Total Hip Arthroplasty Using a Large Femoral Head: The Short-Term Follow-up Results and the Early Complications

Background: Introduction of new implants should be monitored closely to capture any signs of compromising patient safety. Vitamin E infused highly-crosslinked polyethylene liners (VEPE) offer the potential for reduced wear. Highwall liners have been hypothesised to result in increased wear and potential liner fractures. The aim of this study was to determine the 3–7-year follow-up of highwall VEPE for primary total hip arthroplasty (THA), focusing on liner-related complications. Methods: We included 1221 consecutive THA operations from July 2010 to May 2014 with minimum follow-up of 3 (3.1–6.8) years Data collected included demographics, implant data, complications, reoperations, and deaths. Data were cross-referenced with the Danish Hip Arthroplasty Registry in order to ensure validity and completeness. Acetabular shell position was measured using Martell Hip Analysis Suite in a subgroup of 931 THAs. Results: Cumulative stem revision and shell revision at 3-year follow-up was 3.4% and 0.4% respectively. There were no revisions due to liner failure. Reason for revision included 11 dislocations, 15 soft-tissue revisions for infection, 44 stem revisions of which 34 were periprosthetic fractures and 13 shell revisions of which 6 were combined shell and stem revisions. Conclusion: Early follow-up of VEPE liners for primary THA have not shown any revisions associated with liner failure. Continued monitoring of new materials are necessary to capture any signs of compromised patient safety.

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Radiolucent lines do not affect the longevity of highly cross-linked polyethylene cemented components in total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b10.bjj-2020-2298.r2 ◽

2021 ◽

Vol 103-B (10) ◽

pp. 1604-1610

Author(s):

Yusuke Takaoka ◽

Koji Goto ◽

Jiro Tamura ◽

Yaichiro Okuzu ◽

Toshiyuki Kawai ◽

...

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Long Term Outcome ◽

Total Hip ◽

Radiolucent Lines ◽

Kaplan Meier ◽

Acetabular Components

Aims We aimed to evaluate the long-term outcome of highly cross-linked polyethylene (HXLPE) cemented acetabular components and assess whether any radiolucent lines (RLLs) which arose were progressive. Methods We retrospectively reviewed 170 patients who underwent 187 total hip arthroplasties at two hospitals with a minimum follow-up of ten years. All interventions were performed using the same combination of HXLPE cemented acetabular components with femoral stems made of titanium alloy. Kaplan-Meier survival analysis was performed for the primary endpoint of acetabular component revision surgery for any reason and secondary endpoint of the appearance of RLLs. RLLs that had appeared once were observed over time. We statistically assessed potential relationships between RLLs and a number of factors, including the technique of femoral head autografting and the Japanese Orthopaedic Association score. Results The mean follow-up period was 13.0 years (10.0 to 16.3). Femoral head autografting was performed on 135 hips (72.2%). One acetabular component was retrieved because of deep infection. No revision was performed for the aseptic acetabular loosening. The Kaplan-Meier survival curve for the primary and secondary endpoints were 98.2% (95% confidence interval (CI) 88.6% to 99.8%) and 79.3% (95% CI 72.8% to 84.6%), respectively. RLLs were detected in 38 hips (21.2%), at a mean of 1.7 years (1 month to 6 years) postoperatively. None of the RLLs were progressive, and the presence of RLLs did not show a significant association with the survival and clinical score. RLLs were more frequently observed in hips without femoral head autografts than in those with autografts. Conclusion The use of HXLPE cemented acetabular components in total hip arthroplasty demonstrated excellent clinical outcomes after ten years, and no RLLs were progressive, and their presence did not affect the outcome. Femoral head autografting did not negatively impact the acetabular component survival or the appearance of RLLs. Cite this article: Bone Joint J 2021;103-B(10):1604–1610.

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Cost Analysis of Dual-Mobility Versus Large Femoral Head Constructs in Revision Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.09.085 ◽

2019 ◽

Vol 34 (2) ◽

pp. 260-264 ◽

Cited By ~ 8

Author(s):

Matthew P. Abdel ◽

Larry E. Miller ◽

Arlen D. Hanssen ◽

Mark W. Pagnano

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Cost Analysis ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Dual Mobility ◽

Large Femoral Head ◽

Total Hip

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

BioMed Research International ◽

10.1155/2017/8915104 ◽

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.

