Limited implant survival due to aseptic cup loosening is most commonly responsible for revision total hip arthroplasty (THA). Advances in implant designs and materials have been crucial in addressing those challenges. Vitamin E-infused highly cross-linked polyethylene (VEPE) promises strong wear resistance, high oxidative stability, and superior mechanical strength. Although VEPE monoblock cups have shown good mid-term performance and excellent wear patterns, long-term results remain unclear. This study evaluated migration and wear patterns and clinical and radiological outcomes at a minimum of ten years’ follow-up. This prospective observational study investigated 101 cases of primary THA over a mean duration of 129 months (120 to 149). At last follow-up, 57 cases with complete clinical and radiological outcomes were evaluated. In all cases, the acetabular component comprised an uncemented titanium particle-coated VEPE monoblock cup. Patients were assessed clinically and radiologically using the Harris Hip Score, visual analogue scale (pain and satisfaction), and an anteroposterior radiograph. Cup migration and polyethylene wear were measured using Einzel-Bild-Röntgen-Analyze software. All complications and associated treatments were documented until final follow-up.Aims
Methods
We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups.Aims
Methods
Our primary aim was to describe migration of the Exeter stem with a 32 mm head on highly crosslinked polyethylene and whether this is influenced by age. Our secondary aims were to assess functional outcome, satisfaction, activity, and bone mineral density (BMD) according to age. A prospective cohort study was conducted. Patients were recruited into three age groups: less than 65 years (n = 65), 65 to 74 years (n = 68), and 75 years and older (n = 67). There were 200 patients enrolled in the study, of whom 115 were female and 85 were male, with a mean age of 69.9 years (sd 9.5, 42 to 92). They were assessed preoperatively, and at three, 12 and, 24 months postoperatively. Stem migration was assessed using Einzel-Bild-Röntgen-Analyse (EBRA). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), EuroQol-5 domains questionnaire (EQ-5D), short form-36 questionnaire (SF-36,) and patient satisfaction were used to assess outcome. The Lower Extremity Activity Scale (LEAS), Timed Up and Go (TUG) test, and activPAL monitor (energy expelled, time lying/standing/walking and step count) were used to assess activity. The BMD was assessed in Gruen and Charnley zones.Objectives
Patients and Methods
Introduction. Acetabular component positioning, offset, combined anteversion, leg length, and soft tissue envelope around the hip plays an important role in hip function and durability. In this paper we will focus on acetabular positioning of the cup. Technique. The axis of the pelvis is identified intra-operatively as a line drawn from the highest point of the iliac crest to the middle of the greater trochanter. Prior to reaming the acetabulum, an undersized trial acetabular component is placed parallel and inside the transverse ligament, inside the anterior column and projecting posterior to the axis of the pelvis. This direction is marked and the subsequent reaming and final component placement is performed in the same direction. The lateral opening is judged based on the 45-degree angle from the tear drop to the lateral margin of the acetabulum on anteroposterior pelvic radiographs. The final anteversion of the cup is adjusted based on increased or decreased lumbar lordosis and combined anteversion. Methods. Anteroposterior pelvic radiographs of 100 consecutive patients undergoing posterior THR between September 2010 and March 2011 with this method were evaluated for cup inclination angle and anteversion using
We aimed to investigate the clinical consequences of intraoperative acetabular fractures. Between 2003 and 2012, a total of 3391 cementless total hip arthroplasties (THA) were performed at the Dept. of Orthopaedics, Innsbruck Medical University. Of those, a total of 160 patients underwent a CT scan within 30 days postoperatively. The scans of 44 patients were not suitable for analyse due to thick scan layers. Of the remaining 116 patients, 76 had a fracture. Reasons for CT-scans were suspected bleeding, hip pain, abdominal symptoms, etc. The fractures included 59 isolated acetabular fractures, the rest of fractures was in the superior or inferior pubic ramus or the tuber ischiadicum. Four cases out of the 59 acetabular fractures underwent revision surgery due to periprosthetic joint infection after 0, 2, 10 and 23 months. Four patients underwent revision due to cup loosening after 13 and 14 days as well as after 16 and 24 months. Of those, three showed a central acetabular fracture with protrusion. In 33 of the remaining 51 patients, a minimum of 3 x-rays was available for migration analysis with
