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Chen AG, Sogbein OA, McClure JA, Reid J, Welk B, Lanting BA, Degen RM. Total Hip Arthroplasty in Patients Aged 40 to 60 years old: A Population-Based Study. J Arthroplasty 2023:S0883-5403(23)00383-2. [PMID: 37100095 DOI: 10.1016/j.arth.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Contemporary total hip arthroplasty (THA) has resolved many implant longevity concerns in younger patients. Patients in their fourth and fifth decades of life are projected to be the fastest growing demographic of THA patients. We aimed to assess this demographic to evaluate the: 1) rate of THA over time; 2) cumulative incidence of revision; and 3) identify risk factors for revision. METHODS A retrospective population-based study of patients between 40 and 60 years old undergoing primary THA was conducted using administrative data from a large clinical data repository. A total of 28,414 patients were included for analysis with a mean age of 53 years (range, 40-60 years) and median follow up of 9 years (range, 0-17 years). Linear regressions were used to assess annual rates of THA in this cohort over time. Kaplan-Meier analysis was used to determine cumulative incidence of revision. Multivariate cox proportional hazards models were used to determine association of variables with revision risk. RESULTS The annual rate of THA in our population increased by 60.7% over the study period (P <0.0001). Cumulative incidence of revision was 2.9% at 5-years and 4.8% at 10-years. Younger age, women, non-osteoarthritis diagnosis, medical complications, and annual surgeon volume < 60 THA were associated with increased revision risk. CONCLUSION Demand for THA continues to dramatically increase in this cohort. Risk of revision was low but multiple risk factors were identified. Future studies will help delineate the effect of these variables on revision risk and assess implant survivorship beyond 10 years.
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Affiliation(s)
- Aaron G Chen
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Olawale A Sogbein
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - J Andrew McClure
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Reid
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Blayne Welk
- Institute for Clinical Evaluative Sciences (ICES), Western, London, Ontario, Canada; Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Healthcare, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Ryan M Degen
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
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Li L, Fu J, Xu C, Ni M, Chai W, Hao L, Zhou Y, Chen J. Fourth‐Generation Ceramic‐on‐Ceramic THA
in Patients with Ankylosing Spondylitis: A Minimum
10‐Year Follow‐Up. Orthop Surg 2022; 14:860-867. [PMID: 35434922 PMCID: PMC9087442 DOI: 10.1111/os.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/05/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To report the long‐term outcomes of total hip arthroplasty (THA) with fourth‐generation ceramic‐on‐ceramic (CoC) bearing in patients with ankylosing spondylitis (AS). Methods We retrospectively identified 180 primary THAs performed in 110 patients with AS, including 100 (90.9%) men and 10 women (9.1%), from 2009 to 2011.The mean age of the patients at surgery was 33 years (range, 16 to 65 years). Cementless prostheses with fourth‐generation CoC bearings were used in all patients. Survivorship of the implants and postoperative complications were calculated. Functional improvement was assessed by the hip flexion‐extension range of motion (ROM) and Harris hip score (HHS). A special noise assessment questionnaire was performed at the last follow‐up. The cumulative incidence of noise was calculated by the Kaplan–Meier method with 95% confidence intervals (CIs). Clinical characteristics and functional outcomes were compared in the hips with noise to those without noise. Results The mean follow‐up was 11 years (range, 10 to 12 years), and survivorship of the implants was 99.4% at the most recent follow‐up. The complications included dislocation (one hip, 0.6%), periprosthetic joint infection (one hip, 0.6%), mild to moderate pain (five hips, 2.8%), heterotopic ossification (12 hips, 6.7%), and noise (52 hips, 28.9%). The flexion‐extension ROM improved significantly with a median from 10° (range, 0 ~ 130°) to 100° (30 ~ 130°) after THA (p < 0.001), and the HHS increased significantly from 41 ± 20 to 90 ± 8 (p < 0.001). The cumulative incidence of noise at 0.5, 5, and 10 years was 6.1% (95% CI, 2.6 ~ 9.6), 16.7% (95% CI, 11.2 ~ 22.1), and 28.9% (95% CI, 22.2 ~ 35.5), respectively, and that of squeaking at 0.5, 5, and 10 years was 4.4% (95% CI, 1.4 ~ 7.4), 13.3% (95% CI, 8.4 ~ 18.3), and 23.9% (95% CI, 17.6 ~ 30.1), respectively. None of the patients with noise generation in the hip reported it affecting daily activities or causing dissatisfaction. No differences in age, sex, BMI, disease duration, bilateral THA, the frequency of bony ankylosis, the proportion of using a 36‐mm‐diameter femoral head, pre/postoperative flexion‐extension ROM, or pre/postoperative HHS were found between hips with noise and those without noise (p > 0.05). Conclusion THAs with fourth‐generation CoC bearings exhibit excellent long‐term survival and clinical outcomes in patients with AS, with a very low dislocation rate. The incidence of noise associated with CoC bearings in THA performed in patients increases over time, but it does not affect postoperative hip function or daily activities.
