101
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Park KS, Yoon TR, Song EK, Lee KB. Results of isolated femoral component revision with well-fixed acetabular implant retention. J Arthroplasty 2010; 25:1188-95. [PMID: 20189344 DOI: 10.1016/j.arth.2009.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 12/31/2009] [Indexed: 02/01/2023] Open
Abstract
The present study was undertaken to evaluate the clinical and radiological results of isolated femoral revisions conducted while retaining well-fixed cementless acetabular sockets. Thirty-nine patients that underwent isolated femoral stem revisions were reviewed. Mean age at time of surgery was 60.5 years, and mean follow-up duration was 4.2 years. Decisions to retain acetabular sockets were based on clinical and radiographic findings and intraoperative stabilities. During revisions, polyethylene liners were exchanged for metal-inlay polyethylene liners to have a metal-on-metal bearing surface in 23 cases. Mean Harris hip score improved from 58 points preoperatively to 85 points at final follow-up (P < .001). With the exception of one patient, no increases in acetabular radiolucent line numbers or thicknesses were observed during follow-up visits. Isolated femoral stem revisions with acetabular socket retention were found to provide excellent clinical and radiographic results.
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Affiliation(s)
- Kyung Soon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-Gun, Jeonnam, Korea
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102
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Umer M, Sepah YJ, Khan A, Wazir A, Ahmed M, Jawad MU. Morphology of the proximal femur in a Pakistani population. J Orthop Surg (Hong Kong) 2010; 18:279-81. [PMID: 21187535 DOI: 10.1177/230949901001800304] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To measure the morphology of the proximal femur in a Pakistani population. METHODS Standardised anteroposterior pelvic radiographs of 116 male and 20 female healthy volunteers aged 20 to 50 (mean, 33) years were taken. Morphologic dimensions of the proximal femur were measured, including canal flare index (CFI), morphological cortical index (MCI), femoral head offset, femoral head diameter, and femoral head position. RESULTS Based on the CFI, 67% of the subjects had normal canal shapes (CFI, 3.0-4.7), whereas 1% and 33% of the subjects had stovepipe shapes (CFI, <3) and champagne-flute shapes (CFI, 4.7-6.5), respectively. Based on the MCI, 29% of the subjects had cylindrical shapes (MCI, <2.7) and 71% had trumpet shapes (MCI, >2.7). CONCLUSION Morphology of the proximal femur in our study population differed significantly from those in western populations, indicating regional variation. It could also be due to the younger age of our population.
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Affiliation(s)
- Masood Umer
- Section of Orthopedics, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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103
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Simon JP, Maes M, Robbens E, Bellemans J. Total hip arthroplasty in inflammatory arthritis in patients under 35 years. A 7 to 19 year follow-up. Hip Int 2010; 20:163-70. [PMID: 20544644 DOI: 10.1177/112070001002000206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2010] [Indexed: 02/04/2023]
Abstract
Total hip arthroplasty in patients with inflammatory arthritis is compromised by the young age of patients at presentation, intake of non-steroidal anti-inflammatory drugs, steroid use and autoimmune diseases which negatively affect bone quality. This study evaluates the survival of total hip arthroplasties (THA) in 32 patients with inflammatory hip disease who were under the age of 35 at the index operation and on which 57 primary total hip arthroplasties were performed between 1989 and 2001. Polished straight tapered cemented stems were used in all 57 hips. There were 10 cemented and 47 uncemented cups. The average follow-up was 12.2 years (range 7-19). Forty-seven hips had more than 10 years follow-up. There were 3 revisions of cemented metal-backed cups for aseptic loosening at 11, 13 and 16 years post-operatively. No uncemented cups and no stems needed revision. Heterotopic ossifications occured in 3 hips with Brooker type-I ossification in 1 hip and Brooker type-II in 2 hips. Cemented polished tapered straight stems demonstrate excellent survival in young patients suffering from inflammatory arthritis.
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Affiliation(s)
- Jean-Pierre Simon
- Department of Orthopaedic Surgery, University Hospital Pellenberg, Leuven, Belgium.
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104
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Burston BJ, Yates PJ, Hook S, Moulder E, Whitley E, Bannister GC. Cemented polished tapered stems in patients less than 50 years of age: a minimum 10-year follow-up. J Arthroplasty 2010; 25:692-9. [PMID: 19577886 DOI: 10.1016/j.arth.2009.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 05/08/2009] [Indexed: 02/01/2023] Open
Abstract
We report the outcome of 58 consecutive polished tapered stems in 47 patients younger than 50 years, with a minimum of 10 years of follow-up. No stems were revised for aseptic loosening or osteolysis. The Harris hip scores were good or excellent in 76% of the patients. There was excellent preservation of proximal bone. Despite higher patient weight and frequent previous surgery, the outcome of polished tapered stems in patients younger than 50 years is comparable to the general population undergoing total hip arthroplasty and superior to other non-polished tapered stem designs in young patients. Cup wear and cup failure were significantly worse in this group, with a higher incidence of periarticular osteolysis. Polished tapered stem designs are the benchmark for comparison to other arthroplasty options in young patients.
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Affiliation(s)
- Ben J Burston
- Avon Orthopaedic Centre, Southmead Hospital, Bristol
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105
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AlOmran AS. Choice of implant in total hip arthroplasty for sickle cell disease patients. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s12570-010-0006-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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106
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de Kam DCJ, Gardeniers JWM, Veth RPH, Schreurs BW. Good results with cemented total hip arthroplasty in patients between 40 and 50 years of age. Acta Orthop 2010; 81:165-70. [PMID: 20367411 PMCID: PMC2852151 DOI: 10.3109/17453671003717831] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Total hip arthroplasties in young patients have lower long-term survival rates than in older patients. We evaluated the use of a unique treatment protocol in patients aged between 40 and 50 years. In all cases we used a cemented THA, and for acetabular deficiencies we also used impacted bone grafts together with a cemented cup. METHODS In 140 consecutive patients who were between 40 and 50 years of age at index surgery, 168 cemented total hip prostheses were evaluated after a mean follow-up time of 10 (2-19) years. Acetabular deficiencies were reconstructed with wire meshes and impacted bone grafts with a cemented cup (70 hips). During follow-up, 18 patients died (27 hips); in this group 3 hips (3 patients) had been revised. None of the patients were lost to follow-up. In all surviving patients, clinical assessment was performed with hip-score questions and all radiographs were evaluated. RESULTS All clinical questionnaires showed an improved clinical hip score. 29 hips (17%) were revised after a mean of 8 (0.3-18) years. Kaplan-Meier survival analysis showed a survival of 88% (95% CI: 82-94) after 10 years with revision of either component for any reason. Survival with endpoint revision for aseptic loosening of either component was 94% (95% CI: 90-99) after 10 years. INTERPRETATION Cemented implants in young patients have satisfying long-term results. Reconstruction of acetabular deficiencies with impacted bone grafts show promising results.
