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Perez Alamino L, Garabano G, Rodriguez J, Lopreite F, Pesciallo C. Total hip arthroplasty in patients under 50 years old: Does cementless fixation have better results? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00079-1. [PMID: 38643855 DOI: 10.1016/j.recot.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/20/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Cementless fixation for hip arthroplasties has increased in the last decades, particularly in younger patients. The purpose of this study was to compare the long-term results three different types of fixations in patients under 50years old. METHODS Cemented, hybrid and cementless fixations were assessed in patients under 50years old with a minimum follow-up of 8years. Loosening, demarcation, complications, and prosthesis survival were assessed. Functional analysis was performed with the modified Harris Hip Score and Visual analogue scale was collected. RESULTS Final series consisted in 222 patients. Significant improvement was observed regarding mHHS and VAS score in each group. We observed statistically significant difference regarding demarcation between the groups (P<.001). The higher rate of acetabular and femoral stem loosening was observed in the cemented (20.0%) and hybrid (18.9%) group. The lowest prosthesis survival rate after 16 years was observed in hybrid group (P<.001). CONCLUSION Total hip replacement has good long-term clinical and functional outcomes. The lowest rate of prosthesis survival was observed in hybrid group with 84.2% after 16years.
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Affiliation(s)
- L Perez Alamino
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
| | - G Garabano
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - J Rodriguez
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - F Lopreite
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - C Pesciallo
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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Kristóf J, Gupta D, Szabó L, Bucsi L, Zahár Á. Outcomes of Exeter cemented total hip arthroplasty in a county hospital: survivorship of eight hundred and ninety four hips with a minimum ten-year follow up. INTERNATIONAL ORTHOPAEDICS 2024; 48:729-735. [PMID: 37914902 DOI: 10.1007/s00264-023-06026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE A total of 894 hips were evaluated to describe the survivorship of Exeter cemented femoral stems and report the outcomes and complications of our 'Exeter- era', and there is no study from Central or Eastern Europe demonstrating similar results. METHODS Between January 2000 and December 2009, a total of 894 hips were included who underwent Exeter universal and V40 femoral stems with a mean follow up of 13 years. Cemented Exeter low profile polyethylene cups were used in 889 patients (99.4%) cups. Harris hip score (HHS) was used and statistical outcome measures were calculated with revision as an endpoint for aseptic loosening of the stem, aseptic loosening of any component, all-cause revision of the stem, and all-cause revision of the hip. RESULTS A total of 103 patients died and 129 (14.4%) operated hips were lost to follow-up before ten years. Out of the 662, ten stems (1.5%) were revised for aseptic loosening. Aseptic loosening of any component was the reason for revision in 43 cases (6.5%), consisting of 40 cup revisions and ten stem exchanges. Periprosthetic fracture occurred in 17 cases (1.9%) Periprosthetic joint infection occurred in 18 cases (2.01%). Three cups were exchanged for recurrent dislocation, and two stems had broken. CONCLUSION Exeter hip system has provided reproducible results across different centres worldwide, as it did in our series. Thorough surgical and cementing technique is of utmost importance for achieving these results. The cup is the weak point of the system and use of a hybrid system is worth considering.
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Affiliation(s)
- Jánvári Kristóf
- Department of Orthopaedics, Saint George University Teaching and County Hospital Centre for Musculoskeletal Surgery, Székesfehérvár, Hungary
| | - Devanshu Gupta
- Department of Orthopaedics, Saint George University Teaching and County Hospital Centre for Musculoskeletal Surgery, Székesfehérvár, Hungary.