Porous tantalum is a highly osteoinductive biomaterial, initially introduced in orthopedics in 1997, with a subsequent rapid evolution of orthopedic applications. The use of porous tantalum for the acetabular component in primary total hip arthroplasty (THA) has demonstrated excellent short-term and mid-term results. However, long term data are scarce. The purpose of this prospective study is to report the long-term clinical and radiological outcome following use of an uncemented porous tantalum acetabular component in primary THA with a minimum follow-up of 17.5 years, in a previously studied cohort of patients. We prospectively followed 128 consecutive primary THAs in 140 patients, between November 1997 and June 1999. A press-fit porous tantalum monoblock acetabular component was used in all cases. The presence of initial gaps in the polar region, as sign of incomplete seating of the monoblock cup, was assessed on the immediate postoperative radiographs. All patients were followed clinically and radiographically at 6, 12, and 24 weeks and 12 months and then at 2, 5, 8, 10, and 19 years, for a mean of 18.1 years (range 17.5 – 19 years). Periacetabular dome gap filling, acetabular cup migration and polyethylene wear were assessed by the
Aims. This study aimed to determine the diagnostic performance of radiographic
criteria to detect aseptic acetabular loosening after revision total
hip arthroplasty (THA). Secondary aims were to determine the predictive
values of different thresholds of migration and to determine the
predictive values of radiolucency criteria. Patients and Methods. Acetabular component migration to re-revision was measured retrospectively
using Ein-Bild-Rontgen-Analyse (EBRA-Cup) and manual measurements
(Sutherland method) in two groups: Group A, 52 components (48 patients) found
not loose at re-revision and Group B, 42 components (36 patients)
found loose at re-revision between 1980 and 2015. The presence and
extent of radiolucent lines was also assessed. Results. Using
Introduction: Acetabular component positioning, offset, combined anteversion, leg length, and soft tissue envelope around the hip plays an important role in hip function and durability. In this paper we will focus on acetabular positioning of the cup. Technique: The axis of the pelvis is identified intra-operatively as a line drawn from the highest point of the iliac crest to the middle of the greater trochanter. Prior to reaming the acetabulum, an undersized trial acetabular component is placed parallel and inside the transverse ligament, inside the anterior column and projecting posterior to the axis of the pelvis. This direction is marked and the subsequent reaming and final component placement is performed in the same direction. The lateral opening is judged based on 45-degree angle from the tear drop to the lateral margin of the acetabulum on anteroposterior pelvic radiographs. The final anteversion of the cup is adjusted based on increase or decrease of lumbar lordosis and combined anteversion. Methods: Anteroposterior pelvic radiographs of 100 consecutive patients undergoing posterior THR between September 2010 and March 2011 with this method were evaluated for cup inclination angle and anteversion using
Introduction. Radiological Inclination (RI) is defined as the angle formed between the acetabular axis and the longitudinal axis when projected onto the coronal plane. Higher RI angles are associated with adverse outcomes. Methods. Primary aim: to investigate the effect of adjusting patient pelvic position in the transverse plane by using a ‘head-down’ (HD) operating table position. This was to determine, when aiming for 35° Apparent Operative Inclination (AOI), which operating table position most accurately achieved a target post-operative RI of 42°. N=270. Patients were randomised to one of three possible operating table positions:. 0°HD (Horizontal),. 7°HD, or. Y°HD (Patient Specific Table Position). Operating table position was controlled using a digital inclinometer. RI was measured using
