scholarly journals Higher incidence of aseptic loosening caused by a lower canal filling ratio with a modified modular stem in total hip arthroplasty

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Kyosuke Kobayashi ◽  
Kenichi Kidera ◽  
Masaru Itose ◽  
Tetsuhiko Motokawa ◽  
Ko Chiba ◽  
...  
Keyword(s):  
Survival Rate ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Filling Ratio ◽  
Long Term Results ◽  
Stable Fixation ◽  
Total Hip ◽  
Modular Prosthesis

Abstract Purpose Although a cementless modular prosthesis has shown reliable results, cases of unstable fixation and revision due to aseptic loosening were observed in our institute. The purpose of this study was to clarify the causes of unstable fixation of the prosthesis. Methods A total of 144 patients (154 hips) who underwent total hip arthroplasty using the modular prosthesis were retrospectively investigated. For the cohort study, 97 patients (104 hips) were included. The femoral component survival rate and sleeve fixation were assessed at a minimum follow-up of 5 years. Patients were divided into 2 groups, including stable and unstable fixation groups, by sleeve fixation. Clinical and radiographic outcomes were compared. Results The Kaplan-Meier survival rate at 9 years was 93% with revision for any reason as the endpoint in study cohort. The reasons for revision were recurrent dislocation (1 hip) and aseptic loosening of the stem (5 hips). A total of 88 hips (84.6%) showed stable fixation, and 16 hips (15.4%) showed unstable fixation at final follow-up. There was no significant difference in clinical outcomes between the 2 groups at final follow-up. The canal flare index was significantly higher, and the canal filling ratio was significantly lower in the unstable fixation group. Conclusion Although the modified modular prosthesis was useful for treating anatomically difficult patients, we need to pay attention to both proximal/distal mismatch of the intramedullary canal and the canal filling ratio to achieve stable fixation and good long-term results.

scholarly journals Straight stem and threaded cup total hip arthroplasty systems in patients under 60 years of age: outdated or still a benchmark? A report on a cohort of 75 patients after 28.8-30.2 years of follow-up

2020 ◽  
Author(s):  
Lorenz Pisecky ◽  
Jakob Allerstorfer ◽  
Bernhard Schauer ◽  
Günter Hipmair ◽  
Rainer Hochgatterer ◽  
...  
Keyword(s):  
Survival Rate ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Young Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Total Hip ◽  
Straight Stem

Abstract Purpose: The goal of this retrospective observational study of one cohort was to evaluate the long-term outcome in patients younger than 60 years after total hip arthroplasty using a straight uncemented stem and an uncemented threaded cup. Methods: Between 1986 and 1987, 75 hips of 75 patients (mean age: 53.35±6.17 years) were consecutively implanted with an Alloclassic Zweymüller/Alloclassic SL stem and an Alloclassic CSF cup. 44 patients had died over the last 30 years. The remaining 31 patients (mean age: 82.9±6.4years) were reinvited for follow-up examinations. Clinical and radiographic evaluations were carried out. Results: At a mean follow-up of 29.5 (28.8-30.2), 4 patients (5.3%) were lost to follow up. For the endpoint aseptic loosening (defined as the removal of stem or the cup for 2 cases), the overall survival rate is 97.3%. For the endpoint revision for any reason (22 patients), the survival rate is 70.6%. Eleven patients needed an exchange of head and liner due to wear. The mean time from implantation until change of head and liner was 21.44 years (SD 5.92). Other reasons for revisons were septic loosenings (3 cases), aseptic loosening of stem and cup (1 case), aseptic loosening of stem (1 case), periprosthetic calcification (2 cases), implant fracture (1 case), periprosthetic fracture (1 case), intraoperative fissure of stem (1 case), total wear of liner including cup (1 case). Conclusion: The combination of a straight stem (Alloclassic) and a screw cup (CSF) shows excellent results in young patients under the age of 60 at ultra-longterm follow up at 30 years. Revisions due to wear of the polyethylene liner are more likely than in the older patients.

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 Minimum 15-year results of metasul 28-mm metal-on-metal total hip arthroplasty in patients younger than 50 years of age

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sheng-Yu Jin ◽  
Jing-Yao Jin ◽  
Joon-Kyoo Kang ◽  
Taek-Rim Yoon ◽  
Kyung-Soon Park
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Second Generation ◽  
Long Term Results ◽  
Total Hip ◽  
Metal On Metal ◽  
The Mean

Abstract Background Some propitious mid- and long-term studies had been reported for MoM bearings; however, most studies have addressed specific patient groups rather than younger, active patients, who probably represent the most suitable population for investigations on wear and osteolysis. The purpose of this study to evaluate the long-term results of second-generation metal-on-metal cementless total hip arthroplasty (THA) in patients aged <50 years. Methods From December 1997 to January 2004, primary THA using a metal-on-metal bearing cementless implant was performed in 63 patients (72 hips) aged <50 years. The mean follow-up duration was 18.6 (range, 15.9–22.1) years, and the mean age at initial operation was 39 (range, 22–49) years. Clinical results, complications, survivorship, osteolysis, and aseptic loosening were evaluated. Results The mean Harris hip score and Western Ontario and McMaster Universities Arthritis Index scores were improved from 57.8 (range, 28–69) points and 73.4 (range, 63–94) points preoperatively to 91.7 (range, 80–100) points and 25.5 points (range, 17–38) points, respectively, at the last follow-up. Osteolysis lesions were found in 12 hips (acetabulum, 6 and femur, 6). The notching occurred on the femoral stem neck occurred in 12 hips. The mean serum cobalt and chromium concentrations were 2.3 (range, 0.2–10.6) μg/L and 1.7 (range, 0.4–8.1) μg/L, respectively, at a mean follow-up of 12.7 years in 32 patients (50.1%). The Kaplan-Meier survivorship curve analysis with revision for any reason as the endpoint revealed that 93.1% survived at 18.6 years’ follow-up. Conclusions Second-generation metal-on-metal cementless THA was found to produce satisfactory clinical and radiographic results with a low revision rate for osteolysis and aseptic loosening in patients aged less than 50 years.