| | - László Szabó
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary
| | - László Bucsi
- Department of Orthopaedics, Saint George University Teaching and County Hospital Centre for Musculoskeletal Surgery, Székesfehérvár, Hungary
| | - Ákos Zahár
- Department of Orthopaedics, Saint George University Teaching and County Hospital Centre for Musculoskeletal Surgery, Székesfehérvár, Hungary
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McHale SK, Whitehouse SL, Howell JR, Hubble MJ, Timperley AJ, Wilson MJ. The Exeter-Trident THA with ceramic-on-ceramic-bearings: 10-year outcomes in 275 total hip arthroplasties. Hip Int 2024; 34:187-193. [PMID: 37694894 DOI: 10.1177/11207000231198220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
AIMS This study reports on the Exeter-Trident total hip arthroplasty (THA) using an alumina ceramic-on-ceramic bearing with 10-year clinical and radiographic follow-up. PATIENTS AND METHODS Between January 2001 and January 2006, 275 THAs were performed. Mean age at surgery was 52.7 (17-86) years, with 84 patients (33.6%) aged <50 years. The primary outcome was all-cause construct survival at minimum 10 years. Secondary outcomes included functional and noise scores. Radiographs were compared between baseline and latest follow-up and assessed for component loosening, migration and lysis. RESULTS No patient was lost to follow-up. Mean follow-up for surviving patients was 12.5 (9.5-15.6) years. Kaplan-Meier survival for all-cause revision was 94.0% (95% CI, 90.5-97.5) at 14.3 years. 2 patients had a femoral component fracture. All scores improved significantly at latest follow-up. HSS-NQ for 247 hips (90.2%) at mean 9.1 (7.0-14.4) years post implantation showed most hips (93.1%) reported no more than occasional noise. At minimum 5 years, radiolucency around the acetabular component was observed in 2 hips (0.8%), and lysis at the interface in 1 hip (0.4%). On the femoral side, endosteal lysis was observed in 7 hips. CONCLUSIONS The Exeter-Trident THA with alumina ceramic-on-ceramic bearings performed well in this population. Patients are at low risk of revision in the first decade. However, there is a small risk of stem fracture as a late complication and some patients experience significant noise.
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Affiliation(s)
- Stephen K McHale
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
| | - Sarah L Whitehouse
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
- Orthopaedic Research Unit, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jonathan R Howell
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
| | - Matthew Jw Hubble
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
| | - A John Timperley
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
- University of Exeter, UK
| | - Matthew J Wilson
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
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Analysis of the Risk of Wear on Cemented and Uncemented Polyethylene Liners According to Different Variables in Hip Arthroplasty. MATERIALS 2021; 14:ma14237243. [PMID: 34885400 PMCID: PMC8658086 DOI: 10.3390/ma14237243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022]
Abstract
Wear debris in total hip arthroplasty is one of the main causes of loosening and failure, and the optimal acetabular fixation for primary total hip arthroplasty is still controversial because there is no significant difference between cemented and uncemented types for long-term clinical and functional outcome. To assess and predict, from a theoretical viewpoint, the risk of wear with two types of polyethylene liners, cemented and uncemented, a simulation using the finite element (FE) method was carried out. The risk of wear was analyzed according to different variables: the polyethylene acetabular component’s position with respect to the center of rotation of the hip; the thickness of the polyethylene insert; the material of the femoral head; and the relationship of the cervical–diaphyseal morphology of the proximal end of the femur to the restoration of the femoral offset. In all 72 simulations studied, a difference was observed in favour of a cemented solution with respect to the risk of wear. With regard to the other variables, the acetabular fixation, the thickness of the polyethylene, and the acetabular component positioning were statistically significant. The highest values for the risk of wear corresponded to a smaller thickness (5.3 mm), and super-lateral positioning at 25 mm reached the highest value of the von Mises stress. According to our results, for the reconstruction of the acetabular side, a cemented insert with a thickness of at least 5 mm should be used at the center of rotation.
