-up. Failure was defined as revision surgery for infection. Furthermore, functional outcome using the Harris Hip Score was determined initially and at latest follow-up. 26 patients fulfilled the inclusion criteria and were available for final follow-up. Results: The study cohort consists of 16 male and 10 female patients with a mean age of 36.8 years (range 20–45 years) and a mean BMI of 29.8 kg/m2 (range 20.7–40.6 kg/m2). Prior to the single-stage procedure, the patients underwent an average of 3.1 previous surgical interventions (range 1–9). The mean hospital stay after septic revision was 19.7 days (11–33 days). Most infections were caused by Staphylococcus epidermidis ( n = 8, 30.8%), followed by Staph. aureus ( n = 7, 26.9%) and Propionibacterium acnes ( n = 6, 23.1%). At latest follow-up, the overall survival rate was 76.9 %, while infection control could be achieved in 96.2%. At final examination, the mean Harris Hip Score improved from 46.2 to 78.9 (range 18.0–99; SD, 22.6). Conclusions: Single-stage revision surgery for the management of PJI in patients ⩽45 years is a successful treatment option with high infection control, even after long-term follow-up.

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Long-Term results of total Hip Arthroplasty performed using a cementless expansive Acetabular Cup and Spotorno Femoral Stem

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.1.3089 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Engin Çarkçı ◽

Ayse Esin Polat ◽

Yusuf Öztürkmen ◽

Tolga Tüzüner

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Survival Rates ◽

Femoral Stem ◽

Long Term Results ◽

Harris Hip Score ◽

Acetabular Cup ◽

Total Hip ◽

Kaplan Meier

Objective: In this study we aimed to investigate the long-term clinical and radiological results, revision rates and causes, and the rate of implant survival in total hip arthroplasty performed using CLS® expansion cup and Spotorno® cementless femoral stem. Methods: Clinical results of total hip arthroplasty performed on 131 hips of 114 patients in Istanbul Training and Research Hospital between 1993 and 2003 were retrospectively evaluated according to the Harris Hip Score. Revision rates were determined and implant survival rates were identified using the Kaplan-Meier estimator. Results: Of the patients, 39 were males and 75 were females. The average age of the patients at surgery was 48.7±11.3 years. Patients were followed up for a mean period of 13.9±2.4 years. The mean Harris Hip Score was 34.35±6.09 preoperatively and 88.20±7.11 at the final follow-up (p<0.001). The Kaplan-Meier survivorship estimate for the cup at 13.9 years, taking revision for any reason as the end point was 95.6% (95% CI), while the 15th and 17th year survival rates were 90% and 85%, respectively. Conclusion: In total hip arthroplasty using a cementless expansive acetabular cup, a 95.6% survival rate is achieved after an average of 14 years, whereas the rate decreases to 85% after 17 years. Even if the incidence of cup breakage is reduced with proper implantation, particle disease and periacetabular osteolysis remains a problem for the long-term survival. doi: https://doi.org/10.12669/pjms.37.1.3089 How to cite this:Carkci E, Polat AE, Ozturkmen Y, Tuzuner T. Long-Term results of total Hip Arthroplasty performed using a cementless expansive Acetabular Cup and Spotorno Femoral Stem. Pak J Med Sci. 2021;37(1):52-58. doi: https://doi.org/10.12669/pjms.37.1.3089 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

10.21203/rs.3.rs-422921/v1 ◽

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.

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Clinical outcomes and survival rate of cementless modular distal fixation femoral stem for revision hip arthroplasty: A minimum 6-year follow-up

Journal of Orthopaedic Surgery ◽

10.1177/2309499018812241 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901881224 ◽

Cited By ~ 1

Author(s):

Joon Soon Kang ◽

Yeop Na ◽

Bong Seong Ko ◽

Yoon Sang Jeon

Keyword(s):