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Affiliation(s)
- Liangliang Li
- Medical School of Chinese PLA Beijing China
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
- Department of Orthopeadics The Second Hospital of Shanxi Medical University Taiyuan China
| | - Jun Fu
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Chi Xu
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Ming Ni
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Wei Chai
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Libo Hao
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Yonggang Zhou
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Jiying Chen
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
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3
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Survival and complications of total hip arthroplasty using third-generation dual-mobility cups with non-cross-linked polyethylene liners in patients younger than 55years. Orthop Traumatol Surg Res 2022; 108:103208. [PMID: 35081455 DOI: 10.1016/j.otsr.2022.103208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In younger patients, total hip prostheses are subjected to wide motion ranges and wear-inducing forces. Dual-mobility cups (DMCs) are effective in decreasing the risk of dislocation. However, wear and osteolysis have been reported with first-generation DMCs. These complications have not been assessed in younger patients managed with third-generation DMCs associated with a lower risk of intra-prosthetic dislocation (IPD). We therefore designed a retrospective study of patients younger than 55years at THA with third-generation DMCs. Our objectives were to evaluate (1) the complication rate, and (2) the survival rate. HYPOTHESIS The rate of complications of THA with third-generation DMCs in patients younger than 55years of age is comparable to that in the general population of THA patients. MATERIAL AND METHODS This retrospective study included 79 consecutive patients (91 hips) who had total hip arthroplasty (THA) between 2007 and 2012. We included all patients younger than 55years who underwent primary THA with a third-generation DMC and a liner made of non-cross-linked polyethylene. The patients were evaluated clinically and radiologically. RESULTS Mean follow-up was 9.8years (range: 2-13years). At last follow-up, no patient had experienced prosthetic dislocation or IPD. Aseptic and septic cup loosening each occurred in 1 patient. In all, 7 (7.7%) patients required revision surgery with exchange of at least one component (cup loosening, n=2; neck fracture with a short stem fixed to the neck, n=1; peri-prosthetic femoral fracture, n=1; infection, n=1; and femoral-stem loosening, n=2). Peri-acetabular osteolysis developed in 2 (2.2%) hips. Cup survival to aseptic loosening was 98.9% (95% confidence interval, 97%-100%) and survival to revision for any reason except infection was 95.6% (95% confidence interval, 82%-100%). DISCUSSION In patients younger than 55years, third-generation DMCs were associated with absence of prosthetic dislocation, absence of IPD, and a low revision rate for cup loosening, in the medium term. These implants therefore constitute a viable treatment option in younger patients requiring THA. LEVEL OF EVIDENCE IV, retrospective study.
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Chung KY, Cheung KW, Fan CH, Poon WC, Chiu KH, Ho KKW. Long-Term Outcome on the Mal-Seating of Ceramic-on-Ceramic Articulation in Total Hip Arthroplasty. J Arthroplasty 2021; 36:2100-2104. [PMID: 33573813 DOI: 10.1016/j.arth.2021.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty with ceramic-on-ceramic articulation aims to decrease wear, osteolysis, and aseptic loosening. A metal-backed ceramic liner was developed to reduce the risk of liner fracture. However, a significant number of cases of mal-seating of the metal-backed ceramic liner were observed in the 2000s, and there were concerns about their outcome. This review aims to investigate the long-term performance of the mal-seated ceramic liner. METHODS From July 2003 to March 2007, 35 ceramic-on-ceramic total hip arthroplasties were performed with the Trident acetabular system. Clinical assessment, radiological analysis, and outcome assessment were performed. The prevalence of liner mal-seating and its long-term outcomes were investigated. RESULTS There was liner mal-seating in 8 hips (22.9%). One liner was exchanged in the early postoperative period. No revision surgery was required for the remaining 7 hips at a mean follow-up of 14 years. All patients were free of hip pain with a mean Harris Hip Score of 94.7 at the most recent follow-up. No adverse event was observed. CONCLUSION The long-term outcomes of the mal-seated liner were favorable. However, surgeons should exercise meticulous surgical technique to achieve a properly aligned liner within the acetabular shell to minimize this potentially correctable error.
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Affiliation(s)
| | | | - Chi-Ho Fan
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Wai-Chin Poon
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kwok-Hing Chiu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kevin Ki-Wai Ho
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong
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Mei XY, Gong YJ, Safir O, Gross A, Kuzyk P. Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature. Can J Surg 2020; 62:249-258. [PMID: 31348632 DOI: 10.1503/cjs.013118] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Total hip arthroplasty (THA) is increasingly performed in younger patients despite the lack of comprehensive assessment of long-term outcomes. We systematically reviewed the contemporary literature to assess the 1) indications, 2) implant selection and long-term survivorship, 3) complication and reoperation rates and 4) radiographic and functional outcomes of primary THA in patients younger than 55 years. Methods We searched the Embase and MEDLINE databases for English-language articles published between 2000 and 2018 that reported outcomes of primary THA in patients younger than 55 years with a minimum follow-up duration of 10 years. Results Thirty-two studies reporting on 3219 THA procedures performed in 2434 patients met our inclusion criteria. The most common preoperative diagnoses were avascular necrosis (1044 [32.4%]), osteoarthritis (870 [27.0%]) and developmental dysplasia of the hip (627 [19.5%]). Modular implants (3001 [93.2%]), cementless fixation (2214 [68.8%]) and metal-on-polyethylene bearings (1792 [55.7%]) were frequently used. The mean 5- and 10-year survival rates were 98.7% and 94.6%, respectively. Data on survival beyond 10 years were heterogeneous, with values of 27%–99.5% at 10–14 years, 59%–84% at 15–19 years, 70%–77% at 20–24 years and 60% at 25–30 years. Rates of dislocation, deep infection and reoperation for any reason were 2.4%, 1.2% and 16.3%, respectively. The mean Harris Hip Score improved from 43.6/100 to 91.0/100. Conclusion Total hip arthroplasty in patients younger than 55 years provides reliable outcomes at up to 10 years. Future studies should evaluate the outcomes of THA in this population at 15–20 years’ follow-up.