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Takaoka Y, Goto K, Tamura J, Okuzu Y, Kawai T, Kuroda Y, Orita K, Matsuda S. Radiolucent lines do not affect the longevity of highly cross-linked polyethylene cemented components in total hip arthroplasty. Bone Joint J 2021; 103-B:1604-1610. [PMID: 34587810 DOI: 10.1302/0301-620x.103b10.bjj-2020-2298.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to evaluate the long-term outcome of highly cross-linked polyethylene (HXLPE) cemented acetabular components and assess whether any radiolucent lines (RLLs) which arose were progressive. METHODS We retrospectively reviewed 170 patients who underwent 187 total hip arthroplasties at two hospitals with a minimum follow-up of ten years. All interventions were performed using the same combination of HXLPE cemented acetabular components with femoral stems made of titanium alloy. Kaplan-Meier survival analysis was performed for the primary endpoint of acetabular component revision surgery for any reason and secondary endpoint of the appearance of RLLs. RLLs that had appeared once were observed over time. We statistically assessed potential relationships between RLLs and a number of factors, including the technique of femoral head autografting and the Japanese Orthopaedic Association score. RESULTS The mean follow-up period was 13.0 years (10.0 to 16.3). Femoral head autografting was performed on 135 hips (72.2%). One acetabular component was retrieved because of deep infection. No revision was performed for the aseptic acetabular loosening. The Kaplan-Meier survival curve for the primary and secondary endpoints were 98.2% (95% confidence interval (CI) 88.6% to 99.8%) and 79.3% (95% CI 72.8% to 84.6%), respectively. RLLs were detected in 38 hips (21.2%), at a mean of 1.7 years (1 month to 6 years) postoperatively. None of the RLLs were progressive, and the presence of RLLs did not show a significant association with the survival and clinical score. RLLs were more frequently observed in hips without femoral head autografts than in those with autografts. CONCLUSION The use of HXLPE cemented acetabular components in total hip arthroplasty demonstrated excellent clinical outcomes after ten years, and no RLLs were progressive, and their presence did not affect the outcome. Femoral head autografting did not negatively impact the acetabular component survival or the appearance of RLLs. Cite this article: Bone Joint J 2021;103-B(10):1604-1610.
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Affiliation(s)
- Yusuke Takaoka
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan.,Department of Orthopaedic Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Jiro Tamura
- Department of Orthopaedic Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kazuki Orita
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
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Miyamoto S, Iida S, Suzuki C, Nakatani T, Kawarai Y, Nakamura J, Orita S, Ohtori S. Risk factors for a radiolucent line around the acetabular component with an interface bioactive bone cement technique after primary cemented total hip arthroplasty. Bone Jt Open 2021; 2:278-292. [PMID: 33940938 PMCID: PMC8168551 DOI: 10.1302/2633-1462.25.bjo-2021-0010.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA. Methods A retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis. Results RLLs were detected in 27.2% of patients one year postoperatively. In multivariate regression analysis controlling for confounders, atrophic osteoarthritis (odds ratio (OR) 2.17 (95% confidence interval (CI), 1.04 to 4.49); p = 0.038) and 26 mm (OR 3.23 (95% CI 1.85 to 5.66); p < 0.001) or 28 mm head diameter (OR 3.64 (95% CI 2.07 to 6.41); p < 0.001) had a significantly greater risk for any RLLs one year after surgery. Structural bone graft (OR 0.19 (95% CI 0.13 to 0.29) p < 0.001) and location of the hip centre within the true acetabular region (OR 0.15 (95% CI 0.09 to 0.24); p < 0.001) were significantly less prognostic. Improvement of the cement-bone interface including complete disappearance and poorly defined RLLs was identified in 15.1% of patients. Kaplan-Meier survival analysis for the acetabular component at ten years with revision of the acetabular component for aseptic loosening as the end point was 100.0% with a RLL and 99.1% without a RLL (95% CI 97.9 to 100). With revision of the acetabular component for any reason as the end point, the survival rate was 99.2% with a RLL (95% CI 97.6 to 100) and 96.5% without a RLL (95% CI 93.4 to 99.7). Conclusion This study demonstrates that acetabular bone quality, head diameter, structural bone graft, and hip centre position may influence the presence of the any RLL. Cite this article: Bone Joint Open 2021;2(5):278–292.