Survival Rate ◽

Hip Arthroplasty ◽

Periprosthetic Fracture ◽

Femoral Stem ◽

Revision Hip Arthroplasty ◽

Harris Hip Score ◽

The Mean ◽

Distal Fixation

Purpose: Revision hip arthroplasty is a very challenging procedure. Use of a modular distal fixation stem is one of the available options for revision arthroplasty in patients with proximal femoral bone deficiency. The purpose of this study was to evaluate mid- to long-term outcomes of cementless modular distal fixation femoral stem implantation in revision hip surgery. Methods: Clinical and radiological findings, complications, and stem survival rate were analyzed for 46 patients (48 hips) who underwent revision hip arthroplasty using a cementless modular distal fixation femoral stem. The mean patient age was 58.8 years (range 31–82 years) and the mean follow-up period was 95 months (72–122 months). The preoperative diagnoses were aseptic loosening (36 hips), infection (4 hips), ceramic fracture (4 hips), and femoral periprosthetic fracture (4 hips). Results: The mean Harris hip score improved from 56.6 preoperatively to 88.2 postoperatively at the last follow-up. All hips showed stable osteointegration and firm fixation. Complications involved four hips (8.3%); there was one case each of periprosthetic fracture, delayed union of osteotomy site, femoral perforation, and infection. One stem re-revision was performed for deep infection of the femoral side. The Kaplan–Meier survival rate was 97.6% at the final follow-up. Conclusion: Revision hip arthroplasty using a cementless modular distal fixation femoral stem showed satisfactory initial firm fixation and mid- to long-term survival rate. Complications can be minimized by careful surgical planning and meticulous procedure.

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The Modified Dunn Osteotomy for SCFE: Clinical and Radiographical Results at 3 Years Follow-Up

The Journal of Hip Surgery ◽

10.1055/s-0038-1627448 ◽

2017 ◽

Vol 01 (04) ◽

pp. 173-179

Author(s):

Oliver Eberhardt ◽

Thomas Wirth ◽

Michele Surace ◽

Francisco Fernandez ◽

Nicola Guindani

Keyword(s):

Short Form ◽

Slipped Capital Femoral Epiphysis ◽

Long Term Results ◽

Harris Hip Score ◽

Slip Angle ◽

Clinical Consequence ◽

Retrospective Clinical Study ◽

Outcome Scores ◽

The Mean

AbstractThe modified Dunn osteotomy (MDO) gained popularity for the treatment of moderate-to-severe SCFE over the past years, even though both indications and outcomes are currently debated. The aim of this study is to evaluate results and complications of MDO consecutively performed at a single institution for severe slipped capital femoral epiphysis (SCFE) (slip angle ≥ 60°). In this retrospective clinical study, 23 hips (22 patients) were treated with MDO (2009–2015). SCFE was classified according to stability, slip angle, and as chronic/acute. Clinical assessment was performed with clinical examination and nonarthritic hip score (NAHS), modified Harris hip score (mHHS), and short form 12 (SF-12) outcome scores. Residual deformity, avascular necrosis (AVN), and osteoarthrosis (OA) were measured on plain radiographs. The mean slip angle was 70° (range 60–90); 17 of 23(74%) patients had a chronic SCFE, 6 of 23(26%) had acute-on-chronic SCFE, and 1 of 23(4%) had an unstable SCFE. The mean age at surgery was 14 years (range 11–17). At 3 years follow-up (range 1–7), 4 of 23(17%) patients had an AVN or AVN progression, one of these needing a hip arthroplasty. All the cases of AVN or AVN progression were diagnosed within the first year after surgery and there was an association between AVN and operation date (with more AVN among patients operated earlier). Out of 23 patients, 2 (9%) had an implant mobilization or failure and needed a revision surgery without further complications, 1 (4%) developed an asymptomatic heterotopic calcification, and another a partial implant removal without clinical consequence. At follow-up, the slip angle was 9° (range 1–15) and outcome scores were improved. MDO is a demanding technique which allows a near anatomical correction of SCFE and the overall complication rate is not negligible. With actual data, the authors only recommend this procedure for specialized centers, performed by experienced high-volume surgeons, and for severe displaced SCFE (≥50°). The long-term results must be closely monitored and compared with the natural history and other treatment options. This study was a Level IV retrospective study in a case series.