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Affiliation(s)
- Xin Yu Mei
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Ying Jia Gong
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Oleg Safir
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Allan Gross
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Paul Kuzyk
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
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Min BW, Cho CH, Son ES, Lee KJ, Lee SW, Song KS. Highly Cross-Linked Polyethylene in Total Hip Arthroplasty in Patients Younger Than 50 Years With Osteonecrosis of the Femoral Head: A Minimum of 10 Years of Follow-Up. J Arthroplasty 2020; 35:805-810. [PMID: 31690522 DOI: 10.1016/j.arth.2019.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/20/2019] [Accepted: 10/10/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Polyethylene wear and subsequent periprosthetic osteolysis remain a major concern of total hip arthroplasty (THA) failure in young, active patients with osteonecrosis of the femoral head (ONFH). The literature is lacking regarding the long-term performance of highly cross-linked polyethylene (HXLPE) in these patients. The purpose of this study is to evaluate long-term results for cementless THA using metal-on-HXLPE bearing couplings in patients younger than 50 years with ONFH. METHODS We retrospectively evaluated the clinical and radiographic results of a consecutive series of 85 THAs (in 67 patients) performed with HXLPE liners (Durasul) in patients younger than 50 years who had ONFH. All procedures were performed at a single institution by a single surgeon using the same type of implants. The minimum duration of follow-up was 10 years (mean, 13.5 years; range, 10-17.3 years). Wear was measured using computer software. Osteolysis was evaluated with the use of radiography and computed tomography. RESULTS The mean Harris hip score was 49.3 points (range, 26-68 points) before surgery, which improved to 93.6 points (range, 87-98 points) after surgery. Neither femoral nor acetabular components displayed mechanical loosening, and no components had been revised by the final follow-up evaluation. Radiographs and computed tomography scans did not demonstrate osteolysis. The mean liner wear was 0.037 mm/y (range, 0-0.099 mm/y). With the data available, univariate regression analysis did not demonstrate that age, sex, weight, activity level, underlying cause of osteonecrosis, liner thickness, or cup inclination had any influence on liner penetration. CONCLUSION Although the long-term effects of HXLPE particles remain unknown, the implant survivorship rate and wear rate in our study are promising and support the continued use of metal-on-HXLPE bearing couplings in these high-risk patients because they do not produce any of the issues associated with hard-on-hard couplings. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Byung-Woo Min
- Department of Orthopaedic Surgery, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea
| | - Chul-Hyun Cho
- Department of Orthopaedic Surgery, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea
| | - Eun-Suck Son
- Department of Orthopaedic Surgery, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea
| | - Kyung-Jae Lee
- Department of Orthopaedic Surgery, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea
| | - Si-Wook Lee
- Department of Orthopaedic Surgery, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea
| | - Kwang-Soon Song
- Department of Orthopaedic Surgery, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea
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Sobti AS, Busch CA, Afolayan JO, Michael D, Chana R. Early to mid-term outcome of Oxinium on Verilast highly cross-linked polyethylene bearing surface in uncemented total hip arthroplasty. Hip Int 2019; 29:660-664. [PMID: 30630363 DOI: 10.1177/1120700018813316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We report 5- to 10-year clinical and radiological outcomes of a series of uncemented Oxinium on Verilast (highly cross-linked polyethylene liners) total hip replacements (THAs) using the Anthology stem and R3/Reflection cup system. METHODS 116 THAs were performed by 2 senior authors in 104 patients from 2005 to 2009. The mean age at time of operation was 63.8 (45-80) years. The average length of follow-up was 8.8 years. At final data collection 12 patients had died (13 THAs) and 3 patients (3 THAs) were lost to follow-up. RESULTS In the remaining 100 THAs, the preoperative Harris Hip Score of 39 improved to 91 and Oxford Hip Score improved from 16 to 44 (mean at 5 to 10 years). 100 THAs were available for radiographic analysis: all had stable bony ingrowth of both the stem and cup. Dorr's methods for wear in the 100 THAs showed an average wear <0.01 mm/year and no osteolysis; only 1 case showed 0.22 mm/year with some proximal femoral osteolysis but no cup lesions. There were no dislocations or revisions, survivorship in this series for both components for any cause as an endpoint was 100%. 1 intraoperative calcar fracture was sustained and treated with a cerclage wires, 2 peri-prosthetic fractures occurred and were treated with open reduction and fixation, both healed well with excellent outcomes. DISCUSSION The study has shown good clinical and radiological outcomes at 5-10 years and supports existing data on the potential benefits of this bearing performance in literature.
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Affiliation(s)
- Anshul S Sobti
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Constant A Busch
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - John O Afolayan
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Dean Michael
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Rishi Chana
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
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Konan S, Alazzawi S, Yoon BH, Cha YH, Koo KH. A focused update on preventing ceramic fractures in hip arthroplasty. Bone Joint J 2019; 101-B:897-901. [DOI: 10.1302/0301-620x.101b8.bjj-2019-0309.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ceramic bearings have several desirable properties, such as resistance to wear, hardness, and biocompatibility, that favour it as an articulating surface in hip arthroplasty. However, ceramic fracture remains a concern. We have reviewed the contemporary literature, addressing the factors that can influence the incidence of ceramic bearing surface fracture. Cite this article: Bone Joint J 2019;101-B:897–901.
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Affiliation(s)
- S. Konan
- Princess Grace Hospital, London, UK
| | - S. Alazzawi
- Orthopaedic Department, University of British Columbia Hospital and Vancouver General Hospital, Vancouver, Canada
| | - B-H. Yoon
- Inje University Seoul Paik Hospital, Seoul, South Korea
| | - Y-H. Cha
- Orthopedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - K-H. Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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9
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Xing D, Yang C, Li R, Hou Y, Kou B, Li H, Lin J. Severe Wear and multiple Pseudotumor formation due to revision for ceramic head breakage after ceramic-on-ceramic Total hip arthroplasty: a case report. BMC Musculoskelet Disord 2019; 20:332. [PMID: 31315587 PMCID: PMC6637575 DOI: 10.1186/s12891-019-2722-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/15/2019] [Indexed: 12/03/2022] Open
Abstract
Background Head breakage is a serious complication following total hip arthroplasty when using Ceramic on Ceramic bearings surfaces. There is still in controversy about the selection of bearing surfaces when conducting revision surgery. Case presentation We describe the case of a fifty-year-old man who had undergone right total hip arthroplasty (THA) with ceramic-on-ceramic prostheses in 2011. After a fall 6 years after the primary procedures, radiographs suggested a ceramic head breakage for revision THA with exchange of metal-on-polyethylene bearing. However, 8 months later, severe metallosis and multiple pseudotumor was confirmed in pelvis and surrounding hip after re-revision THA with ceramic-on-polyethylene prostheses. Analysis of the serum metal ion indicated massive wear of the metal head and erosion of the stem neck and taper. Conclusions This case vividly demonstrates metal bearings should be avoided and revision with complete synovectomy and thorough debridement should be performed whenever possible for a fractured ceramic bearing.