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Affiliation(s)
- Daniël C J de Kam
- Department of Orthopaedic Surgery at Radboud University Nijmegen Medical Centre, Nijmegenthe Netherlands
| | - Jean W M Gardeniers
- Department of Orthopaedic Surgery at Radboud University Nijmegen Medical Centre, Nijmegenthe Netherlands
| | - René P H Veth
- Department of Orthopaedic Surgery at Radboud University Nijmegen Medical Centre, Nijmegenthe Netherlands
| | - B Willem Schreurs
- Department of Orthopaedic Surgery at Radboud University Nijmegen Medical Centre, Nijmegenthe Netherlands
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107
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Flecher X, Pearce O, Parratte S, Aubaniac JM, Argenson JN. Custom cementless stem improves hip function in young patients at 15-year followup. Clin Orthop Relat Res 2010; 468:747-55. [PMID: 19690930 PMCID: PMC2816777 DOI: 10.1007/s11999-009-1045-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 07/31/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D'Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%-97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%-97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xavier Flecher
- Department of Orthopaedic Surgery, Center for Arthritis Surgery, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Oliver Pearce
- Department of Orthopaedic Surgery, Center for Arthritis Surgery, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Sebastien Parratte
- Department of Orthopaedic Surgery, Center for Arthritis Surgery, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Jean-Manuel Aubaniac
- Department of Orthopaedic Surgery, Center for Arthritis Surgery, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Jean-Noel Argenson
- Department of Orthopaedic Surgery, Center for Arthritis Surgery, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France ,Service de Chirurgie Orthopédique, Hôpital Sainte Marguerite, 270, Boulevard Sainte-Marguerite, 13009 Marseille, France
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108
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Moyer JA, Metz CM, Callaghan JJ, Hennessy DW, Liu SS. Durability of second-generation extensively porous-coated stems in patients age 50 and younger. Clin Orthop Relat Res 2010; 468:448-53. [PMID: 19727992 PMCID: PMC2807011 DOI: 10.1007/s11999-009-1062-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 08/12/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Early versions of uncemented femoral total hip stems were often associated with thigh pain thought to be due to micromotion between the implant and bone in the distal uncoated regions. An extensively coated stem was introduced in 1992 to reduce that risk. We therefore asked whether second-generation extensively porous-coated cementless femoral stems in patients younger than 50 years of age would (1) be durable in terms of revisions; (2) provide high functional scores and reduce thigh pain; and (3) show radiographic signs of durability, including a reduction in stress shielding. We prospectively followed all 100 patients (115 hips) age 50 and younger treated with primary cementless total hip arthroplasties using a second-generation extensively porous-coated femoral stem between June 1994 and December 1999. The average age was 39.6 years (range, 17-50 years). The stems were mated to cementless acetabular components. Ninety patients were followed for a minimum of 5 years (mean, 8.6 years; range, 5-10 years). One stem was revised after a periprosthetic fracture. None were revised for loosening and all stems demonstrated bony ingrowth at last followup. No acetabular shell was revised for loosening and none was radiographically loose. Six acetabular liners were revised for wear (three each were 22-mm and 26-mm heads). This second-generation extensively porous-coated stem was durable at 5- to 10-year followup in this young active population. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | - John J. Callaghan
- University of Iowa, Iowa City, IA USA ,VA Hospital Administration, Iowa City, IA USA ,Department of Orthopaedics, University of Iowa Health Care, Iowa City, IA 52242 USA
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109
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Similar survival of eccentric rotational acetabular osteotomy in patients younger and older than 50 years. Clin Orthop Relat Res 2009; 467:2630-7. [PMID: 19424675 PMCID: PMC2745461 DOI: 10.1007/s11999-009-0866-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 04/15/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Pelvic osteotomy for middle-aged patients with hip dysplasia remains controversial. We asked whether pelvic osteotomy would yield lower Harris hip scores and survivorship in older patients than in younger patients. We compared patients younger than 50 years (n = 123) with patients 50 years or older (n = 41). At last followup, the mean Harris hip scores improved similarly in both groups: from 60 to 89 points in the older group and from 63 to 92 points in the younger group. However, in patients with bilateral surgery, the older group tended to have lower mean scores than the younger group (86 versus 93 points, respectively). Fifteen-year survivorship with a Harris hip score less than 80 points as the end point was similar in the two groups (71% in older patients and 81% in younger patients). In patients with bilateral surgery, the 15-year survivorship was lower in the older group (66% in older patients and 83% in younger patients). The data suggest eccentric rotational osteotomy for older patients can provide lasting function in most patients. However, prudent selection of patients is required for older patients with bilateral osteoarthritis. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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110
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Greene JW, Malkani AL, Kolisek FR, Jessup NM, Baker DL. Ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2009; 24:15-8. [PMID: 19577887 DOI: 10.1016/j.arth.2009.04.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 04/21/2009] [Indexed: 02/01/2023] Open
Abstract
Ceramic bearing surfaces have been introduced to prevent bone loss after osteolysis seen with conventional polyethylene bearing surfaces. One hundred three ceramic-on-ceramic total hip arthroplasties in 97 patients were retrospectively reviewed. Average follow-up was 50.4 months. Preoperative Harris Hip Score was 49.5 points, which improved to 87.2 postoperatively (P < .05). Pain score improved from 13.7 points preoperatively to 40.6 points postoperatively (P < .05). Functional score improved from 30 points preoperatively to 41 points postoperatively (P < .05). No fractures, dislocations, infections, or osteolysis was observed on radiographs. Five patients (4.9%), at 11, 16, 30, 38, and 60 months postoperatively, presented with "squeaky" hips that continue to perform well. Long-term studies will be required to determine the true efficacy of these hard bearing surfaces.
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Affiliation(s)
- Joseph W Greene
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
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111
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Survival of the cementless Spotorno stem in the second decade. Clin Orthop Relat Res 2009; 467:2297-304. [PMID: 19504161 PMCID: PMC2866918 DOI: 10.1007/s11999-009-0906-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 05/12/2009] [Indexed: 01/31/2023]
Abstract
High survival rates have been reported for the uncemented CLS Spotorno stem up to 10 years. To confirm survival at longer followup we report the minimum 15-year (mean, 17 years; range, 15-20 years) for 257 hips using this stem. We retrospectively evaluated the clinical and radiographic results of all 326 patients (354 THAs) operated between 1985 and 1989. The patients had a mean age of 57 years using an uncemented grit-blasted, tapered titanium femoral stem. Eighty-six patients (89 hips) died and eight patients (eight hips) were lost to followup, leaving 240 patients (257 hips) for evaluation. The femoral component was revised in 35 hips: eight for infection, nine for periprosthetic fracture, one for traumatic loosening, and 17 for aseptic loosening. Survival of the stem was 88% at 17 years (95% confidence interval, 84%-92%), and survival with femoral revision for aseptic loosening as an end point was 94% (95% confidence interval, 91%-97%). The median Harris hip score at followup was 80 points. No thigh pain was reported. Small osteolytic lesions (< 1 cm(2)) were found in the proximal Gruen zones (1 or/and 7) in 28 hips (15%). No distal femoral osteolysis was found. The long-term survival with this type of femoral component remains high in the second decade.