Objectives. High failure rates of metal-on-metal hip arthroplasty implants have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices. The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage. We aimed to identify validated surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty (THA). Methods. We conducted a systematic review of studies evaluating surrogate markers for predicting long-term outcome in primary THA. Long-term outcome was defined as revision rate of an implant at ten years according to National Institute of Health and Care Excellence guidelines. We conducted a search of Medline and Embase (OVID) databases. Separate search strategies were devised for the Cochrane database and Google Scholar. Each search was performed to include articles from the date of their inception to June 8, 2015. Results. Our search strategy identified 1082 studies of which 115 studies were included for full article review. Following review, 17 articles were found that investigated surrogate markers of long-term outcome. These included one systematic review, one randomised control trial (RCT), one case control study and 13 case series. Validated surrogate markers included Radiostereometric Analysis (RSA) and Einzel-Bild-Röntgen-Analyse (EBRA), each measuring implant migration and wear. We identified five RSA studies (one systematic review and four case series) and four
Introduction. Acetabular fixation is one of the major factors affecting long-term longevity and durability of total hip arthroplasty (THA). Limited data exist regarding mid-term performance of modern non-cemented rim-fit cups with HA coating. The aim of this study was to assess the minimum 5 year clinical and radiographic performance of PSL cups. Therefore we retrospectively analyzed results of this component in patients that had adequate followup from a prospective institutional database. Materials and Methods. A retrospective analysis of a prospective database was performed to identify patients that underwent non-cemented THA between 2003 and 2007. 223 primary THA (210 patients) were performed by single surgeon via posterolaeral approach using a grit-blasted, HA coated rim-fit design and highly cross-linked polyethylene and were followed with minimum 5 years. The mean age was 62.5 years ± 10.8. The majority of the stems were non-cemented (87%) and the majority of the femoral heads were metal (75%), 22- or 28-mm diameter. 72% of the cups were solid and 28% were multi-hole. Clinical assessment included the Hospital for Special Surgery (HSS) hip score [18] at final follow-up, and Kaplan-Meier survivorship. All patients received pre- and post-operative anteroposterior (AP) weight bearing pelvis radiograph as well as a false profile view of the hip. Cup positioning was analyzed using the
Background. Reasons for revision of metal-on-metal hip resurfacing arthroplasty (MoMHRA) have evolved with improving surgical experience and techniques. Early revisions were often due to fracture of the femoral neck while later revisions are associated with loosening and/or adverse local tissue reactions (ALTR) to wear debris. In some studies, revisions of MoMHRA with ALTR have been complicated by an increased risk of rerevision and poor outcome. The purpose of this study was to investigate the causes of failure and to identify factors that improve outcome following revision of a failed HRA. Methods. From 2001 to May 2015, 180 consecutive HRA revisions were performed in 172 patients. Ninety-nine primary surgeries were done at a HRA specialist centre (99/4211, revision rate: 2.4%), 81 elsewhere. Eight different HRA designs were revised mainly in females (60%). Components’ orientation was measured from radiographs using
Femoral head diameters in THA have been increasing due to good long-term outcomes of 1st generation HXLP cups. Furthermore, some 2nd generation HXLP cups allow 36mm or larger heads. However, larger femoral head diameters increase the frictional torque and may lead to early cup migration and loosening. And there is a concern that larger head diameters and reduced liner thickness may increase polyethylene wear. In this study, we compared early acetabular component migration and wear rates between a group of larger heads using a 2nd generation HXLP and a group smaller heads using a 1st generation HXLP. The larger head group comprising 30 hips underwent THA between February 2010 and March 2011 with the use of a sequentially cross-linked polyethylene liner (X3). 