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Affiliation(s)
- Dan Xing
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Chaolei Yang
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China.,Orthopedic Department, The First People's Hospital of Pingdingshan, Henan, China
| | - Rujun Li
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yunfei Hou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Bolong Kou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Hu Li
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China. .,Arthritis Institute, Peking University, Beijing, China.
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10
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Lau YJ, Sarmah S, Witt JD. 3 rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study. Hip Int 2018; 28:133-138. [PMID: 29890910 DOI: 10.1177/1120700018768617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION 3rd generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings. The purpose of our study was to investigate the long-term clinical and radiographic results of 3rd generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture. METHODS The database of the senior author (J.D.W.) was reviewed. A total of 126 hip replacements performed in 108 patients (average age 39.6 years) with an average follow-up of 12.1 years (10-16 years) was identified. Clinical notes and plain radiographs were reviewed. To measure function, patients were contacted and an Oxford Hip Questionnaire was completed. Patients were also directly questioned about the presence of squeaking or any other sounds from the hip. Radiographs were evaluated for signs of wear, osteolysis, loosening and heterotopic ossification. The abduction angle of the acetabular component was measured. RESULTS The average Oxford Hip Score was 39.8 out of 48. Survivorship at 10 years was 94.6% (95% CI) with revision for any cause as the endpoint. There was 1 femoral head fracture, no osteolysis, no squeaking and no detectable wear. CONCLUSIONS The good clinical and radiographic results for this series of patients are similar to other recent long-term studies looking at 3rd generation ceramic-on-ceramic THA. The results compare favourably with other bearing surfaces. The lack of osteolysis associated with this articulation is encouraging and may also make it a good choice for younger patients requiring total hip replacement.
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Abstract
INTRODUCTION Total hip arthroplasties (THAs) in younger patients are becoming increasingly popular. However, the outcome of subsequent revisions in younger patients is not well known and, therefore, their success (subsequent revision prosthesis survival) might be overestimated. We investigated available data on the outcome of primary- and subsequent revision THAs performed in the same cohort of patients who underwent primary THA under the age of 50. METHODS Medline, Embase and the Cochrane Library (CENTRAL) were searched up until April 13, 2016 for studies that reported both the survival of primary and subsequent revisions THA of single cohorts of patients younger than 50. Eligible articles had to include Kaplan Meier analysis or competing risk analysis for survival of the primary THA at a mean follow-up of 10 years, as well as for the subsequent revision THA within the same cohort. RESULTS We found 4,799 unique records; 43 of which were potentially eligible. Only 1 paper met our inclusion criteria. It reported on the survival of 69 primary prostheses at a mean of more than 10 years follow-up and 13 subsequent revisions. CONCLUSIONS There is a clear lack of evidence about the outcomes of the revision arthroplasty in younger patients. Only 1 study reported the survival-rate of subsequent revision arthroplasty with the minimum 10-year survival rate of the original THA cohort. In the future, this serious lack of knowledge could result in a large number of patients with no further reconstructive options after failed THA, and a large medical burden for society.
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12
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Klugarova J, Klugar M, Mareckova J, Gallo J, Kelnarova Z. The effectiveness of inpatient physical therapy compared to outpatient physical therapy in older adults after total hip replacement in the post-discharge period: a systematic review. ACTA ACUST UNITED AC 2018; 14:174-209. [PMID: 26878927 DOI: 10.11124/jbisrir-2016-2392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Total hip replacement is the most effective and safest method for treating severe degenerative, traumatic and other diseases of the hip joint. Total hip replacement can reliably relieve pain and improve function in the majority of patients for a period of 15 to 20 years or more postoperatively. Physical therapy follows each total hip replacement surgery. Physical therapy protocols after total hip replacement in the post-discharge period vary widely in terms of setting (inpatient, outpatient), content (the particular set of exercises used), and frequency (e.g. daily versus twice a week). In current literature, there is no systematic review which has compared the effectiveness of inpatient and outpatient physical therapy in patients after total hip replacement in the post-discharge period. OBJECTIVES The objective of this systematic review was to compare the effectiveness of inpatient physical therapy with outpatient physical therapy on the quality of life and gait measures in older adults after total hip replacement in the post-discharge period. INCLUSION CRITERIA This review considered studies that include older adults (over 65 years) who have had total hip replacement and are in the post-discharge period. Adults with bilateral or multiple simultaneous surgeries and also patients who have had hemiarthroplasty of the hip joint were excluded.This review considered studies that included any type of physical therapy delivered in inpatient settings provided by professionals with education in physical therapy. Inpatient physical therapy delivered at any frequency and over any duration was included.This review considered studies that included as a comparator any type of physical therapy delivered in outpatient settings provided by professionals with education in physical therapy or no physical therapy.This review considered studies that included the following primary and secondary outcomes. The primary outcome was quality of life, assessed by any validated assessment tool. The secondary outcome was measures of gait assessed by any valid methods.This review considered both experimental and observational study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies for inclusion. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 12 databases. Studies published in all languages and any date were considered for inclusion in this review. METHODOLOGICAL QUALITY Assessment of methodological quality was not conducted as no studies were identified that met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS Data extraction and synthesis was not performed because no studies were included in this systematic review. RESULTS During to the three-step search strategy 4330 papers were identified. The primary and secondary reviewer independently retrieved 42 potentially relevant papers according to the inclusion criteria by title and abstract screening. Following assessment of full text all of the retrieved papers were excluded based on the inclusion criteria. CONCLUSIONS There is no scientific evidence comparing the effectiveness of inpatient physical therapy with outpatient physical therapy in older patients after total hip replacement in the post-discharge period. IMPLICATIONS FOR RESEARCH This systematic review has identified gaps in the literature for comparing the effectiveness of inpatient physical therapy with and outpatient physical therapy on the quality of life and gait measures in older adults after total hip replacement in the post-discharge period. Prospective randomized double blind multicenter controlled trials are needed to answer this important clinical question.