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.

3rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study

2018 ◽  
Vol 28 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Yeong J. Lau ◽  
Shashank Sarmah ◽  
Johan D. Witt
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Senior Author ◽  
Long Term Results ◽  
Abduction Angle ◽  
Wear Properties ◽  
Total Hip ◽  
Ceramic On Ceramic

Introduction: 3rd generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings. The purpose of our study was to investigate the long-term clinical and radiographic results of 3rd generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture. Methods: The database of the senior author (J.D.W.) was reviewed. A total of 126 hip replacements performed in 108 patients (average age 39.6 years) with an average follow-up of 12.1 years (10-16 years) was identified. Clinical notes and plain radiographs were reviewed. To measure function, patients were contacted and an Oxford Hip Questionnaire was completed. Patients were also directly questioned about the presence of squeaking or any other sounds from the hip. Radiographs were evaluated for signs of wear, osteolysis, loosening and heterotopic ossification. The abduction angle of the acetabular component was measured. Results: The average Oxford Hip Score was 39.8 out of 48. Survivorship at 10 years was 94.6% (95% CI) with revision for any cause as the endpoint. There was 1 femoral head fracture, no osteolysis, no squeaking and no detectable wear. Conclusions: The good clinical and radiographic results for this series of patients are similar to other recent long-term studies looking at 3rd generation ceramic-on-ceramic THA. The results compare favourably with other bearing surfaces. The lack of osteolysis associated with this articulation is encouraging and may also make it a good choice for younger patients requiring total hip replacement.

Mid- to long-term outcomes of cementless modular, fluted, tapered stem for massive femoral bone loss in revision total hip arthroplasty

2020 ◽  
Author(s):  
Kai Zheng ◽  
Ning Li ◽  
Weicheng Zhang ◽  
Jun Zhou ◽  
Yaozeng Xu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Long Term Results ◽  
Revision Total Hip Arthroplasty ◽  
Femoral Bone ◽  
Total Hip ◽  
Tapered Stem

Abstract Background: Revision total hip arthroplasty is frequently accompanied by bone loss. The purpose of this study is to evaluate mid- to long-term results of revision total hip arthroplasty for massive femoral bone loss using cementless modular, fluted, tapered stems.Methods: During the period of 2007 to 2015 at a single hospital, 34 hips (33 patients) underwent primary revision surgery with cementless modular, fluted, tapered stems due to massive bone loss, and patients with prosthetic joint infection (PJI) or tumours were excluded. The hips were revised with the LINK MP (Waldemar Link, Hamburg, Germany) prosthesis. Bone loss was categorized by the Paprosky classification for prosthesis loosening and Vancouver classification for peri-prosthetic fracture. All revision bearing surfaces were ceramic-on-ceramic (CoC). Clinical outcomes, radiographic outcomes and survivorship were evaluated.Results: The mean follow-up was 9.1±2.5 years (range, 5-13 years). The Harris hip score was 43.6±11.5 preoperatively and maintained at 86.5±6.6 at the time of latest follow-up (p<0. 05). The X-ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in 3 hips (9%) and instability in 1 hip (3%). The average stem subsidence was 3.9±2.2 mm (range, 1 to 10 mm). The survivorship of prostheses with re-revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10-year follow-up. Three (9%) re-revisions were needed, including 1 for aseptic loosening, 1 for dislocation and 1 for infection.Conclusions: The mid- to long-term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stem (LINK MP stem) are encouraging for massive femoral bone loss.

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.

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.

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 Comparative Outcomes Assessment: Hip Hemiarthroplasty as an Alternative to THA in Patients with Surgically Pristine Acetabulum—Is There Still a Role?

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Thomas B. Pace ◽  
Brad Prather ◽  
Brian Burnikel ◽  
Brayton Shirley ◽  
Stephanie Tanner ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Groin Pain ◽  
Long Term Results ◽  
Overall Survival Rate ◽  
Total Hip ◽  
Group 2 ◽  
Group 1

This is a retrospective review of 243 hip arthroplasties treated with either hemiarthroplasty (61 surgeries-Group 1) or total hip arthroplasty (182 surgeries-Group 2). The mid- to long-term results of relatively similar, predominately young patient cohorts were assessed annually via radiographs and the Harris Hip Scores for pain and clinical function. Groin pain persisted in 16.4% of Group 1 and 5.5% of Group 2 (). Thigh pain persisted in 11.5% of Group 1 and 2.2% of Group 2 (). Complications in Group 1 were 4/61 including 2 revisions with an overall survival rate of 96.7% versus Group 2 complication rate of 29/182 with 15 revisions and an overall survival rate of 91.8%. There were no cases of acetabular protrusio in Group 1, but 2 cases (1%) in Group 2 had cup loosening or osteolysis. Two cases were revised in Group 1 (3.2%). Both were undersized femoral stems. The fifteen revisions (8.2%) in Group 2 included loose stem (1), instability (8), infections (3), cup loosening (2), and accelerated polyethylene wear (1). Hemiarthroplasty has a higher incidence of thigh and groin pain but fewer complications compared with total hip arthroplasty.

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