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Short term outcome of primary un-cemented total hip arthroplasty in osteonecrosis of femoral head

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211603 ◽

2021 ◽

Vol 7 (3) ◽

pp. 513

Author(s):

Mohmad Nawaz Rather ◽

Wajahat Ahmad Mir ◽

Shahid Shabir Khan ◽

Naseer Ahmad Mir ◽

Nadeem Ali

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Short Term ◽

Range Of Movement ◽

Term Outcome ◽

Osteonecrosis Of Femoral Head ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty ◽

Advanced Stages

Background: Osteonecrosis of femoral head (ONFH) is characterised by cell death in the subchondral bone caused by abnormalities of blood flow to the femoral head. About 5% to 13% of arthroplasties are performed yearly for ONFH in United States. Ficat and Arlet classification is the commonest system used for grading of ONFH. Advanced stages 3 and 4 are best managed with total hip arthroplasty (THA). THA restores hip range of movement and allows early ambulation in ONFH.Methods: After seeking approval from local institutional ethical committee 25 patients with stage 3 and stage 4 ONFH (Ficat and Arlet) were admitted from OPD of SKIMS MC and Hospital Bemina, Srinagar. The study was conducted from February 2018 to February 2020 in department of Orthopaedics SKIMS MC and Hospital Bemina, Srinagar. 25 patients with mean age of 50.64 years comprising of 13 females and 12 males with unilateral osteonecrosis of femoral head with collapsed head underwent uncemented total hip arthroplasty and were followed up to a minimum of 1 year post-operatively.Results: Outcome was evaluated by comparing pre-operative and post-operative Harris hip scores. The average Harris hip scores improved from 65.87 in the pre-operative group to 96.54 at 1-year follow-up post-operatively. Marked improvement was noted in pain scores. No revisions were performed during the study. One patient developed superficial surgical site infection which healed with supervised dressings and oral antibiotics.Conclusions: Uncemented THA has excellent short-term outcomes in advanced stages of ONFH. It provides mobile hip joint and pain free ambulation shortly after surgery.

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Is large femoral head a better option than a conventional femoral head primary total hip arthroplasty in Indian population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210622 ◽

2021 ◽

Vol 7 (2) ◽

pp. 295

Author(s):

Hiranya Kumar Seenappa ◽

Karthik Mittemari Naraynamurthy ◽

Rasiq Rashid ◽

Shivraj Nadagouda ◽

Vamshhikrishna Chand

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Age Group ◽

Neck Of Femur ◽

Large Femoral Head ◽

Total Hip ◽

Modified Harris Hip Score ◽

Primary Total Hip Arthroplasty

Background: Study aimed to assess and compare the functional outcome in patients underwent the large femoral head THA and conventional femoral head THA.Methods: It is a comparative prospective cross sectional study conducted among the patients undergoing primary total hip arthroplasty through postero-lateral approach at department of orthopaedics Vydehi institute of medical sciences, Bengaluru during the period of July 2017 to July 2019. Patients aged between 18-80years of both genders undergoing Primary THA for Osteoarthritis (OA), Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Post traumatic arthritis, Avascular necrosis (AVN), Acute fracture neck of femur, Non-union fracture neck of femur (NOF). Patients undergoing primary total hip arthroplasty in Intertrochanteric fracture, Acetabular fracture and patients undergoing Revision Hip Arthroplasty were excluded from study. Patients were grouped as the ones treated with large femoral head THA and conventional femoral head THA.Results: This series consisted of 36 patients with 44 diseased hips treated with primary total hip arthroplasty (THA). Out of 36 patients, 9 patients (25%) belonged to an age group of below 30 years of age, 10 patients (27.8%) belonged to the age group between 31-40 years of age, 8 patients (22.2%) belonged to the age group 41-51 years of age and 9 patients (25%) belonged to age group of 51-60 years of age. The mean level of Modified Harris Hip score and improvement of movements in all planes was found to be statistically significantly in the patients treated with large femoral head primary THA compared to those treated with conventional method. (p<0.001)Conclusions: Study has shown improved functional outcome (Modified harris hip score) and range of movement in the patients treated with the large femoral head primary THA as compared to those treated with a conventional femoral head.