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Affiliation(s)
- Jitka Klugarova
- 1. The Czech Republic (Middle European) Centre for Evidence-Based Health Care: an Affiliate Center of the Joanna Briggs Institute; Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
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13
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Abstract
Metal-on-highly cross-linked polyethylene is considered the preferred bearing surface for conventional total hip arthroplasty because of its safety profile and excellent results in the first 10 to 15 years of use. However, with younger patient age, activity expectations increase, and the life expectancy of patients with total hip arthroplasty also has increased, so interest remains in other bearing couples. These other options include the use of various ceramic composites for the femoral head on highly cross-linked polyethylene, the so-called second-generation antioxidant polyethylenes, and ceramic acetabular liners. Several of these bearing couples have shown excellent wear rates in vitro, and short-term clinical studies have demonstrated favorable wear and safety results. It is uncertain whether any of these bearing couples should be adopted at present. Understanding the unique properties and possible complications of these bearing couples is critical for appropriate implant selection.
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14
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Hannouche D, Zingg M, Miozzari H, Nizard R, Lübbeke A. Third-generation pure alumina and alumina matrix composites in total hip arthroplasty: What is the evidence? EFORT Open Rev 2018; 3:7-14. [PMID: 29657840 PMCID: PMC5890134 DOI: 10.1302/2058-5241.3.170034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Wear, corrosion and periprosthetic osteolysis are important causes of failure in joint arthroplasty, especially in young patients. Ceramic bearings, developed 40 years ago, are an increasingly popular choice in hip arthroplasty. New manufacturing procedures have increased the strength and reliability of ceramic materials and reduced the risk of complications. In recent decades, ceramics made of pure alumina have continuously improved, resulting in a surgical-grade material that fulfills clinical requirements. Despite the track record of safety and long-term results, third-generation pure alumina ceramics are being replaced in clinical practice by alumina matrix composites, which are composed of alumina and zirconium. In this review, the characteristics of both materials are discussed, and the long-term results with third-generation alumina-on-alumina bearings and the associated complications are compared with those of other available ceramics.
Cite this article: EFORT Open Rev 2018;3:7-14. DOI: 10.1302/2058-5241.3.170034
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Affiliation(s)
- Didier Hannouche
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Matthieu Zingg
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Hermes Miozzari
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Remy Nizard
- Department of Orthopaedic Surgery, AP-HP, Hôpital Lariboisière, Paris University, Paris, France
| | - Anne Lübbeke
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
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15
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Lau YJ, Sarmah S, Witt JD. 3rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study. Hip Int 2017:0. [PMID: 28777383 DOI: 10.5301/hipint.5000541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION 3rd generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings.The purpose of our study was to investigate the long-term clinical and radiographic results of 3rd generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture. METHODS The database of the senior author (J.D.W.) was reviewed. A total of 126 hip replacements performed in 108 patients (average age 39.6 years) with an average follow-up of 12.1 years (10-16 years) was identified. Clinical notes and plain radiographs were reviewed. To measure function, patients were contacted and an Oxford Hip Questionnaire was completed. Patients were also directly questioned about the presence of squeaking or any other sounds from the hip. Radiographs were evaluated for signs of wear, osteolysis, loosening and heterotopic ossification. The abduction angle of the acetabular component was measured. RESULTS The average Oxford Hip Score was 39.8 out of 48. Survivorship at 10 years was 94.6% (95% CI) with revision for any cause as the endpoint. There was 1 femoral head fracture, no osteolysis, no squeaking and no detectable wear. CONCLUSIONS The good clinical and radiographic results for this series of patients are similar to other recent long-term studies looking at 3rd generation ceramic-on-ceramic THA. The results compare favourably with other bearing surfaces. The lack of osteolysis associated with this articulation is encouraging and may also make it a good choice for younger patients requiring total hip replacement.
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16
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Gaillard MD, Gross TP. Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis : 1285 cases, 12-year survivorship. J Orthop Surg Res 2017; 12:79. [PMID: 28578684 PMCID: PMC5455178 DOI: 10.1186/s13018-017-0579-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship. These results do not meet the 95% 10-year survivorship guideline posed by the UK's National Institute for Health and Care Excellence (NICE) in 2014. METHODS The purpose of this study is threefold: First, we evaluate if metal-on-metal hip resurfacing arthroplasty meets these high standards in younger patients. Next, we compare outcomes between age groups to determine if younger patients are at higher risk for revision or complication. Lastly, we assess how outcomes between sexes changed over time. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal hip resurfacings in patients younger than 50 years old. We compared these to an older cohort matched by sex and BMI. RESULTS Kaplan-Meier implant survivorship was 96.5% at 10 years and 96.3% at 12 years; this did not differ from implant survivorship for older patients. Implant survivorship at 12 years was 98 and 93% for younger men and women, respectively; survivorship for women improved from 93 to 97% by using exclusively Biomet implants. There were four (0.3%) adverse wear-related failures, with no instances of wear or problematic ion levels since 2009. Activity scores improved from 5.4 ± 2.3 preoperatively to 7.6 ± 1.9 postoperatively (p < 0.0001), with 43% of patients reporting a UCLA activity score of 9 or 10. CONCLUSIONS Hip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.