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Affiliation(s)
- Shuichi Miyamoto
- Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan
| | - Satoshi Iida
- Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan
| | - Chiho Suzuki
- Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan
| | - Takushi Nakatani
- Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan
| | - Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan.,Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Minimum 5 year follow-up of clinical and radiographic results of cemented acetabular components with an interface bioactive bone cement technique in primary cemented total hip arthroplasty. Arch Orthop Trauma Surg 2021; 141:139-147. [PMID: 33123811 DOI: 10.1007/s00402-020-03638-6] [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: 04/28/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION A well-fixed cement-bone interface is a crucial factor for acetabular and femoral components in cemented total hip arthroplasty (THA). The aim of the present study was to evaluate the middle-term clinical and radiological results of fixing the acetabular component with an interface bioactive bone cement (IBBC) technique in primary cemented THA. MATERIALS AND METHODS We undertook a retrospective review was undertaken of 193 primary cemented THAs in 174 patients using acetabular components cemented with an IBBC technique and followed for a minimum of 5 years (mean 8.3 years; range 5-17 years). Baseline data, clinical and radiological outcomes were evaluated. RESULTS Japanese Orthopedic Association hip score and modified Harris hip scores demonstrated significant clinical improvement in all patients (p < 0.001). Radiolucent lines were detected in 15 hips (7.8%) at the first year and 24 hips (12.4%) at the final post-operative follow-up. The Kaplan-Meier survivorship with radiographic loosening as the end point was 97.8% [95% confidence interval (CI) 95.2-100]. With revision of the acetabular component for aseptic loosening as the end point, component survival was 99.0% (95% CI 97.5-100). With revision of the acetabular component for any reason as the end point, component survival was 97.0% (95% CI 93.9-100). CONCLUSIONS Clinical and radiological results of the acetabular component with the IBBC technique in primary cemented THA were excellent.
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8
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Lee KJ, Min BW, Bae KC, Cho CH, Son ES, Lee SW, Lee SJ, Kang MK. Unintended Retention of Temporary Articulating Spacers in the Treatment of Periprosthetic Hip Joint Infection. Orthopedics 2020; 43:e251-e257. [PMID: 32271933 DOI: 10.3928/01477447-20200404-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/22/2019] [Indexed: 02/03/2023]
Abstract
A considerable number of patients who underwent a 2-stage exchange protocol for periprosthetic hip joint infection could not complete the second-stage reimplantation. The aim of this study was to evaluate the results of unintended retention of temporary articulating spacers for the treatment of periprosthetic hip joint infection. Ninety-four patients with infection after total hip arthroplasty were treated by using a 2-stage exchange protocol with temporary articulating spacers. Of the 94 patients, 35 did not complete the 2-stage exchange protocol and retained spacers for more than 12 months. The authors retrospectively investigated the clinical and radiographic results after a mean follow-up of 36.1 months. Thirty-one patients had well-healed wounds without recurrent infection and did not receive further surgery for any reason (success group). Spacers were revised in 2 patients, and the other 2 patients underwent incision and debridement because of recurrent infection (failure group). There were no statistical differences between the 2 groups in terms of demographics or presence of resistant organisms. After 3 years of follow-up, temporary articulating spacers functioned well in 89% of the patients who retained them. These results support that retention of temporary articulating spacers could be considered an alternative treatment option for select patients. [Orthopedics. 2020;43(4):e251-e257.].
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9
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Gwynne-Jones DP, Gray AR. Cemented or uncemented acetabular fixation in combination with the Exeter Universal cemented stem. Bone Joint J 2020; 102-B:414-422. [PMID: 32228075 DOI: 10.1302/0301-620x.102b4.bjj-2019-0656.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To compare long-term survival of all-cemented and hybrid total hip arthroplasty (THA) using the Exeter Universal stem. METHODS Details of 1,086 THAs performed between 1999 and 2005 using the Exeter stem and either a cemented (632) or uncemented acetabular component (454) were collected from local records and the New Zealand Joint Registry. A competing risks regression survival analysis was performed with death as the competing risk with adjustments made for age, sex, approach, and bearing. RESULTS There were 61 revisions (9.7%; 0.82 revisions/100 observed component years, (OCYs)) in the all-cemented group and 18 (4.0%; 0.30/100 OCYs) in the hybrid group. The cumulative incidence of revision at 18 years was 12.1% for cemented and 5.2% for hybrids. There was a significantly greater risk of revision for all-cemented compared with hybrids (unadjusted sub-hazard ratio (SHR) 2.44; p = 0.001), and of revision for loosening, wear, or osteolysis (unadjusted SHR 3.77; p < 0.001). After adjustment, the increased risk of all-cause revision did not reach significance at age 70 years and above. The advantage for revision for loosening, wear, and osteolysis remained at all ages. CONCLUSION This study supports the use of uncemented acetabular fixation when used in combination with the Exeter stem with improved survivorship for revision for aseptic loosening, wear, and osteolysis at all ages and for all-cause revision in patients less than 70 years. Cite this article: Bone Joint J 2020;102-B(4):414-422.