30 patients were included in this study (30 women). Their mean age was 59.3years; mean weight was 53.6kg. Trident HA-coated cementless cups were used and the sizes ranged from 46mm to 56mm (mean 50.5mm). The head diameters were 36mm in 23hips, 40mm in 5 hips, and 44mm in 2hips. All X3 liners were 5.9mm or less in thickness. A control group was selected from a previous case series that had undergo THA between July 2007 and January 2008 using a 1st generation HXLP liner (Crossfire) by matching age and sex. Therefore 30 patients were included in this study (30 women) too. Their mean age was 60.0 years; mean weight was 55.5kg. The same Trident cups were used and the sizes ranged from 46mm to 56mm (mean 49.5mm). The head diameters were 26mm in 19hips and 32mm in 11hips. The liner thicknesses were 7.8mm or more. All hips had standardized anteroposterior pelvic digital radiographs performed postoperatively and cup migration was measured on digital radiographs at the immediate postoperative period and two year using EBRA-CUP software. We analyzed horizontal and vertical cup migration distance and the difference in cup anteversion and inclination angle at two years. Additionally, total head penetrarion and polyethylene liner volumetric wear rates were measured using a computer-assited method with PolyWear software. The larger head group revealed an average of 0.48mm of horizontal migration, 0.75mm of vertical migration, 0.19degree of inclination change, and 1.26 degrees of anteversion change. The control group showed an average of 0.63mm of horizontal migration, 0.36mm of vertical migration, 0.07 degree of inclination change, and 0.88 degree of anteversion change. Based on the EBRA-CUP measurements, there were no cases of significant early loosening which was indicated by more than 1mm of migration, more than 2.5 degree of inclination change, or more than 3.3 degree of anteversion change. The liner penetration rates were 0.388±0.192mm/yr in the large head group and 0.362±0.178mm/yr in the control group. The difference was not significant (p=0.64.) The volumetric wear rates were 42.8±27.9mm⁁3/yr in the large head group and 42.0±33.0mm⁁3/yr in the control group. Again, the difference was not significant (p=0.94). No significant early cup migration or increased wear rate were detected in THA with the sequentially cross-linked polyethylene liner and 36mm or large heads at two years.
Introduction. Total hip arthroplasty (THR) with non-cemented or hybrid fixation remains one of the most successful procedures performed today. The aim of this study was to assess the safety and efficacy of a hydroxyapatite (HA) coated, hemispherical cup. Material and Methods. Between 2003 and 2007, 223 THAs (210 patients) with peripheral self-locking (PSL) cup and highly cross-linked polyethylene (Crossfire, Stryker, Mahwah, NJ) with minimum 5 years clinical and radiographic follow-up (5–9 years) were analyzed. The mean age was 62.5 years ± 10.8 (range, 32.7 – 86.3) at the time of surgery and the predominant preoperative diagnoses was osteoarthritis (97.8%). 72% were solid cups without screw augmentation and 28% were multi-hole with screw. Clinical analysis included Hospital for Special Surgery (HSS) hip scores at latest follow-up. Detail radiographic analysis was carried out on anteroposterior and false profile views for evidence of osseointegration in all Charnley's zones. Osseointegration was assessed based on presence of Stress Induced Reactive Cancellous Bone (SIRCaB) with trabecular bone hypertrophy 5–15mm extending from the cup, and absence of radiolucency or demarcation.
Introduction. Cup positioning in total hip arthroplasty (THA) is an important variable for short and long term durability of any hip implant. This novel method utilises internal and external bony landmarks, and the transverse acetabular ligament for positioning the acetabular component. Methods. The cup is placed parallel and superior to the transverse ligament and inside the anterior wall notch of the true acetabulum, and then adjusted for femoral version and pelvic tilt, fixed obliquity, and transverse rotational deformity based on weight bearing pre-operative radiographs. Seventy consecutive THRs (68 patients) were performed using the above technique. The cup radiographic and functional anteversion and abduction angle were measured on post-operative weight bearing pelvic radiographs using
Background. Migration analysis after total joint arthroplasty are performed using
Introduction. Squeaking is a potential problem of all hard on hard bearings yet it has been less frequently reported in metal-on-metal hips. We compared a cohort of 11 squeaking metal-on-metal hip resurfacings to individually matched controls, assessing cup inclination and anteversion between the groups to look for any differences. Methods. We retrospectively reviewed the patient records of 332 patients (387 hip resurfacings) who underwent hip resurfacing between December 1999 and Dec 2012. 11 hips in 11 patients were reported to squeak postoperatively. Each of these patients, except one, were matched by age, sex, BMI and implant to 3 controls. The final patient only had one control due to his high BMI. The latest post-operative radiographs of the squeaking group and controls were analysed using