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Affiliation(s)
- Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA.
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
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17
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Rambani R, Kepecs DM, Mäkinen TJ, Safir OA, Gross AE, Kuzyk PR. Revision Total Hip Arthroplasty for Fractured Ceramic Bearings: A Review of Best Practices for Revision Cases. J Arthroplasty 2017; 32:1959-1964. [PMID: 28189439 DOI: 10.1016/j.arth.2016.12.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/27/2016] [Accepted: 12/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty revision for a fractured ceramic bearing is rare but offers unique challenges. The purpose of this review was to provide a summary of existing literature on fractured ceramic bearings. METHODS Two authors performed a literature search of the MEDLINE OVID and PubMed databases with the following search terms: ceramic, fracture, total hip arthroplasty, and revision. RESULTS The search identified 228 articles of which 199 were selected for review. CONCLUSIONS It is mandatory to perform a complete synovectomy and thorough debridement of the fractured ceramic fragments. A well-fixed acetabular component should be removed if either the locking mechanism is damaged or the component is malpositioned. If the femoral stem taper is damaged, the femoral stem should be removed. However, if minimal damage is present, the femoral stem may be retained and revised using a fourth generation ceramic head with a titanium sleeve. Metal bearings should be avoided and revision with ceramic bearings should be performed whenever possible.
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Affiliation(s)
- Rohit Rambani
- Department of Orthopaedics, United Lincolnshire Hospital NHS Trust, Boston, Lincolnshire, UK
| | - David M Kepecs
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - Tatu J Mäkinen
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - Oleg A Safir
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - Allan E Gross
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - Paul R Kuzyk
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
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18
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Lee KH, Jo WL, Ha YC, Lee YK, Goodman SB, Koo KH. Total hip arthroplasty using a monobloc cementless femoral stem for patients with childhood Perthes’ disease. Bone Joint J 2017; 99-B:440-444. [DOI: 10.1302/0301-620x.99b4.bjj-2016-0259.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/07/2016] [Indexed: 11/05/2022]
Abstract
Aims Modular or custom-made femoral components have been preferred for total hip arthroplasty (THA) in patients with a history of Perthes’ disease because of the distortion in the anatomy of the proximal femur. However, it has not been established whether a monobloc cementless stem will fit the distorted proximal femur or whether the results of the procedure are satisfactory in this group of patients. Patients and Methods We reviewed 68 consecutive patients who had undergone THA for childhood Perthes’ disease between June 2003 and December 2008. There were 35 men and 33 women with a mean age of 48 years (16 to 73) at the time of index arthroplasty. Their mean body mass index was 24.4 (18.3 to 32.9). Of the 68 hips, 32 were classified as Stulberg class III and 36 as class IV. The mean pre-operative shortening of the affected leg was 17.2 mm (5 to 34). The minimum follow-up was five years (mean 8.5 years; 5.2 to 10). Results An intra-operative calcar fracture occurred in eight hips (11.8%) and was successfully treated by cerclage wiring. The mean stem version was 14.6° (-2.3 to 30; standard deviation (sd) 7.3). The mean acetabular component abduction was 40.2° (23.7 to 56.0; sd 6.5) and the mean anteversion 28.3° (6.4 to 43.0; sd 7.6), respectively. The mean follow-up was 8.5 years (5.2 to 10). No dislocations occurred and no hips were revised during the course of the study. At final follow-up, the mean Harris Hip Score was 91 points (59 to 100) and the mean University of California, Los Angeles activity score was 3.2 (2 to 8). Conclusion Monobloc cementless stems reliably restore the anatomy in Perthes’ disease at THA without the need for custom-made or modular implants. Cite this article: Bone Joint J 2017;99-B:440–444.
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Affiliation(s)
- K. H. Lee
- National Medical Center, 245, Eulji-ro, Jung-gu, Seoul, South
Korea
| | - W-L. Jo
- The Catholic University of Seoul St. Mary’s
Hospital, 222, Banpo-daero, Seocho-gu, Seoul
06591, South Korea
| | - Y. C. Ha
- Chung-Ang University Hospital, 102
Heukseok-ro, Dongjak-gu, Seoul, South
Korea
| | - Y. K. Lee
- Seoul National University, Bundang
Hospital, 166 Gumi-ro, Bundang-gu, Seongnam
463-707, South Korea
| | - S. B. Goodman
- Joint Replacement Center, 450
Broadway St Pavilion A 1st Fl MC 6110 Redwood City, CA94063, USA
| | - K. H. Koo
- Seoul National University, Bundang
Hospital, 166 Gumi-ro, Bundang-gu, Seongnam
463-707, South Korea
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Schmidt-Braekling T, Renner L, Mintz DN, Waldstein W, Endo Y, Boettner F. Do Changes in the Production Process Affect the Outcome of Ceramic Liners: A 3-Year Follow-Up Study. J Arthroplasty 2017; 32:1314-1317. [PMID: 27876256 DOI: 10.1016/j.arth.2016.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/24/2016] [Accepted: 10/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In 2011, the current liner was withdrawn from the market because of the potential risk for liner fracture secondary to increased pressures used to assemble the metal locking ring. The present study provides a short-term follow-up of patients with this implant. METHODS We retrospectively evaluated 63 consecutive hips in 53 patients operated by a single surgeon using a recalled ceramic-on-ceramic bearing. There were 30 women and 23 men with an average age of 50.6 years (range 20.3-63.5 years). The mean follow-up was 36.8 months. RESULTS Six hips in 6 patients were revised (9.5%) because of a liner-fracture during the follow-up period. All liner fractures were identified on computer tomography imaging. Nine patients had self-reported episodes of squeaking (14.3%). All 6 patients that underwent revision surgery for liner fracture described squeaking before revision. There were no revisions for other causes. Two of the revised patients had a subsequent dislocation (33%). CONCLUSION The recalled ceramic liner lots have an increased liner fracture rate. Patients with mechanical symptoms or squeaking should undergo computer tomography to rule out liner facture.
