European Hip Society 11th Congress Stockholm, Sweden, 9-11 October 2014 (original) (raw)
Related papers
Cementless cup fixation in total hip arthroplasty after 5–8 years
International Orthopaedics, 2001
A series of 199 total hip arthroplasties was performed using a porous-coated, hemispherical press-fit acetabular cup. At a mean follow-up of 91.5 months 158 cups were available for clinical and radiological review. The mean age of the patients at the time of the index arthroplasty was 62.5 years. The mean Harris Hip score at final follow-up was 87.3. No shells were revised although eccentric polyethylene wear prompted liner replacement in two cases. Osteolysis was noted in six cases but predominantly in relation to the femoral stem. Focal pelvic osteolytic lesions were rare. All the cups were classified as stable on radiography. Résumé Une série de 199 arthroplasties totales de la Hanche a été exécutée utilisant une cupule acétabulaire hémisphérique avec surface réhabitable de type "pressfit". Cent cinquante cupules étaient disponibles pour étude une clinique et radiologique à un suivi moyen de 91.5 mois. L'âge moyen des patients à l'arthroplastie était de 62.5 ans. Le score de Harris au dernier examen était 87.3. Aucune cupule n'a été révisée bien que l'usure du polyéthylène excentrique ait conduit au remplacement du liner dans 2 cas. Une ostéolyse a été notée dans 6 cas, d'une manière prédominante au niveau de la tige fémorale. Toutes les cupules ont été classées comme stables radiologiquement.
The Journal of Arthroplasty
Background: Treatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell. Methods: We retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.8) after IBG combined with a graft-compressing titanium shell implant. The patients were reviewed by clinical score and radiography. Three patients were lost to follow-up. The medical journals of the 33 deceased cases were reviewed for any reoperation. Of the 170 cases, 74 had a cavitary acetabular bone defect, 93 had combined segmental and cavitary bone defects, and 3 had a pelvic dissociation. Bone graft incorporation was assessed and correction of the hip center of rotation was calculated. Results: Five cases (3%) were reoperated for mechanical loosening. One more was assessed as loose but asymptomatic and was not planned for revision. There were 3 reoperations for recurrent dislocation, 2 for deep infection and 1 for technical error. Reoperation for any reason, as the end point of survivorship, showed a survival rate of 92% after 10 years. Hip score according to Merle, d'Aubigne, and Postel increased from 10.8 (preoperatively) to 16.4 at follow-up. The clinical and radiological results were excellent. Conclusion: IBG combined with the compressing shell results in excellent results for this challenging condition.
The Journal of Arthroplasty, 1998
Thirty-nine uncemented porous-coated long-term stable fixation total hip prostheses with a minimum 5-year follow-up, were retrospectively reviewed for clinical and radiographic outcome. Clinical evaluation was performed using the modified Harris Hip Score. Additionally, all patients completed a satisfaction questionnaire. Anteroposterior view and lateral view radiographs were obtained and compared with immediate postoperative films utilizing the Hip Society radiographic evaluation form for uncemented implants. The follow-up period averaged 69 months (range, 60-87 months). At the most recent follow-up visit Harris Hip Scores averaged 88 points (range, 68-100 points), with 79% good or excellent results. Of the 8 hips (6 patients) with fair or poor results, 5 patients (6 hips) were Charnley category C patients. All patients were satisfied with their surgery and all, but 2 stated that their function had significantly improved. The incidence of significant thigh pain was 13%. Calcar osteolysis was present in 13 of 39 femurs with the majority of cases being minimal. All but one femoral component demonstrated bone ingrowth. There was no distal femoral osteolysis present and no femoral revisions have been performed or are planned. Acetabular osteolysis was present in 7 of 39 hips, with 4 of the 7 centered around acetabular fixation screws. All patients who had acetabular bone loss had some degree of femoral osteolysis. Thus far, one patient has required acetabular revision secondary to osteolysis. Acetabular osteolysis in this series was more profound than on the femoral side and two other patients are being considered for revision due to pelvic side osteolysis. In conclusion, the uncemented long-term stable fixation femoral component proved to be durable in this series of patients. The circumferential porous coating on the femoral implant may protect against distal osteolysis. A concerning rate of severe pelvic osteolysis and impending failure was noted and may lead to a greater need for revision surgery with longer follow-up.
Primary total hip arthroplasty without the use of bone cement: a 10-year follow-up of 157 hips
Chang Gung Medical Journal, 2002
Background: The cementless fixation technique in total hip arthroplasty (THA) was developed to solve clinical problems such as aseptic loosening and osteolysis which were thought to be associated with the use of bone cement. This retrospective study reports our mid-term results with cementless THA. Methods: A series of 173 consecutive, unselected cementless THA procedures using the Omnifit prosthesis was performed by a single surgeon. Sixteen hips were excluded from the study because of insufficient follow-up evaluation. One hundred and fifty-seven THAs with an average follow-up period of 10.2 (range, 5-12) years were retrospectively reviewed. Results: The overall revision rate was 7.0%. Ninety-five percent of unrevised hips achieved a Merle D'Aubigne hip score of 16 points or above. Radiographically, bone ingrowth occurred in all unrevised cups, and in 95% of unrevised stems. Osteolytic lesions, seen on 28.1% of femora and 8.9% of pelvises, appeared at an average of 3.8 years postoperatively. Femoral osteolytic lesions were confined to the proximal Gruen zones 1 and 7. The mean annual polyethylene wear rate was 0.15 mm. Approximately 1/3 of the hips were noted to have excessive wear. Conclusion: These results suggest that cementless Omnifit THA provides stable fixation for as long as 12 years after implantation. Of significant concern is the high incidence of excessive polyethylene wear and associated osteolysis. Our experience also indicates that a femoral stem with a circumferential porous coating in the proximal region can protect the femur from distal osteolysis.