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112
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Springer BD, Connelly SE, Odum SM, Fehring TK, Griffin WL, Mason JB, Masonis JL. Cementless femoral components in young patients: review and meta-analysis of total hip arthroplasty and hip resurfacing. J Arthroplasty 2009; 24:2-8. [PMID: 19556097 DOI: 10.1016/j.arth.2009.04.032] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 04/22/2009] [Indexed: 02/01/2023] Open
Abstract
The study purpose was to analyze current results of modern cementless femoral components in young patients having total hip arthroplasty (THA) or hip resurfacing. Twenty-two studies (n = 5907; hips = 6408) evaluating modern cementless THA in young patients and 15 studies evaluating hip resurfacing (n = 3002; hips = 3269) were included. Meta-analysis techniques were used to pool failure rates. The pooled failure rate for THA using femoral revision for mechanical failure as an end point was 1.3% (95% confidence interval [CI], 1.0%-1.7%) at a mean 8.4 years of follow-up. At a mean of 3.9 years of follow-up, the pooled mechanical failure rate of the femoral component for hip resurfacing was 2.6% (95% CI, 2.0-3.4). In conclusion, the enthusiasm for hip resurfacing should be tempered by these data. Longer follow-up and direct comparison trials are required to confirm these findings.
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Affiliation(s)
- Bryan D Springer
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina 28207, USA
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113
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Alumina-on-alumina total hip arthroplasty in young patients: diagnosis is more important than age. Clin Orthop Relat Res 2009; 467:2281-9. [PMID: 19495898 PMCID: PMC2866919 DOI: 10.1007/s11999-009-0904-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 05/12/2009] [Indexed: 01/31/2023]
Abstract
Total hip arthroplasty (THA) in young patients has a high loosening rate, due in part to acetabular deformities that may compromise bone fixation and polyethylene wear. We therefore asked whether wear or osteolysis and loosening differ in patients under 40 years of age with alumina-on-alumina THA compared to those who are older. We prospectively followed 56 patients (63 hips) younger than 40 years (Group 1) and 247 patients (274 hips) older than 40 (Group 2) who had an alumina-on-alumina THA. The minimum followup was 4 years (mean, 5.6 years; range, 4-9 years). The two groups differed in various features: there were no patients with primary osteoarthritis in Group 1 and they had worse preoperative function and range of mobility, while weight, activity level, and implant size were greater in Group 2. The survival rate for cup loosening at 80 months postsurgery was 90.8% (95% confidence interval, 82.9-98.6%) for Group 1 and 96.5% (95% confidence interval, 94.2-98.7%) for Group 2. Cup loosening was less frequent with primary osteoarthritis than with severe developmental dysplasia of the hip. Although an alumina-on-alumina THA provided similar midterm survival and radiographic loosening in both age groups, the preoperative diagnosis seems more important than age for outcome. Continued followup will be required to determine if the alumina-on-alumina bearings in young patients result less risk of osteolysis and loosening.
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114
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Kim YH, Kim JS, Choi YW, Kwon OR. Intermediate results of simultaneous alumina-on-alumina bearing and alumina-on-highly cross-linked polyethylene bearing total hip arthroplasties. J Arthroplasty 2009; 24:885-91. [PMID: 18617363 DOI: 10.1016/j.arth.2008.05.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 05/02/2008] [Indexed: 02/01/2023] Open
Abstract
This study compared the clinical and radiographic results and the prevalence of osteolysis between alumina-on-alumina and alumina-on-highly cross-linked polyethylene bearings after cementless total hip arthroplasties in the 100 patients younger than 50 years of age. There were 66 men and 34 women; the mean age at the time of surgery was 45.3 years (range, 25 to 49 years). The mean duration of follow-up was 5.6 years (range, five to seven years). The pre-and postoperative Harris hip scores were similar (39 and 41 points, respectively and 93 points and 94 points, respectively). No acetabular or femoral component had aseptic loosening in either group. The mean annual penetration of the highly cross-linked polyethylene was 0.06 +/- 0.03 mm. No hip in either group had acetabular or femoral osteolysis.
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Affiliation(s)
- Young-Hoo Kim
- Joint Replacement Center of Korea, Ewha Womans University School of Medicine, Seoul, South Korea
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115
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Abstract
UNLABELLED Although uncemented cup implants frequently are used in young patients, we believe long-term survival rates of cups in these patients are somewhat disappointing, and therefore we have continued to use cemented cups in primary THA, even in young patients. However, in cases of acetabular bone stock defects, we also use bone impaction grafting. We prospectively followed 130 patients with 175 cemented cups; no patients were lost to followup. The mean age of the patients at surgery was 31 years (range, 16-39 years). An acetabular reconstruction with bone impaction grafting was performed in 84 hips (48%). The minimum followup was 2 years (average, 8.1 years; range, 2.0-18.5 years). Twenty-one of the 175 cups (12%) were revised at an average of 8.1 years (range, 2.0-18.5 years). Reasons for revision were infection (one early, seven late), recurrent dislocations (two), traumatic loosening (one), and aseptic loosening (10). The 10-year survival rate of all cemented cups with end point of revision for any cause was 85%. Survival with end point of aseptic loosening of all cups was 92%. Survival with end point of revision for aseptic loosening was 90% for the cups without impaction grafting and 95% for the cups with impaction grafting. We believe cemented acetabular cups in young patients have acceptable midterm survival; however, in the case of acetabular bone defects, we recommend reconstruction with impaction grafting. LEVEL OF EVIDENCE Level III, therapeutic study.
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116
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Aldinger PR, Jung AW, Pritsch M, Breusch S, Thomsen M, Ewerbeck V, Parsch D. Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results. J Bone Joint Surg Am 2009; 91:1432-9. [PMID: 19487522 DOI: 10.2106/jbjs.h.00297] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty without cement is frequently performed in young active patients, but only limited outcomes data are available after durations of follow-up of more than fifteen years. METHODS We retrospectively evaluated the clinical and radiographic results of a consecutive series of 154 total hip arthroplasties (in 141 patients) performed with an uncemented grit-blasted straight tapered titanium femoral stem combined with a threaded socket in patients under the age of fifty-five years. The median duration of follow-up was seventeen years. Clinical results were evaluated with use of the Harris hip score. The canal fill index was used as the criterion to determine the adequacy of stem sizing. Kaplan-Meier survivorship analysis was performed to predict long-term outcomes. RESULTS The stem was undersized, with a canal fill index of < or =80%, in forty-one hips (27%). Late aseptic loosening of the stem occurred in four femora, and the femoral component was undersized in all four. These four stems were stable for ten years and then underwent progressive subsidence, which was associated with pain. Five stems were revised because of a late postoperative periprosthetic fracture following trauma. Localized proximal femoral osteolysis was seen in seven hips without signs of loosening. Survivorship of the stem with revision for any reason as the end point was estimated to be 90% (95% confidence interval, 87% to 97%) at twenty years. Survivorship with aseptic loosening as the end point was estimated to be 95% (95% confidence interval, 91% to 99%) at twenty years. Sixty-seven (44%) of the threaded uncemented acetabular components were revised during the follow-up period. CONCLUSIONS After a minimum duration of follow-up of fifteen years, the survival of this type of femoral component is excellent in individuals younger than fifty-five years. The main mode of stem failure was a periprosthetic fracture due to trauma, or late aseptic loosening in a small percentage of the hips in which the femoral implant was undersized. The high rate of failure of the acetabular components was attributable to a poor design that is no longer in use.
