This study was performed to evaluate the minimum 5-year clinical and radiological results of liner cementation into a stable acetabular shell using a metal-inlay, polyethylene liner during revision total hip arthroplasty (THA). Sixty-six hips (63 patients) that underwent revision THA using a metal-inlay polyethylene liner cementation were included. The causes of revision were; polyethylene wear in 37 cases, femoral stem loosening in 20 cases, ceramic head fracture in 4 cases, and recurrent dislocation in 5 cases. Clinical results were graded at final follow-up using Harris hip scores, and radiographs were evaluated to determine acetabular component inclination, the stabilities of acetabular and femoral components, correction of hip centers, and the progression of osteolysis.Introduction
Methods
The purpose of this study is to know the peri-operative morbidity, clinical and radiographical outcomes of conversion THA from failed transtrochanter rotational osteotomy (TRO). From 2003 January to 2009 January, there were 18 hips(18 patients) who underwent conversion THA from TRO for osteonecrosis of the femoral head (ONFH) (Group I). The mean duration from TRO to conversion THA was 2.6 years. We made a matched control group of 18 primary THA for ONFH (Group II) and we evaluated perioperative morbidity and complications in each group. For the clinical evaluation, we checked Harris hip score (HHS) and WOMAC score. For the radiographical evaluation, we evaluated implant position, stability and osteolysis.Purpose
Patients and methods
Hip arthroplasty is a good treatment option for displaced femoral neck fracture in elderly patients. However, neuromuscular disease such as cerebral infarction or hemorrhage can be a concerning problem for THA since dislocation after operation can frequently occur. The purpose of this prospective study was to evaluate the functional results of modified minimally invasive (MI) two-incision total hip arthroplasty (THA) with the use of large-diameter (>38mm) metal-on-metal articulation in patients with muscle weakness. 19 consecutive patients (19 hips) with displaced femoral neck fracture with muscle weakness were enrolled. There were 11 patients with cerebral infarction, 4 patients with cerebral hemorrhage and 4 patients with Parkinson's disease. In the lateral position, an anterolateral approach between the gluteus medius and tensor fascia lata and a posterior approach between the piriformis and gluteus medius were used. Surgical morbidity, functional recovery, radiological implantation properties, range of motion (ROM) and complications were assessed.Purpose
Patients and Methods
CLS Spotorno expansion acetabular cup is in use since 1984 for uncemented Metal-Polyethylene (PE) total hip arthroplasties (THA). Metal-PE articulations are notoriously known to wear and lead to failure of THA. However, catastrophic breakage of expansion acetabular cup is rare. Our 74-year-old male who was diagnosed with bilateral osteonecrosis of femoral head, underwent bilateral THA using CLS Spotorno metal expansion acetabular cups (Protek, AG, Bern) in 1991. He had irregular follow-up since then. In 2005, he presented with right hip pain and inability to walk without support. Anteroposterior (AP) hip radiographs established the diagnosis of catastrophic failure of right THA secondary to severe liner wear and acetabular osteolysis. Patient chose to postpone the revision surgery and opted for wheel chair ambulation. He presented 4 years later, when the right hip pain became unbearable. Anteroposterior as well as lateral hip radiographs showed worsening of cup breakage with superolateral migration of metal femoral head. Pelvic CT scans confirmed severe acetabular osteolysis in DeLee and Charnley's Zone 1, 2 & 3 with secondary loss of bony support to the expansion cup [Fig. 1]. A revision THA was strongly advised. However, patient sought for a pain-free rather than a fully ambulatory right hip and decided against a second THA. We performed resection arthroplasty of right hip with bone cement loading, respecting patient's decision. Intra-operatively, the metal femoral head was lying in the huge osteolytic defect in the roof of acetabulum. The 3 cranial wings of metal expansion shell were broken with corresponding wear of the cranial pole of polyethylene liner [Fig. 2]. We were able to gratify patient's expectations and patient is able to ambulate with the aid of one crutch at latest follow-up. However, it is clearly evident that a timely and regular follow-up would have identified the initial PE wear and secondary osteolysis. Additionally, it can avoid extensive procedures like a revision THA or resection arthroplasty by allowing simple procedures like modular PE liner and the femoral head exchange. A comprehensive review of literature for catastrophic acetabular component breakage revealed 10 such cases, although with different cup designs. To the best of our knowledge, this is the first case of CLS expansion cup breakage for metal-PE articulation. Majority of these cases have a presence of extensive liner wear and pelvic osteolysis along with a post-operative irregular follow up. This case stresses on importance of regular follow-up even after many years of index THA to identify early PE wear and prevent secondary catastrophic complications.