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

Tạp chí Y học Cộng đồng ◽

10.52163/jcm.v62i1.6 ◽

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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The Corail Stem as a Reverse Hybrid – Survivorship and X-Ray Analysis at 10 Years

Hip International ◽

10.5301/hipint.5000477 ◽

2017 ◽

Vol 27 (4) ◽

pp. 354-360 ◽

Cited By ~ 5

Author(s):

Helge Wangen ◽

Lars Nordsletten ◽

Jens G. Boldt ◽

Anne M. Fenstad ◽

David E. Beverland

Keyword(s):

Clinical Outcome ◽

Femoral Stem ◽

Successful Outcome ◽

Harris Hip Score ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

X Rays ◽

The Mean ◽

Cemented Cup

Background The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA have been sparsely described. We report our experience of reverse hybrid THA, using the Elite plus polyethylene cemented cup together with the Corail fully hydroxyapatite-coated uncemented stem and a 28-mm alumina ceramic head. Patients and methods 132 consecutive reverse hybrid hip arthroplasties were performed from January 2000 to December 2003 in 126 patients with a mean age of 54.3 years (28-65). All patients were routinely reviewed at 3 months, 1, 5, 7 and 10 years postoperatively. At each follow-up patients were seen either by a consultant orthopaedic surgeon or a senior trainee. Anteroposterior pelvic and lateral x-rays of the hip were taken at each visit. To estimate the survival of the THAs we used the Kaplan-Meier method with 95% confidence interval (CI). Logistic regression analysis was performed to determine which factors affected the presence of radiolucency around the femoral stem. Results The mean follow-up was 11.1 years (9.0-14.2). 1 patient was lost to follow-up, and 7 patients were deceased at the time of 10-year follow up. At 10 years 7 patients have had further surgery. 5 for infection, 1 periprosthetic femoral fracture and 1 heterotopic bone formation. All stems were classified as well fixed. 2 cups were defined as loose at 10 years. 1 patient is scheduled for revision the other refused revision. The clinical outcome and radiological findings were assessed in 123 hips. The mean Harris Hip Score was 94 (35-100) at 10 years and the mean WOMAC score was 89 (30.2-100). Conclusions We report good results with respect to clinical outcome and survival of the reverse hybrid concept in patients younger than 65. A successful outcome depends on meticulous preoperative planning, use of modern cementing techniques in the acetabulum and experience in implanting an uncemented stem.

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Higher UHMWPE wear-rate in cementless compared with cemented cups with the Saturne® Dual-Mobility acetabular system

Hip International ◽

10.1177/1120700018768615 ◽

2018 ◽

Vol 28 (2) ◽

pp. 125-132 ◽

Cited By ~ 3

Author(s):

Steffan Tabori-Jensen ◽

Christina Frølich ◽

Torben B. Hansen ◽

Søren Bøvling ◽

Morten Homilius ◽

...

Keyword(s):

Wear Rate ◽

Polyethylene Wear ◽

Walking Distance ◽

Harris Hip Score ◽

Evaluation Activity ◽

Dual Mobility ◽

Time Of Surgery ◽

Activity Measurements ◽

The Mean

Introduction: Dual mobility (DM) total hip arthroplasty (THA) may reduce dislocation risk, but might increase the risk of high polyethylene (PE) wear due to double wearing surfaces. Methods: 127 patients (97 female) with 129 hips operated with THA after displaced femoral neck fracture FNF between 2005 and 2011, were seen for a cross-sectional clinical follow-up. Acetabular components were Saturne® DM cups with 28mm chrome-cobalt heads in UHMWPE. Cementless cups (n = 73) were hydroxyapatite coated. Radiographs were obtained for analysis of cup placement, 2D polyethylene wear and wear-rate (PolyWare 3D), and further radiological evaluation. Activity measurements included Timed Up and Go test (TUG) and walking distance from Harris Hip Score (HHS). Results: At a mean follow-up of 2.83 (1.0-7.7) years the mean wear was 0.82 mm (range 0.17-4.51, SD 0.50), and the wear-rate was 0.37 mm (range 0.06-1.90, SD 0.29). Wear-rate of 0.43 mm/year (SD 0.30) in cementless cups was higher (p = 0.004) than 0.30 mm/year (SD 0.27) in cemented cups. Mean age at time of surgery was 75.1 years (range 30-95). There was no correlation between age at time of surgery and wear (p = 0.56). There was no correlation between cup inclination and wear-rate (p = 0.35). TUG was mean 13.4 seconds (range 4.5-30.1) and correlated with wear rate (p = 0.03). Conclusions: At short term follow-up, the mean wear-rate in old and low demand patients was high, correlated to activity, and was above the generally accepted osteolysis threshold (0.1 mm/yr.). Cementless HA-coated cups had higher wear-rate than cemented cups.

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