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Affiliation(s)
- Peter R Aldinger
- Stiftung Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
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117
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Engh CA, Mohan V, Nagowski JP, Sychterz Terefenko CJ, Engh CA. Influence of stem size on clinical outcome of primary total hip arthroplasty with cementless extensively porous-coated femoral components. J Arthroplasty 2009; 24:554-9. [PMID: 18534449 DOI: 10.1016/j.arth.2008.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 02/10/2008] [Indexed: 02/01/2023] Open
Abstract
This study retrospectively evaluated the clinical outcome of primary total hip arthroplasty as a function of stem diameter in 1545 patients implanted with extensively porous-coated stems. Less than 2% of femoral components were loose or revised; femoral survivorship was 97.9% at 15 years. Of patients with stable components, 95 to 97% had increased function, decreased pain, and overall satisfaction. Although 17% of patients indicated activity-limiting pain, only 3% were dissatisfied with the results of their hip arthroplasty. Logistic regression demonstrated no statistical relationship between stem size and either revision, loosening, pain, or satisfaction. We conclude that patients with large-diameter, extensively porous-coated femoral components are no more likely to be revised, loose, or have thigh or activity-limiting pain than patients with smaller diameter stems.
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Affiliation(s)
- C Anderson Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
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Computer-assisted vs conventional mechanical jig technique in hip resurfacing arthroplasty. J Arthroplasty 2009; 24:341-50. [PMID: 18534413 DOI: 10.1016/j.arth.2007.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Accepted: 12/17/2007] [Indexed: 02/01/2023] Open
Abstract
To compare the effectiveness of computer-assisted surgery (CAS) and mechanical jig technique in hip resurfacing arthroplasty, we reviewed 176 hip resurfacing arthroplasty performed in 158 patients. The initial 131 hips were resurfaced using the conventional mechanical jig technique, and the remaining 45 hips with the CAS technique. The demographic data of the patients were similar for both techniques. Follow-up radiographs taken 2 months after the surgery showed patients in the CAS technique having a significantly better alignment of the femoral component on the frontal and sagittal planes. There was no difference in the risk of implant notching on the femoral neck for both techniques. The implant sizes were similar for both techniques; thus, the amount of bone stock preserved was not technique specific.
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119
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Cheng T, Feng JG, Liu T, Zhang XL. Minimally invasive total hip arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2009; 33:1473-81. [PMID: 19277652 DOI: 10.1007/s00264-009-0743-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 02/01/2009] [Accepted: 02/01/2009] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to compare the operative outcome between mini and standard incisions in total hip arthroplasty (THA). We identified 12 randomised or quasi-randomised control trials (RCT or qRCT) published between 1996 and 2008. Subgroup and sensitivity analyses were performed to evaluate the differences in results for surgical approach, trial quality, and follow-up duration. Operative time and blood loss were significantly reduced in the mini-incision group for studies with the posterior or posterolateral approach. Concerning postoperative complications, there were no significant differences between the two groups with no significant heterogeneity. No differences were observed between the two groups for Harris hip score and radiographic results except for cup anterversion. Although mini-incision appeared to have similar outcomes compared to standard incision, the follow-up is short-term according to current standards in THA. High-quality studies are required to compare the outcomes of these two procedures.
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Affiliation(s)
- T Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Medical College, Shanghai Jiaotong University, Shanghai, China
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120
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Sanz Reig J, Lizaur Utrilla A, Plazaola Gutiérrez J, Cebrián Gómez R. Supervivencia del componente acetabular no cementado con par polietileno-metal en pacientes jóvenes: estudio prospectivo con seguimiento de 8 a 13 años. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/j.recot.2008.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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121
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Survivorship of uncemented PE/metal acetabular components in young patients. Prospective study with an 8-13 year follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/s1988-8856(09)70147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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de Kam DCJ, Klarenbeek RLWA, Gardeniers JWM, Veth RPH, Schreurs BW. The medium-term results of the cemented Exeter femoral component in patients under 40 years of age. ACTA ACUST UNITED AC 2008; 90:1417-21. [PMID: 18978258 DOI: 10.1302/0301-620x.90b11.20557] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated the outcome of 104 consecutive primary cemented Exeter femoral components in 78 patients (34 men, 44 women) under the age of 40 years who underwent total hip replacement between October 1993 and May 2004. The mean age at operation was 31 years (16 to 39). No hip was lost to follow-up, but three patients (four hips) died. None of the deaths were related to the surgery. At a mean follow-up of 6.2 years (2 to 13), three femoral components had been revised for septic loosening. Using Kaplan-Meier survival analysis, the seven-year survival of the component with revision for any reason as the endpoint was 95.8% (95% confidence interval 86.67 to 98.7). The seven-year survival with aseptic femoral loosening as the endpoint was 100% (95% confidence interval 100). The cemented Exeter femoral component in patients under the age of 40 shows promising medium-term results. As it is available in a wide range of sizes and offsets, we could address all types of anatomical variation in this series without the need for custom-made components.
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Affiliation(s)
- D C J de Kam
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, P. O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Sharifi E, Sharifi H, Morshed S, Bozic K, Diab M. Cost-effectiveness analysis of periacetabular osteotomy. J Bone Joint Surg Am 2008; 90:1447-56. [PMID: 18594092 DOI: 10.2106/jbjs.g.00730] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A lack of long-term outcomes data following periacetabular osteotomy makes it difficult for surgeons to recommend the most appropriate procedure to young patients who might be candidates for a joint-preserving procedure. In this study, we compared the cost-effectiveness of periacetabular osteotomy with total hip arthroplasty in terms of cost per quality-adjusted life year for the young adult. METHODS A decision model was constructed for a cost-utility analysis of periacetabular osteotomy compared with total hip arthroplasty. Outcome probabilities and effectiveness were derived from the literature. Effectiveness was expressed in quality-adjusted life years gained. Cost data were compiled and verified from our institution. Costs and utilities were discounted in accord with the United States Panel on Cost-Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and net health benefits. Multivariate sensitivity analysis was used to assess the contribution of included variables in the model's outcomes. RESULTS For Tönnis grade-1 coxarthrosis, periacetabular osteotomy dominates with an average incremental cost-effectiveness of $7856 per quality-adjusted life year and an average incremental effectiveness of 0.15. For Tönnis grade-2 coxarthrosis, periacetabular osteotomy is, on the average, more cost-effective than total hip arthroplasty with an incremental cost-effectiveness of $824 per quality-adjusted life year, but it is less effective than total hip arthroplasty, on the average, with an incremental effectiveness of -1.4 quality-adjusted life years. Periacetabular osteotomy becomes more cost-effective at a longevity of 5.5 years for Tönnis grade-1 coxarthrosis and 18.25 years for Tönnis grade-2 coxarthrosis. In Tönnis grade-3 coxarthrosis, total hip replacement becomes the dominant treatment strategy. CONCLUSIONS Periacetabular osteotomy is, on the average, more cost-effective in Tönnis grade-1 and grade-2 coxarthrosis, while it is both more costly and less effective in Tönnis grade-3 coxarthrosis. These findings can inform clinical decision-making in the absence of long-term data. On the basis of this model, periacetabular osteotomy is preferable to total hip arthroplasty in Tönnis grade-1 and grade-2 coxarthrosis when the patient is sufficiently young and when functionality in sports is important.