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Affiliation(s)
- Tom Schmidt-Braekling
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Orthopedics and Tumor Orthopedics, University of Muenster, Muenster, Germany
| | - Lisa Renner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Wenzel Waldstein
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Friedrich Boettner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
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Cementless total hip arthroplasty using Biolox®delta ceramic-on-ceramic bearing in patients with osteonecrosis of the femoral head. Hip Int 2017; 26:144-8. [PMID: 26868115 DOI: 10.5301/hipint.5000311] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the results of cementless total hip arthroplasty (THA) using a 32 mm or larger Biolox®delta ceramic-on-ceramic (CoC) bearing in patients with osteonecrosis of the femoral head after a minimum of 5 years of follow-up. MATERIALS AND METHODS We retrospectively analysed 44 patients (53 hips) who underwent cementless THA using Biolox®delta CoC bearing. There were 33 men (40 hips) and 11 women (13 hips) with the mean age of 49 years. A 36 mm head was used in 42 (79%) of 53 hips and a 32 mm head was used in 11 hips with smaller acetabular shells. The mean duration of follow-up was 5.3 years (range 5-6 years). RESULTS The mean Harris Hip Score improved from 50 points preoperatively to 97 points at final follow-up (p<0.001). All acetabular and femoral components showed radiographic evidence of osseointegration. No osteolysis was observed. No patients sustained ceramic fracture. An audible hip noise was identified in 2 (4%) of the 53 hips (1 squeaking and 1 clicking). Survivorship with revision for any reason at a minimum of 5 years was 100% in the best-case scenario and 95 % in the worst-case scenario. CONCLUSIONS The minimum 5-year results of cementless THA using a 32 mm or larger Biolox®delta CoC bearing in patients with osteonecrosis of the femoral head were encouraging with excellent survivorship. However, it was also found that the risk of noise development remains even for the new alumina matrix composite ceramic.
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21
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Puch JM, Derhi G, Descamps L, Verdier R, Caton JH. Dual-mobility cup in total hip arthroplasty in patients less than fifty five years and over ten years of follow-up : A prospective and comparative series. INTERNATIONAL ORTHOPAEDICS 2016; 41:475-480. [PMID: 27826763 DOI: 10.1007/s00264-016-3325-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/17/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We report clinical and radiological outcome of a dual mobility cup (DMC) of 2nd generation after a minimum of ten year-follow-up (FU). The goal of this work was to compare the results of this DMC in patients aged less than 55 years and in patients aged more than 55 years. METHODS From 2000 to 2005, a prospective and consecutive series of 119 THAs with a cementless DMC of 2nd generation (GIROS) were performed in patients aged less than 55 years and 444 in patients aged more than 55 years. RESULTS The mean FU was 11 years (8 to 15 years). Survivorships (failure of both components or cup loosening) were not different between patients aged less than 55 years and patients aged more than 55 years. There was no dislocation. DEVANE classification, Harris, PMA and Oxford scores improved after THA but no difference could be found between between < 55 years and > 55 years patients. CONCLUSION These results are better than those of first generation (BOUSQUET) DMC (77 % of survival rate at 20 years of FU). These results are in the same agreement than those of the literature: 99 % of survival rate at 14.2 years of FU for KERBOULL with a low friction arthroplasty and 96.5 % at ten years of FU for ceramic/ceramic bearing (R CHANA). The DMC for young patient is a relevant surgical option with no dislocation and excellent clinical results and survival rate at more than ten years of FU.
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Affiliation(s)
- Jean-Marc Puch
- Clinique Saint-Georges, 2 Avenue de Rimiez, 06100, Nice, France
| | - Guy Derhi
- Pôle Santé Saint-Jean, 53 avenue des alpes, 06800, Cagnes-sur-Mer, France
| | - Loys Descamps
- Clinique Saint-Georges, 2 Avenue de Rimiez, 06100, Nice, France
| | - Régis Verdier
- , 175 rue Jacquard - CS 50307, 69727, Genay Cedex, France.
| | - Jacques H Caton
- , Clinique orthopédique 103 rue Coste 69300, Caluire, France
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22
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A Randomized Trial Comparing Ceramic-on-Ceramic Bearing vs Ceramic-on-Crossfire-Polyethylene Bearing Surfaces in Total Hip Arthroplasty. J Arthroplasty 2016; 31:1240-1245. [PMID: 26730451 DOI: 10.1016/j.arth.2015.11.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/19/2015] [Accepted: 11/23/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bearing surfaces in total hip arthroplasty (THA) may affect implant longevity and hence patient outcomes. This randomized clinical trial determined how ceramic-on-ceramic (CERAMIC) bearing THA affected joint-specific pain, function, and stiffness and prosthesis fixation/longevity over 10 postoperative years compared with ceramic-on-highly-crosslinked-polyethylene (POLYETHYLENE) bearing THA. This is a follow-up to previously reported 5-year outcomes. METHODS Subjects aged <61 years were randomized to CERAMIC (n = 48) or POLYETHYLENE (n = 44) THA. Subjects were assessed using the Western Ontario McMaster Osteoarthritis Index and the RAND 12-Item Health Survey preoperatively, and at 1, 5, and 10 years postoperatively. Plain radiographs were evaluated at 10 years for fixation, and medical records were reviewed for revisions. RESULTS Of 92 subjects, 6 (7%) died within 10 years; 68 (79%) survivors provided radiographic and/or clinical follow-up at 10 years postoperatively. Improvements seen at 5 years in both the Western Ontario McMaster Osteoarthritis Index and RAND 12-Item Health Survey were retained at 10 years with no group differences (P > .48). There were no failures or loss of fixation related to bearing surfaces/wear in either group. Over 10 years, 3 subjects in the POLYETHYLENE group had revisions that were related to recurrent dislocation; 2 revisions were performed within 2 years of surgery, and one further subject underwent revision at 7 years postoperatively. CONCLUSIONS This is one of the first randomized clinical trials to examine 10-year outcomes between CERAMIC and POLYETHYLENE bearing THAs. Both bearing surfaces performed well out to 10 years in subjects who were <61 years at time of surgery.