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Affiliation(s)
- David P Gwynne-Jones
- Centre for Musculoskeletal Outcomes Research, Section of Orthopaedic Surgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Consultant Orthopaedic Surgeon, Dunedin Public Hospital, Southern District Health Board, Great King Street, Dunedin, New Zealand
| | - Andrew R Gray
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Keeling P, Howell JR, Kassam AAM, Sathu A, Timperley AJ, Hubble MJW, Wilson MJ, Whitehouse SL. Long-Term Survival of the Cemented Exeter Universal Stem in Patients 50 Years and Younger: An Update on 130 Hips. J Arthroplasty 2020; 35:1042-1047. [PMID: 31882346 DOI: 10.1016/j.arth.2019.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is variable evidence regarding survivorship beyond 20 years of total hip arthroplasties in young patients. We report the long-term results of the Exeter cemented hip system in patients ≤50 years at minimum of 20 years. METHODS Clinical and radiological outcomes of 130 consecutive total hip arthroplasties in 107 patients aged 50 years or younger at primary operation were reviewed; 77% had a diagnosis other than osteoarthritis. All patients were followed at 5-year intervals, no patients were lost to follow-up, and the status of every implant is known. RESULTS Mean age at surgery was 41.8 (17-50) years. Mean follow-up was 22.0 (20.0-26.1) years. There were 79 hips surviving, 14 hips (11 patients) deceased, and 37 hips revised. Reasons for revision: 29 hips for aseptic cup loosening (26 stems revised using cement-in-cement, three left in-situ); three stems for femoral osteolysis, two related to acetabular polyethylene wear (14.1 and 17.0 years), one with Gaucher's disease (21.1 years); one broken stem (12.9 years); one cup for instability (4.3 years-stem revised using cement-in-cement); and two hips with infection (8.5 and 23.8 years). There were no cases of aseptic loosening of the Exeter stem. There were no radiologically loose stems although eight patients had radiological evidence of loosening of the cemented cup. Survivorship at 22 years was 74.9% for revision for all causes and 96.3% for revision of the stem for aseptic loosening or lysis. CONCLUSION The Exeter cemented stem has excellent survivorship at minimum 20 years in young patients. Acetabular component survivorship was less favorable, but the advent of highly cross-linked polyethylene may improve this in the long term.
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Affiliation(s)
- Parnell Keeling
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Jonathan R Howell
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Al-Amin M Kassam
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Anubhav Sathu
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - A John Timperley
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK; College of Engineering, Maths and Physical Science, University of Exeter, Exeter, Devon, UK
| | - Matthew J W Hubble
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Matthew J Wilson
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Sarah L Whitehouse
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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11
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Smith LK, Dures E, Beswick AD. Systematic review of the clinical effectiveness for long-term follow-up of total hip arthroplasty. Orthop Res Rev 2019; 11:69-78. [PMID: 31308766 PMCID: PMC6613453 DOI: 10.2147/orr.s199183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
Objectives: Total hip arthroplasty (THA) is highly successful but national registries indicate that average age has lowered and that younger patients are at higher risk of revision. Long-term follow-up of THA was historically recommended to identify aseptically failing THA, minimising the risks associated with extensive changes, but follow-up services are now in decline. A systematic review was conducted to search for evidence of the clinical or cost-effectiveness of hip arthroplasty surveillance. Methods: The study was registered with PROSPERO International Prospective Register of Systematic Reviews and conducted according to PRISMA guidelines; databases included MEDLINE and Embase, and all studies were quality assessed. Original studies (2005 to 2017) reporting follow-up of adults with THA in situ >5 years were included. Researchers extracted quantitative and qualitative data from each study. Results: For eligibility, 4,137 studies were screened: 114 studies were included in the final analysis, representing 22 countries worldwide. Data extracted included study endpoint, patient detail, loss to follow-up, revisions, scores and radiographic analysis. Six themes were derived from inductive content analysis of text: support for long-term follow-up, subgroups requiring follow-up, effect of materials/techniques on THA survival, effect of design, indicators for revision, review process. Main findings-follow-up was specifically recommended to monitor change (eg asymptomatic loosening), when outcomes of joint construct are unknown, and for specific patient subgroups. Outcome scores alone are not enough, and radiographic review should be included. Conclusion: There were no studies directly evaluating the clinical effectiveness of the long-term follow-up of THA but expert opinions from a range of international authors advocated its use for defined subgroups to provide patient-centred care. In the absence of higher level evidence, these opinions, in conjunction with emerging outputs from the national joint registries, should be used to inform services for long-term follow-up of THA.