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Affiliation(s)
- Emile Sharifi
- School of Medicine, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
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124
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Baek SH, Kim SY. Cementless total hip arthroplasty with alumina bearings in patients younger than fifty with femoral head osteonecrosis. J Bone Joint Surg Am 2008; 90:1314-20. [PMID: 18519326 DOI: 10.2106/jbjs.g.00755] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are conflicting reports with respect to the outcomes of total hip arthroplasties with ceramic bearings in young patients with osteonecrosis of the femoral head. We prospectively investigated the outcomes after cementless total hip arthroplasties with contemporary alumina bearings in patients with osteonecrosis of the femoral head in this age group. METHODS We prospectively followed sixty patients (seventy-one hips) with a mean age of 39.1 years for an average of 7.1 years. All procedures were performed at the same institution by one surgeon, and the results were evaluated serially. The clinical evaluations included use of the Harris hip score, and activities of daily living were evaluated with use of the criteria of Johnston et al. RESULTS The mean Harris hip score was 97.0 points at the time of final follow-up. Thirteen patients (fourteen hips, 20%) reported noise in the hip. Loosening or osteolysis was not observed in any hip, and no prosthesis had been revised. No hip had dislocated, and no ceramic fracture had occurred. CONCLUSIONS After a minimum of six years of follow-up, this cementless total hip arthroplasty with contemporary alumina bearings was found to be a promising procedure for young, active patients with osteonecrosis of the femoral head. However, we remain concerned about the long-term implications of the noise that was reported in these hips.
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Affiliation(s)
- Seung-Hoon Baek
- Department of Orthopaedic Surgery, Catholic University of Daegu Hospital, 3056-6 Dae-Myung-4, Nam-Gu, Daegu 705-718, South Korea.
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Flecher X, Casiraghi A, Aubaniac JM, Argenson JN. [Periacetabular osteotomy medium term survival in adult acetabular dysplasia]. ACTA ACUST UNITED AC 2008; 94:336-45. [PMID: 18555859 DOI: 10.1016/j.rco.2007.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2007] [Indexed: 11/15/2022]
Abstract
PURPOSE OF THE STUDY Acetabular dysplasia is a recognized cause of early onset degenerative hip disease. With the widespread use of arthroplasty, the role for conservative treatment has become a controversial issue. Periacetabular osteotomy (PAO) as proposed by Ganz has several advantages, but remains a technically difficult procedure. The purpose of this work was to assess our mid-term results considering indications and potential complications and to describe changes in our technique. MATERIAL AND METHODS This study included 33 dysplasic hips in 24 women and four men, treated by PAO. Mean age was 32 years (range 18-47). Mean follow-up was 12 years (range 2-19). The radiographic work-up included an anteroposterior view of the pelvis and anterior and Lequesne oblique views of the hip joint. The cephalocervicodiaphyseal (CC'D), lateral cover (VCE), anterior cover (VCA), and acetabular roof horizontality (HTE) angles and noted whether osteoarthritis was present or not. Hips were classified with the Hip Study Group system as moderate dysplasia (VCE and VCA 25 degrees to 21 degrees ), severe dysplasia (20 degrees to 5 degrees ) and extreme dysplasia (less than 5 degrees ). The complete work-up included an assessment of joint congruency with recentered films in addition to the surgical lateral view of the hip in order to determine a new index called S/FH (S: acetabular surface, FH: half of the femoral head surface). ArthroCT and MRI were performed in patients with signs of osteoarthritis. The original technique included three cuts (ilio-ischiatic, iliopubic, and iliac) close to the acetabulum using a triple access: infracoxofemoral, intrapelvic, and extrapelvic. The first change in the technique was an osteotomy of the anterosuperior iliac spine and an oblique iliac cut farther from the acetabulum. RESULTS Preoperatively, average angle measurements were as follows: 135 degrees (121 to 150 degrees ) for CC'D, 23.2 degrees (3 degrees to 40 degrees ) for HTE, 7.6 degrees (-14 degrees to 22 degrees ) for VCE, 11.3 degrees (-26 degrees to 32 degrees ) for VCA. Postoperatively, the values were as follows: 134.5 degrees (121 degrees to 150 degrees ) for CC'D, 9.5 degrees (-9 degrees to 20 degrees ) for HTE, 31.7 degrees (14 degrees to 60 degrees ) for VCE and 31.7 degrees (10 degrees to 48 degrees ) for VCA. An intertrochanteric osteotomy was also performed in one patient. The mean Postel-Merle-d'Aubigné score improved from 7.5 points (range 5.6-11) preoperatively to 14.9 (range 8.1-18). At last follow-up, there was no sign of osetoarthritic degradation in 17 patients (51.5%). Seven patients required total hip arthroplasty at mean four years (two to nine years), including one for aseptic acetabular necrosis. Survival was 73.8+/-9 % at 12 years. DISCUSSION AND CONCLUSION This study confirmed the importance of PAO as part of the therapeutic armamentarium for conservative treatment of acetabular dyplasia. Several changes were made in the original technique: the three cuts were all done via the intrapelvic access; for severe and extreme dysplasia, a two thirds PAO was performed. At the present time, the best indication appears to be young subjects (aged less than 30 years) with moderate to severe dysplasia, with no sign (even minimal) of intra-articular disorder or osteoarthritis.
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Affiliation(s)
- X Flecher
- Centre Hospitalo-Universitaire Sud, Hôpital Sainte-Marguerite, Marseille, France.