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Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3023-0 ◽

2019 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Weikun Meng ◽

Zhong Huang ◽

Haoyang Wang ◽

Duan Wang ◽

Zeyu Luo ◽

...

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Length Of Hospital Stay ◽

Operation Time ◽

Short Term ◽

Incision Length ◽

Total Hip ◽

Hip Function

Abstract Background The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH). Methods Patients with bilateral late-stage ONFH were prospectively recruited from our department from March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within approaches. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA approaches within 12-month postoperatively. Results Four male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded shorter incision length (7.62 vs. 11.12 cm), longer operation time (103.25 vs. 66.50 min), more blood loss (1108.50 vs. 843.50 ml), deficient abduction angle of the acetabular cup (38.75° vs. 44.50°), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25) at 12-month postoperatively. Soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both approaches. Conclusion The SuperPath may be a minimally invasive technique but the present study shows less favorable short-term outcomes than PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches. Trial registration information The trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4993) on July 04, 2019. The first participant was enrolled on March 13, 2017.

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Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03610-4 ◽

2020 ◽

Vol 140 (12) ◽

pp. 2091-2100

Author(s):

Yama Afghanyar ◽

Christoph Danckwardt ◽

Miriam Schwieger ◽

Uwe Felmeden ◽

Philipp Drees ◽

...

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Migration Pattern ◽

Short Stem ◽

Stem Design ◽

Total Hip ◽

Migration Analysis ◽

Short Stems

Abstract Introduction Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. Materials and methods This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. Results At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. Conclusion The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.

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Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls

10.21203/rs.2.15442/v1 ◽

2019 ◽

Author(s):

Qi Cheng ◽

fengchao zhao ◽

Shi-zhuang Xu ◽

Li Zheng ◽

Xin Zheng ◽

...

Keyword(s):

Articular Cartilage ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

X Rays ◽

Clinical Failure ◽

Light Bulb ◽

Total Hip

Abstract Background The aim of the present study was to investigate clinical and radiological outcomes of autologous tricortical iliac graft through a window created at the femoral head, without suturing the opened articular cartilage to treat osteonecrosis of the femoral head (ONFH), called modified trapdoor procedures. Methods A total of 59 consecutive patients (67 hips ) with ONFH were included in this study, which was conducted during the period from April 2009 to March 2012. Harris hip scores (HHS) were used to evaluate hip function pre- and postoperatively. Anteroposterior and frog-position X-rays and magnetic resonance imaging (MRI) were conducted to evaluate lesion location, size, and ARCO stage. Clinical failure was defined as score < 80 points or treatment by total hip arthroplasty(THA). Radiographic failure was defined as a > 3 mm of collapse in the hip. This group was retrospectively matched according to the ARCO stage, extent, location, etiology of the lesion, average age, gender, and preoperative Harris hip score to a group of 59 patients (67 hips) who underwent the“light bulb”approach during March 2007 to April 2009. Results Mean follow-up was 91.2 ± 13.6 months (range, 75–115 months). Mean HHS was 91.3 ± 4.5, compared with 83.1± 4.5 in the “light bulb” cohort at the 6 years follow-up examination ( P < 0.001). At the 6 years follow-up, for modified trapdoor procedures, five hips (8.5%) were classified as clinical failure, and 3 hips underwent total hip arthroplasty; Seven hips were classified as (10.4%) radiographic failure.The clinical and radiographic failure of the hips treated with the modified trapdoor procedure was significantly lower than that of the hips treated with the “light bulb” procedure (p < 0.05). Survival of the joint was not significantly related to the location of the femoral head lesion between two groups, but there was better clinical and radiographic results in modified trapdoor procedures with Size-C and the ARCO stage III. Conclusion The study demonstrated superior medterm clinical results in ONFH with the use of autologous tricortical iliac block graft through a femoral head window, without suturing the opened articular cartilage.

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