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Affiliation(s)
- Lindsay K Smith
- Department of Trauma and Orthopaedics, Weston Area Health NHS Trust, Weston-super-Mare, North Somerset, UK
| | - Emma Dures
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - AD Beswick
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
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12
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Jain S, Magra M, Dube B, Veysi VT, Whitwell GS, Aderinto JB, Emerton ME, Stone MH, Pandit HG. Reverse hybrid total hip arthroplasty. Bone Joint J 2018; 100-B:1010-1017. [PMID: 30062952 DOI: 10.1302/0301-620x.100b8.bjj-2017-1297.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims This study aimed to evaluate implant survival of reverse hybrid total hip arthroplasty (THA) at medium-term follow-up. Patients and Methods A consecutive series of 1082 THAs in 982 patients with mean follow-up of 7.9 years (5 to 11.3) is presented. Mean age was 69.2 years (21 to 94). Of these, 194 (17.9%) were in patients under 60 years, 663 (61.3%) in female patients and 348 (32.2%) performed by a trainee. Head size was 28 mm in 953 hips (88.1%) or 32 mm in 129 hips (11.9%). Survival analysis was performed and subgroups compared using log rank tests. Results Ten-year survival (122 hips at risk) was 97.2% (95% confidence interval (CI) 95.77 to 98.11) for all-cause revision. There was no difference in survival by age (p = 0.50), gender (p = 0.78), head size (p = 0.63) or surgeon grade (p = 0.36). No acetabular components underwent revision for aseptic loosening in the entire series. Four (0.4%) aseptic stem failures occurred early at a mean of 2.5 years (0.6 to 4.8) and were associated with age under 60 years (p = 0.015). There was no difference in survival by gender (p = 0.12), head size (p = 0.43) or surgeon grade (p = 0.77) for stem revision. Conclusion This is the largest reported study into reverse hybrid THA and it confirms successful outcomes, irrespective of age, gender, head size and surgeon grade. Cite this article: Bone Joint J 2018;100-B:1010-17.