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126
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Alumina-on-alumina hip arthroplasty in patients younger than 30 years old. Clin Orthop Relat Res 2008; 466:317-23. [PMID: 18196412 PMCID: PMC2505152 DOI: 10.1007/s11999-007-0068-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 11/05/2007] [Indexed: 01/31/2023]
Abstract
UNLABELLED THA in patients younger than 30 years old presents challenges: the initial technical challenge relates to the initial disease that often causes deformities making reconstruction difficult, while the long-term challenge is wear and subsequent osteolysis and component loosening. Ceramic-on-ceramic prostheses may represent a valuable option to reduce wear. We retrospectively studied 101 patients (132 hips) with ceramic-on-ceramic prostheses implanted from 1977 to 2004. As a result of the long span of time, different implant designs and modes of fixation were used. The average age of the patients was 23.4+/-5 years (range, 13-30 years), and the main indication for THA was femoral head necrosis. The minimum followup was 1 year (mean, 6.9 years; range, 1-26.5 years). We documented 17 revisions (13%) for aseptic loosening. Twelve were for isolated acetabular loosening, two for isolated femoral loosening, and three for loosening of both components. Survivorship was 82.1% at 10 years and 72.4% at 15 years. Inferior survivorship was observed for THA performed after secondary arthritis related to slipped capital epiphysis or trauma. Limited osteolysis was observed in one hip. The main limiting factor in this series was the fixation of the acetabular component. However, improvements in the design and in the mode of fixation of this component should enhance long-term results. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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127
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The Exeter Universal hip in patients 50 years or younger at 10-17 years' followup. Clin Orthop Relat Res 2008; 466:324-31. [PMID: 18196413 PMCID: PMC2505153 DOI: 10.1007/s11999-007-0049-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 11/01/2007] [Indexed: 01/31/2023]
Abstract
UNLABELLED The Exeter Universal hip (Stryker Inc., Newbury, UK) has reported survival rates of 91.74% at 12 years in all patients with reoperation as an endpoint. However, its performance in younger patients has not been fully established. We reviewed survivorship and the clinical and radiographic outcomes of this hip system implanted in 107 patients (130 hips) 50 years old or younger at the time of surgery. The mean age at surgery was 42 years. The minimum followup was 10 years (mean, 12.5 years; range, 10-17 years) with no patients lost to followup. Twelve hips had been revised. Of these, nine had aseptic loosening of the acetabular component and one cup was revised for focal lysis and pain. One hip was revised for recurrent dislocation and one joint underwent revision for infection. Radiographs demonstrated 14 (12.8%) of the remaining acetabular prostheses were loose but no femoral components were loose. Survivorship of both stem and cup from all causes was 92.6% at an average of 12.5 years. Survivorship of the stem from all causes was 99% and no stem was revised for aseptic loosening. The Exeter Universal stem performed well, even in the young, high-demand patient. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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128
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Delaunay CP, Bonnomet F, Clavert P, Laffargue P, Migaud H. THA using metal-on-metal articulation in active patients younger than 50 years. Clin Orthop Relat Res 2008; 466:340-6. [PMID: 18196415 PMCID: PMC2505155 DOI: 10.1007/s11999-007-0045-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 11/01/2007] [Indexed: 01/31/2023]
Abstract
UNLABELLED The main concern of patients with longer life expectancies and of patients who are younger and more active is the longevity of their total hip arthroplasty. We retrospectively reviewed 83 cementless total hip arthroplasties in 73 patients implanted with metal-on-metal articulation. All patients were younger than 50 years old (average age, 41 years) at the time of the index procedure, and 80% of the patients had an activity level graded 4 or 5 when measured with the system of Devane et al. A 28-mm Metasul articulation was used with three different cementless titanium acetabular components. At the most recent followup (average, 7.3 years), the average Merle d'Aubigné-Postel score improved from a preoperative 11.1 points to 17.4 points. We observed no radiographic evidence of component loosening. Ten acetabular components had lucency limited to one zone. The 10-year survivorship with the end point of revision (ie, exchange of at least one prosthetic or bearing component) was 100% (95% confidence interval, 90%-100%). Metasul bearings with cementless acetabular components remain promising in this high-risk younger patient population. However, additional followup strategies are recommended to determine any possible long-term deleterious effects associated with the dissemination of metallic ions. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christian P Delaunay
- Department of Orthopaedic Surgery, Clinique de l'Yvette, 67-71 route de Corbeil, 91160 Longjumeau, France.
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129
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Abstract
Contemporary metal-on-metal hip resurfacing is the third attempt by its proponents to eliminate a diaphyseal femoral component. I have multiple objections with the resurfacing concept and believe even the premises for the use of resurfacing invalid. There is a high rate of success with circumferential bead or mesh-coated uncemented stemmed femoral components at 10 to 20 years and there have been no long-term adverse consequences of femoral stress shielding with a diaphyseal component. More acetabular bone may be removed with resurfacing, negating its "conservative" premise. One computer simulation suggested the range of hip motion might be considerably less with resurfacing compared with conventional hip arthroplasty. There are a very limited number of patients for whom hip resurfacing is truly indicated, and the femoral head may be unsuitable for resurfacing in 40% of selected patients. Resurfacing is technically more difficult than conventional hip arthroplasty. Early complications and revision for femoral neck fractures are more likely with resurfacing. Blood and urine metal ion levels, capsular lymphocytic aggregation, and hypersensitivity are concerns with metal-on-metal articulation. Metal-on-metal hip resurfacing should only be used by a limited number of hip surgeons. The risks and complications of metal-on-metal hip resurfacing outweigh any possible advantages.
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Affiliation(s)
- Paul F Lachiewicz
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7055, USA.
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130
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Minimally Invasive Total Hip Arthroplasty Using a Posterolateral Approach: Technique and Preliminary Results. Kaohsiung J Med Sci 2007; 23:611-7. [DOI: 10.1016/s1607-551x(08)70059-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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131
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Yoo JJ, Kim YM, Yoon KS, Koo KH, Kim JW, Nam KW, Kim HJ. Contemporary alumina-on-alumina total hip arthroplasty performed in patients younger than forty years: a 5-year minimum follow-up study. J Biomed Mater Res B Appl Biomater 2007; 78:70-5. [PMID: 16506182 DOI: 10.1002/jbm.b.30457] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ceramic-on-ceramic bearing surfaces in total hip arthroplasties (THAs) are an attractive alternative coupling and may offer a promising option for young active patients. We evaluated the clinical results of 72 contemporary primary cementless alumina-on-alumina THAs performed in 61 patients younger than 40 years (mean age, 30 years), after a 5-year minimum follow-up. Most patients (97%) were able to return to their prearthritic activity levels, and none changed occupation because of a postoperative hip joint problem. No implant loosened radiographically and no stem or cup was revised. Ceramic wear was undetectable in 24 hips, where differentiation of the femoral head from the cup was possible on radiographs and no osteolysis was observed. One ceramic fracture following a major motor vehicle accident and a recurrent subluxation-associated ceramic liner edge fracture attributed to inadequate hip muscle tone occurred. We believe that this alternative articulation offers a promising option for young active patients. However, our findings also suggest that contemporary ceramic implant fracture is not a potential, but a real danger. Careful preoperative patient evaluation, proper indications for ceramic bearings, and meticulous surgical techniques are recommended to minimize the possibility of modern ceramic failure.