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Syed MA, Hutt NJ, Shah N, Edge AJ. Hydroxyapatite ceramic-coated femoral components in young patients followed up for 17 to 25 years: an update of a previous report. Bone Joint J 2015; 97-B:749-54. [PMID: 26033053 DOI: 10.1302/0301-620x.97b6.35278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged < 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. This represents an update of previous reports of the same cohort at ten and 16 years, which were reported in 2004 and 2009, respectively. We describe the survival, radiological and functional outcomes at a mean follow-up of 21 years (17 to 25). Of the surviving 34 THAs, one underwent femoral revision for peri-prosthetic fracture after 21 years, and one patient (one hip) was lost to follow-up. Using aseptic loosening as the end-point, 12 hips (31.5%) needed acetabular revision but none needed femoral revision, demonstrating 100% survival (95% confidence interval 89 to 100). In young patients with high demands, the Furlong HAC-coated femoral component gives excellent long-term results.
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Affiliation(s)
- M A Syed
- Worthing General Hospital, Lyndhurst Road, West Sussex BN11 2DH, UK
| | - N J Hutt
- Worthing General Hospital, Lyndhurst Road, West Sussex BN11 2DH, UK
| | - N Shah
- Worthing General Hospital, Lyndhurst Road, West Sussex BN11 2DH, UK
| | - A J Edge
- Worthing General Hospital, Lyndhurst Road, West Sussex BN11 2DH, UK
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Klugarova J, Klugar M, Gallo J, Mareckova J, Kelnarova Z. The effectiveness of inpatient physical therapy compared to outpatient physical therapy for older adults after total hip replacement in the post-discharge period: a systematic review protocol. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513070-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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25
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Kloth JK, Rickert M, Gotterbarm T, Stiller W, Burkholder I, Kauczor HU, Ewerbeck V, Weber MA. Pelvic X-ray examinations in follow-up of hip arthroplasty or femoral osteosynthesis – Dose reduction and quality criteria. Eur J Radiol 2015; 84:915-20. [DOI: 10.1016/j.ejrad.2015.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/03/2015] [Indexed: 11/29/2022]
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26
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Kang BJ, Ha YC, Ham DW, Hwang SC, Lee YK, Koo KH. Third-generation alumina-on-alumina total hip arthroplasty: 14 to 16-year follow-up study. J Arthroplasty 2015; 30:411-5. [PMID: 25449586 DOI: 10.1016/j.arth.2014.09.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/16/2014] [Accepted: 09/23/2014] [Indexed: 02/01/2023] Open
Abstract
Ceramic-on-ceramic articulation has the lowest wear with little osteolysis. However, the wear and osteolysis in long-term follow-up are not known. Another concern is ceramic fracture, which might occur after repeated stress during a long period. Ninety hips (76 patients with a mean age of 47 years) that underwent cementless total hip arthroplasty using third-generation ceramic-on-ceramic articulation were followed for 14-16 years. At final follow-up, there was no measurable ceramic wear and no periprosthetic osteolysis was identified. No ceramic fracture occurred during the follow-up. One hip was revised because of late infection. All prostheses were bone-ingrown. Two patients experienced a grinding sensation. However, no patient had squeak. The mean Harris hip score at the final evaluation was 89 points and the survival rate was 98.9%.
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Affiliation(s)
- Bun-Jung Kang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Dae-Woong Ham
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Imbuldeniya AM, Walter WL, Zicat BA, Walter WK. Cementless total hip replacement without femoral osteotomy in patients with severe developmental dysplasia of the hip. Bone Joint J 2014; 96-B:1449-54. [DOI: 10.1302/0301-620x.96b11.33698] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe the clinical and radiological results of cementless primary total hip replacement (THR) in 25 patients (18 women and seven men; 30 THRs) with severe developmental dysplasia of the hip (DDH). Their mean age at surgery was 47 years (23 to 89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe type IV. Cementless acetabular components with standard polyethylene liners were introduced as close to the level of the true acetabulum as possible. The modular cementless S-ROM femoral component was used with a low resection of the femoral neck. A total of 21 patients (25 THRs) were available for review at a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified Harris hip score improved from 46 points pre-operatively to 90 at final follow up (p < 0.001). A total of 15 patients (17 THRs; 57%) underwent revision of the acetabular component at a mean of 14.6 years (7 to 20.8), all for osteolysis. Two patients (two THRs) had symptomatic loosening. No patient underwent femoral revision. Survival with revision of either component for any indication was 81% at 15 years (95% CI 60.1 to 92.3), with 21 patients at risk. This technique may reduce the need for femoral osteotomy in severe DDH, while providing a good long-term functional result. Cite this article: Bone Joint J 2014;96-B:1449–54.
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Affiliation(s)
- A. M. Imbuldeniya
- Mater Clinic, Specialist
Orthopaedic Group, Suite 1.08, 3-9
Gillies Street, North Sydney, New
South Wales 2060, Australia
| | - W. L. Walter
- Mater Clinic, Specialist
Orthopaedic Group, Suite 1.08, 3-9
Gillies Street, North Sydney, New
South Wales 2060, Australia
| | - B. A. Zicat
- Mater Clinic, Specialist
Orthopaedic Group, Suite 1.08, 3-9
Gillies Street, North Sydney, New
South Wales 2060, Australia
| | - W. K. Walter
- Mater Clinic, Specialist
Orthopaedic Group, Suite 1.08, 3-9
Gillies Street, North Sydney, New
South Wales 2060, Australia
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