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Affiliation(s)
- S Jain
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M Magra
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - B Dube
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital
| | - V T Veysi
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - G S Whitwell
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - J B Aderinto
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M E Emerton
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M H Stone
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - H G Pandit
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
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vanWinterswijk PJTS, Whitehouse SL, Timperley AJ, Hubble MJW, Howell JR, Wilson MJ. The Rim Cutter does not show an advantage over modern cementing techniques: a five-year radiological and clinical follow-up of the Rim Cutter used with flanged acetabular components. Bone Joint J 2017; 99-B:1450-1457. [PMID: 29092983 DOI: 10.1302/0301-620x.99b11.bjj-2017-0138.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/08/2017] [Indexed: 11/05/2022]
Abstract
AIMS We report the incidence of radiolucent lines (RLLs) using two flanged acetabular components at total hip arthroplasty (THA) and the effect of the Rim Cutter. PATIENTS AND METHODS We performed a retrospective review of 300 hips in 292 patients who underwent primary cemented THA. A contemporary flanged acetabular component was used with (group 1) and without (group 2) the use of the Rim Cutter and the Rimfit acetabular component was used with the Rim Cutter (group 3). RLLs and clinical outcomes were evaluated immediately post-operatively and at five years post-operatively. RESULTS There was no significant difference in the incidence of RLLs on the immediate post-operative radiographs (p = 0.241) or at five years post-operatively (p = 0.463). RLLs were seen on the immediate post-operative radiograph in 2% of hips in group 1, in 5% in group 2 and in 7% in group 3. Five years post-operatively, there were RLLs in 42% of hips in group 1, 41% in group 2 and in 49% in group 3. In the vast majority of hips, in each group, the RLL was present in DeLee and Charnley zone 1 only (86%, 83%, 67% respectively). Oxford and Harris Hip scores improved significantly in all groups. There was no significant difference in these scores or in the change in scores between the groups, with follow-up. CONCLUSION Despite the Rim Cutter showing promising results in early laboratory and clinical studies, this analysis of the radiological and clinical outcome five years post-operatively does not show any advantage over and above modern cementing techniques in combination with a well performing cemented acetabular component. For this reason, we no longer use the Rim Cutter in routine primary THA. Cite this article: Bone Joint J 2017;99-B:1450-7.
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Affiliation(s)
| | - S L Whitehouse
- Queensland University of Technology (QUT) , Brisbane, Queensland, Australia
| | - A J Timperley
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
| | - M J W Hubble
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
| | - J R Howell
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
| | - M J Wilson
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
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14
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Petheram TG, Whitehouse SL, Kazi HA, Hubble MJW, Timperley AJ, Wilson MJ, Howell JR. The Exeter Universal cemented femoral stem at 20 to 25 years: A report of 382 hips. Bone Joint J 2017; 98-B:1441-1449. [PMID: 27803218 DOI: 10.1302/0301-620x.98b11.37668] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/05/2016] [Indexed: 11/05/2022]
Abstract
AIMS We present a minimum 20-year follow-up study of 382 cemented Exeter Universal total hip arthroplasties (350 patients) operated on at a mean age of 66.3 years (17 to 94). PATIENTS AND METHODS All patients received the same design of femoral component, regardless of the original diagnosis. Previous surgery had been undertaken for 33 hips (8.6%). During the study period 218 patients with 236 hips (62%) died, 42 hips (11%) were revised and 110 hips (29%) in 96 patients were available for review. The acetabular components were varied and some designs are now obsolete, however they were all cemented. RESULTS With an endpoint of revision for aseptic loosening or lysis, survivorship of the stem at 22.8 years was 99.0% (95% confidence interval (CI) 97.0 to 100). One stem was revised 21 years post-operatively in a patient with Gaucher's disease and proximal femoral osteolysis. Survivorship with aseptic loosening or lysis of the acetabular component or stem as the endpoint at 22.8 years was 89.3% (95% CI 84.8 to 93.8). With an endpoint of revision for any reason, overall survivorship was 82.9% (95% CI 77.4 to 88.4) at 22.8 years. Radiological review showed excellent preservation of bone stock at 20 to 25 years, and no impending failures of the stem. CONCLUSION The Exeter femoral stem continues to perform well beyond 20 years. Cite this article: Bone Joint J 2016;98-B:1441-9.
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Affiliation(s)
- T G Petheram
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - S L Whitehouse
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - H A Kazi
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - M J W Hubble
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - A J Timperley
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - M J Wilson
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
| | - J R Howell
- The Princess Elizabeth Orthopaedic Centre, Exeter EX2 5DW, UK
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15
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Abstract
The results of modern cemented and uncemented total hip arthroplasties are outstanding and both systems have their advantages and disadvantages. This paper aims to examine the designs of different types of prostheses, some history behind their development and the reported results. Particular emphasis is placed on cemented stem design and the details of cementing technique.
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Affiliation(s)
- Joanna Maggs
- Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK
| | - Matthew Wilson
- Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK,Address for correspondence: Dr. Matthew Wilson, Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK. E-mail:
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