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Affiliation(s)
- Jeong Joon Yoo
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
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132
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Ziegler J, Amlang M, Bottesi M, Kirschner S, Witzleb WC, Günther KP. [Results for endoprosthetic care in patients younger than 50 years]. DER ORTHOPADE 2007; 36:325-36. [PMID: 17387449 DOI: 10.1007/s00132-007-1068-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Arthroplasty has become the most successful surgical procedure in developed countries. Replacement of severely damaged joints results in a substantial relief of pain, as the main symptom of osteoarthritis, in the majority of treated patients. With improved results in endoprosthetic surgery over the last decades, however, patients are increasingly undergoing the procedure to enhance their functional capacity and physical mobility. Especially younger patients, who cannot accept a restriction in their professional or sports activity, have become demanding candidates for surgery. This review summarizes the published results on shoulder, hip, knee, ankle and first metatarsophalangeal joint replacement in patients who are younger than 50 years of age. Mid- and long-term follow-up studies in this age group are evaluated in terms of prosthesis survival as well as functional improvement.
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Affiliation(s)
- J Ziegler
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus Dresden an der Technischen Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Deutschland.
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133
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Abstract
Total hip arthroplasty was originally indicated for older, sedentary patients because of concerns that catastrophic wear and failure would occur in younger and more active patients. With advances in implant design, tribology, and surgical technique, total hip arthroplasty has now become a viable option for younger patients seeking excellent pain relief and improvement in function. Long-term studies are needed to evaluate the outcome of hip arthroplasty in younger patients using the modern generation of implants and bearing surfaces.
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Affiliation(s)
- Peter F Sharkey
- Department of Orthopaedic Surgery, Jefferson Medical College, Philadelphia, Pennsylvania, USA
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134
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Eskelinen A, Paavolainen P, Helenius I, Pulkkinen P, Remes V. Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years. Acta Orthop 2006; 77:853-65. [PMID: 17260192 DOI: 10.1080/17453670610013132] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The results of total hip arthroplasty (THA) in young patients with rheumatoid arthritis (RA) have been reported in only a few studies. On a nationwide level, the outcome of THA in these patients is unknown. We evaluated the population-based survival of THA in patients under 55 years of age with RA and factors affecting the survival. PATIENTS Between 1980 and 2003, 2,557 primary THAs performed for RA in patients less than 55 years of age were reported to the Finnish Arthroplasty Register. RESULTS Proximally circumferentially porous-coated uncemented stems had a 15-year survival rate of 89% (95% CI 83-94) with aseptic loosening as endpoint. The risk of stem revision due to aseptic loosening was higher with cemented stems than with proximally porouscoated uncemented stems implanted during the same period (RR 2.4; p < 0.001). In contrast, Cox regression analysis showed that the risk of cup revision was significantly higher for all uncemented cup concepts than for all-polyethylene cemented cups with any cup revision as endpoint. There were no significant differences in survival between the THR concepts. INTERPRETATIONS Uncemented proximally circumferentially porous-coated stems and cemented all-poly-ethylene cups are currently the implants of choice for young patients with RA.
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Affiliation(s)
- Antti Eskelinen
- ORTON Orthopedic Hospital, Invalid Foundation, Helsinki, Finland.
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135
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Kearns SR, Jamal B, Rorabeck CH, Bourne RB. Factors affecting survival of uncemented total hip arthroplasty in patients 50 years or younger. Clin Orthop Relat Res 2006; 453:103-9. [PMID: 17006361 DOI: 10.1097/01.blo.0000238868.22852.dd] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Providing a long-lasting total hip arthroplasty for patients younger than 50 years remains one of the greatest challenges for modern arthroplasty surgery. We retrospectively reviewed 221 patients younger than 50 years who underwent 299 uncemented total hip arthroplasties from 1983 to 2000. We assessed 5- to 15-year survival with revision as the endpoint. Femoral stem survival was 99.3% (range, 98.4-100%), 98.9% (range, 97.7-100%), and 96.8% (92.5-100%) at 5, 10, and 15 years, respectively. Including all component designs acetabular survival was 98.7% (range, 97.4-100%), 84.6% (78.8-90.4%), and 52.5% (40.7-64.3%) at 5, 10, and 15 years, respectively. Overall survival was 46.8% (33.5-58.1%) at 15 years. Total hip arthroplasties performed for hip dysplasia had lower 10-year and 15-year survival. Zirconium-on-polyethylene articulations had lower acetabular revision rates compared with cobalt-chrome-on-polyethylene. Sixty-nine revisions were performed, most commonly for polyethylene wear. Uncemented femoral stems resulted in 90% survival at 15 years followup in patients younger than 50 years at index operation. Contemporary bearing surfaces in association with such stems may provide long-lasting total hip arthroplasties, even in young, active patients.
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Affiliation(s)
- S R Kearns
- Department of Orthopedic Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada.
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136
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Parvizi J, Campfield A, Clohisy JC, Rothman RH, Mont MA. Management of arthritis of the hip in the young adult. ACTA ACUST UNITED AC 2006; 88:1279-85. [PMID: 17012414 DOI: 10.1302/0301-620x.88b10.17859] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Arthritis of the hip in the young adult can be a disabling condition. Recent years have witnessed extensive research related to the management of this condition. This article reviews the current status with regard to aetiology, diagnosis and treatment of arthritis of the hip in the young adult.
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Affiliation(s)
- J Parvizi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Archibeck MJ, Surdam JW, Schultz SC, Junick DW, White RE. Cementless total hip arthroplasty in patients 50 years or younger. J Arthroplasty 2006; 21:476-83. [PMID: 16781397 DOI: 10.1016/j.arth.2005.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2005] [Accepted: 08/14/2005] [Indexed: 02/01/2023] Open
Abstract
This report examines the mean 9-year results of 100 second-generation cementless total hip arthroplasty in 91 patients 50 years or younger. The mean age at arthroplasty was 39 years (range, 14-50 years), and follow up averaged 9 years (range, 5-13 years). There were 13 revisions (7 related to polyethylene wear and/or osteolysis, 5 for instability, and 1 for infection). No femoral components were revised for loosening and none were radiographically loose. Two acetabular shells were revised for loosening secondary to extensive osteolysis. Ten-year survivorship using revision for any reason as the end point was 87.5%, using femoral component aseptic loosening as the end point was 100%, and using acetabular component aseptic loosening as the end point was 97.1%.
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Affiliation(s)
- Michael J Archibeck
- New Mexico Center for Joint Replacement Surgery, New Mexico Orthopaedics, 201 Cedar SE, Suite 6600, Albuquerque, NM 87106, USA.