Osteolysis After Total Hip Arthroplasty: Basic Science
Acetabular Revision Surgery in Major Bone Defects, 2018
Total hip arthroplasty (THA) represents the most successful and revolutionary intervention achieved in orthopedic surgery in the last century [1-3]. This surgery is performed to restore the injured or degenerated joint function when conservative treatment options have failed and pain, stiffness and other limitations drastically reduce the patient's quality of life. The clinical settings in which hip arthroplasty is indicated involve acute and chronic underlying joint-related diseases, mostly degenerative osteoarthritis and rheumatoid arthritis but also other arthropathies including avascular necrosis, developmental and congenital disorders, neoplasias, fractures and post-traumatic degenerative arthritis [4]. In 2010, the number of individuals bearing hip implants in USA was estimated in more than 2.5 millions [5]. In Europe, countries with high incidence are Germany, Switzerland and Belgium with ratios, of 296, 287 and 240 THA procedures per 100,000 inhabitants, respectively, while in US and UK the frequencies are 184 and 194 [3]. Early hip failure (within 5 years of implantation) is mainly associated to instability, aseptic loosening (AL), infections, wear and fracture and has a decreasing trend due to improvements in surgery techniques and advances in the biomaterials field. However, an alarming prevalence has been detected in some cohorts, especially in patients with metal-on metal (MoM) bearings [6, 7]. In the long-term, the survival rate (endpoint at revision) of prosthesis after 10-15 years of implantation has been estimated about a 90-95% [8-10] although percentages of only 58-62% or even less have been also reported after longer service periods [10-12].
Osteolysis with a cementless second generation metal-on-metal cup in total hip replacement
International Orthopaedics, 2009
This study examined the long-term results of a metal-on-metal total hip replacement with a Metasul-lined cup. Twenty-nine total hip arthroplasties were performed in 27 young patients (mean age 49 years). Twenty-two patients (23 hips) were available for clinical and radiographic analysis after a mean duration of 99 months. Mean preoperative Harris hip score of 60 improved to 93 at most recent follow-up. One patient required revision of his cup for periacetabular osteolysis. Radiographic analysis showed osteolysis in another four hips. The high rate of osteolysis found in this series has not previously been reported with this type of implant. The length of follow-up in this series is greater than other reports in the literature and may explain this difference.
Cementless hemispheric acetabular component in total hip replacement
International Orthopaedics, 2000
A series of 198 total hip arthroplasties was performed using a porous-coated, hemispheric press-fit cup. One hundred and twenty-seven cups were available for clinical and radiological examination at mean followup of 10.6 years. The mean age at the index procedure was 61.2 years. The mean Harris hip score at final follow-up was 89.8. Three cups were revised for aseptic loosening and two liners were changed for eccentric wear and pelvic osteolysis. Nine additional patients showed mild or suspected osteolysis. Two cups were rated "fibrous" stable. There was no correlation between additional screw fixation of the press-fit cup and osteolysis or revision. Résumé Nous avons réalisé une étude rétrospective comprenant 127 prothèses totales de la hanche en utilisant une cupule acetabulaire non cimentée. 'Age moyen des patients lors d'intervention était de 61.2 ans. La durée moyenned' observation post-operatoire était de 10.6 ans. Le score de Harris lors du dernier examen clinique était de 89.9. Trois cupules étaient révisées pour descellement aseptique et deux inserts en polyéthylène étaient changés pour usure et ostéolyse. Neuf autres patients montraient une ostéolyse discrète. Deux cupules étaient stables avec une fixation dite «fibreuse». Aucune corrélation entre utilisation de vis pour la fixation primaire et le développement d'osteolyse n'a été trouvée.
Revision Total Hip Arthroplasty Using a Cementless Acetabular Component
Clinical Orthopaedics and Related Research, 1995
Are the midterm results (range, 7-11 years) for revision of the acetabulum with a cementless hemispherical component comparable with other published revision techniques at similar followup? One hundred thirty-eight acetabular revisions for aseptic loosening were done in 132 patients using a cementless hemispherical component coated with titanium mesh and inserted with supplemental screw fixation. Twelve patients died, 9 were lost to followup, and 6 could not return for followup, leaving 111 patients (115 hips) with a mean of 100 months of followup. Thirteen hips required revision (11%): 4 were done for recurrent dislocations, and 6 for sepsis; 3 stable cups were revised (at the time of stem revision). No cup was revised for aseptic loosening. Radiographic review was available for 105 patients (109 hips) at mean 98-month followup (78-135 months). A complete radiolucency was seen in 4% of the cups, a partial progressive radiolucency in 370, and a partial nonprogressive radiolucency in 54%; no radiolucency was present in 39%. A screw radiolucency was seen in 270, and osteolysis at the cup margin in 4%. Revision of the acetabulum with a cementless