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138
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Schreurs BW, Gardeniers JWM. Second letter to the editor concerning "Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register" by Eskelinen et al. and correspondence, Acta Orthop 2005; 76: 28-41, 604-607. Acta Orthop 2006; 77:337-8; author reply 338-41. [PMID: 16752300 DOI: 10.1080/17453670610046217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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139
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Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P. Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish Arthroplasty Register. Acta Orthop 2006; 77:57-70. [PMID: 16534703 DOI: 10.1080/17453670610045704] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The survival of total hip arthroplasties (THAs) has been considered to be poor in young patients. We evaluated the population-based survival of uncemented THA for primary osteoarthritis (OA) in patients under 55 years of age and the factors affecting survival. METHODS The Finnish Arthroplasty Register was established in 1980. Between that year and 2003, 92,083 primary THAs were entered in the register, 5,607 of which were performed for primary OA in patients under 55 years of age. Using records from these 5,607 THAs, we selected uncemented femoral and acetabular components that had been used in more than 100 operations during the study period. Survival of both components (cup/stem) and their combinations were analyzed separately with the Kaplan-Meier analysis and the Cox regression model. RESULTS All uncemented stems studied showed a survival rate of over 90% at 10 years. The Biomet Bi-Metric stem had a 95% (95% CI 93- 97) survival rate even at 15 years. Overall survival of the extendedly porous-coated Lord Madréporique stem (p = 0.003) and the proximally porous-coated Anatomic Mesh stem (p = 0.0008) were poorer than that of the Biomet Bi-Metric stem. When endpoint was defined as stem revision for any reason, results were generally similar; there was no difference, however, between the survival rates of the Lord Madréporique stem and the Bi-Metric stem. Of the acetabular components, the Biomet Universal, the ABG Il and the Harris-Galante II cups showed < 90% survival rates at 10 years with aseptic loosening as endpoint; at 13 years the corresponding survival rates were 94% (95% CI 91-97) for the Biomet Universal and 95% (95% CI 91-98) for the Harris-Galante II cups with aseptic loosening as endpoint. The PCA Pegged porous-coated uncemented cup showed a poor 13-year survival rate of 68% (95% CI 59-78) with aseptic loosening as endpoint. However, when endpoint was defined as any revision (including exchange of liner), the 10-year survival rates of all brands of cup except Harris-Galante II declined to under 80%. INTERPRETATION Modern second-generation uncemented stems, with proximal circumferential porous- or HA-coating, seem to be a good choice for young patients with primary OA. Similarly, modern press-fit porous- and HA-coated cups appear to have good endurance against aseptic loosening in these young patients. However, liner revisions were common; thus, survival rates of uncemented cups were unsatisfactorily low. Polyethylene wear and unfavorable locking mechanisms between the metal shell and the polyethylene liner and their sequelae remain matters of concern in this young and active group of patients.
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Affiliation(s)
- Antti Eskelinen
- ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland.
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140
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The B, Mol L, Diercks RL, van Ooijen PMA, Verdonschot N. Correction of error in two-dimensional wear measurements of cemented hip arthroplasties. Clin Orthop Relat Res 2006; 442:180-6. [PMID: 16394758 DOI: 10.1097/01.blo.0000185032.94102.2b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The irregularity of individual wear patterns of total hip prostheses seen during patient followup may result partially from differences in radiographic projection of the components between radiographs. A method to adjust for this source of error would increase the value of individual wear curves. We developed and tested a method to correct for this source of error. The influence of patient position on validity of wear measurements was investigated with controlled manipulation of a cadaveric pelvis. Without correction, the error exceeded 0.2 mm if differences in cup projection were as small as 5 degrees. When using the described correction method, cup positioning differences could be greater than 20 degrees before introducing an error exceeding 0.2 mm. For followup of patients in clinical practice, we recommend using the correction method to enhance accuracy of the results.
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Affiliation(s)
- Bertram The
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
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141
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Abstract
A woman who is elderly, lightweight, and low demand has traditionally been considered an ideal candidate for a cemented femoral stem. Patients who are young, heavy, and high demand have been considered higher risk for failure and, therefore, better suited for cementless femoral stems. However, modern cement techniques and implants have improved outcomes in high-risk cohorts, and stress shielding, thigh pain, and osteolysis have emerged as long-term challenges for cementless femoral stems. Recently reported positive bone remodeling around a cemented, triple-tapered, polished, collarless stem behaving according to the taper-slip philosophy of femoral stem fixation may widen the traditional indications for cemented femoral stems. Paradoxically, patients initially thought to be poor candidates for cemented fixation may benefit most from the long-term bone preservation and positive loading characteristics of this new generation of cemented stem technology.
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142
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Schreurs BW, Gardeniers JWM. Total hip arthroplasty for primary osteoarthroses in younger patients in the Finnish arthroplasty register. Acta Orthop 2005; 76:604-5; author reply 605-7. [PMID: 16195081 DOI: 10.1080/17453670510041637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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143
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Abstract
UNLABELLED Three hundred twenty-eight ceramic bearings were implanted by six surgeons in 316 patients as a part of a prospective randomized US Investigational Device Exemption study comparing alumina ceramic bearings with cobalt chrome-on-polyethylene bearings. There was no difference between the control metal-on-polyethylene and the alumina bearing couple patient cohorts regarding demographics or clinical scores through 7 years. Revision for any reason occurred in 2.7% of the patients with alumina bearings and 7.5% of the control patients with polyethylene bearings. Osteolysis was found in 1.4% of the patients with alumina bearings and in 14.0% of the control patients. At an average followup of 5.0 years (range, 1-86 months) no ceramic fractures or ceramic bearing failures have occurred. Results of this study suggest that alumina ceramics perform as well as the metal-on-polyethylene in clinical scores, but the patients with ceramic bearings had fewer revisions and less osteolysis. These results lead us to think that this new alumina ceramic bearing provides a safe option for younger and more active patients. LEVEL OF EVIDENCE Therapeutic study, Level I-1b (randomized controlled trial, no significant difference, but narrow confidence intervals). See the Guidelines for Authors for a complete description of levels of evidence.
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144
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Glyn-Jones S, Gill HS, Beard DJ, McLardy-Smith P, Murray DW. Influence of stem geometry on the stability of polished tapered cemented femoral stems. ACTA ACUST UNITED AC 2005; 87:921-7. [PMID: 15972903 DOI: 10.1302/0301-620x.87b7.16079] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Polished, tapered stems are now widely used for cemented total hip replacement and many such designs have been introduced. However, a change in stem geometry may have a profound influence on stability. Stems with a wide, rectangular proximal section may be more stable than those which are narrower proximally. We examined the influence of proximal geometry on stability by comparing the two-year migration of the Exeter stem with a more recent design, the CPS-Plus, which has a wider shoulder and a more rectangular cross-section. The hypothesis was that these design features would increase rotational stability. Both stems subsided approximately 1 mm relative to the femur during the first two years after implantation. The Exeter stem was found to rotate into valgus (mean 0.2°, sd 0.42°) and internally rotate (mean 1.28°, sd 0.99°). The CPS-Plus showed no significant valgus rotation (mean 0.2°, sd 0.42°) or internal rotation (mean −0.03°, sd 0.75°). A wider, more rectangular cross-section improves rotational stability and may have a better long-term outcome.
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Affiliation(s)
- S Glyn-Jones
- Oxford Orthopaedic Engineering Centre, The Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
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