Aims. The aim of this study was to radiologically evaluate the quality of cement mantle and alignment achieved with a polished tapered cemented
Polished taper-slip (PTS) cemented stems have an excellent clinical track record and are the most common stem type used in primary total hip arthroplasty (THA) in the UK. Due to low rates of aseptic loosening, they have largely replaced more traditional composite beam (CB) cemented stems. However, there is now emerging evidence from multiple joint registries that PTS stems are associated with higher rates of postoperative periprosthetic femoral fracture (PFF) compared to their CB stem counterparts. The risk of both intraoperative and postoperative PFF remains greater with uncemented stems compared to either of these cemented stem subtypes. PFF continues to be a devastating complication following primary THA and is associated with high complication and mortality rates. Recent efforts have focused on identifying implant-related risk factors for PFF in order to guide preventative strategies, and therefore the purpose of this article is to present the current evidence on the effect of cemented
Aims. The Exeter V40 cemented
Aims. Although CT is considered the benchmark to measure femoral version, 3D biplanar radiography (hipEOS) has recently emerged as a possible alternative with reduced exposure to ionizing radiation and shorter examination time. The aim of our study was to evaluate
Early micromotion of hip implants measured with radiostereometric analysis (RSA) is a predictor for late aseptic loosening. Computed Tomography Radiostereometric Analysis (CT-RSA) can be used to determine implant micro-movements using low-dose CT scans. CT-RSA enables a non-invasive measurement of implants. We evaluated the precision of CT-RSA in measuring early stem migration. Standard marker-based RSA was used as reference. We hypothesised that CT-RSA can be used as an alternative to RSA in assessing implant micromotions. We included 31 patients undergoing Total Hip Arthroplasty (THA). Distal
The Accolade®TMZF is a taper-wedge cementless metaphyseal coated
Aims. The direct anterior (DA) approach has been associated with rapid patient recovery after total hip arthroplasty (THA) but may be associated with more frequent femoral complications including implant loosening. The objective of this study was to determine whether the addition of a collar to the
INTRODUCTION. Short
Aims. The Exeter V40 cemented polished tapered stem system has demonstrated excellent long-term outcomes. This paper presents a systematic review of the existing literature and reports on a large case series comparing implant fractures between the Exeter V40 series; 125 mm and conventional length stem systems. Methods. A systematic literature search was performed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In parallel, we performed a retrospective single centre study of Exeter V40
Purpose. Short metaphyseal fitting
Aims. The aim of this study was to compare the design of the generic
OptiStem XTR
Aims.
Following the recall of modular neck hip stems
in July 2012, research into femoral modularity will intensify over
the next few years. This review aims to provide surgeons with an
up-to-date summary of the clinically relevant evidence. The development
of femoral modularity, and a classification system, is described.
The theoretical rationale for modularity is summarised and the clinical
outcomes are explored. The review also examines the clinically relevant problems
reported following the use of
Background. Short bone-conserving
Fixation of cemented
Aims. Highly polished stems with force-closed design have shown satisfactory clinical results despite being related to relatively high early migration. It has been suggested that the minimal thickness of cement mantles surrounding the
Purpose. The purpose of this study was to evaluate and compare the clinical, radiological outcomes of the group of patients with distal femoral cortical hypertrophy (DFCH) and without DFCH after hip arthroplasty using a cementless double tapered
As an increasing number of young, active, large patients are becoming candidates for total hip replacements, there is an increasingly urgent need to identify arthroplasties that will be durable, highly functional and amenable to possible future successful revision. In an era when cemented
Background. Safety and efficacy of novel prostheses relies on the determination of early implant migration and subsequent risk of loosening. Radiostereometric Analysis (RSA) has been used to evaluate the clinical failure risks of
Aims. Compared with primary total hip arthroplasty (THA), revision
surgery can be challenging. The cement-in-cement femoral revision
technique involves removing a femoral component from a well-fixed
femoral cement mantle and cementing a new stem into the original
mantle. This technique is widely used and when carried out for the
correct indications, is fast, relatively inexpensive and carries
a reduced short-term risk for the patient compared with the alternative
of removing well-fixed cement. We report the outcomes of this procedure
when two commonly used
Background. It is known that excessive varus alignment of the
The removal of well-fixed bone cement from the femoral canal during revision of a total hip replacement (THR) can be difficult and risks the loss of excessive bone stock and perforation or fracture of the femoral shaft. Retaining the cement mantle is attractive, yet the technique of cement-in-cement revision is not widely practised. We have used this procedure at our hospital since 1989. The stems were removed to gain a better exposure for acetabular revision, to alter version or leg length, or for component incompatibility. We studied 136 hips in 134 patients and followed them up for a mean of eight years (5 to 15). A further revision was required in 35 hips (25.7%), for acetabular loosening in 26 (19.1%), sepsis in four, instability in three, femoral fracture in one and stem fracture in one. No
Aims. This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. Methods. We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018. Results. Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient’s comorbidities. The periprosthetic fracture patients showed radiological evidence of change in bone stock around the
Aims: The bone – conductive proparties of hydroxyapatite (HA) coatings are attractive in revision surgery with bone loss. The purpose of this study is to analyse the clinical and radiological results of 55 cases of revision hip arthroplasty using hydroxyapatite
The Lubinus SP II is an anatomical
It is known that excessive varus alignment of the
We report the results of the Charnley Elite Plus
Aims. The objective of this study was to compare the two-year migration and clinical outcomes of a new cementless hydroxyapatite (HA)-coated titanium acetabular shell with its previous version, which shared the same geometrical design but a different manufacturing process for applying the titanium surface. Methods. Overall, 87 patients undergoing total hip arthroplasty (THA) were randomized to either a Trident II HA or Trident HA shell, each cementless with clusterholes and HA-coating. All components were used in combination with a cemented Exeter V40
INTRODUCTION:. Modular
The Exeter. ™. V40 cemented polished tapered stem system has demonstrated excellent long-term outcomes. This paper presents a systematic review of the existing literature and reports on a large case series comparing implant fractures between the Exeter V40 series; 125 mm and conventional length stem systems. A systematic literature search was performed adhering to PRISMA criteria. In parallel we performed a retrospective single centre study of Exeter. ™. V40
Roentgen Stereophotogrammetric Analysis (RSA) can predict long-term outcome of prostheses by measuring migration over time. The Exeter
Introduction. The longevity of total hip replacements in young active patients is a cause for concern as increased cyclical loading can result in early loosening of implants resulting in multiple revisions during the patient's lifetime. The study presented demonstrates excellent survival of the HAC-coated
Aims. Hip arthroplasty aims to accurately recreate joint biomechanics. Considerable attention has been paid to vertical and horizontal offset, but femoral head centre in the anteroposterior (AP) plane has received little attention. This study investigates the accuracy of restoration of joint centre of rotation in the AP plane. Methods. Postoperative CT scans of 40 patients who underwent unilateral uncemented total hip arthroplasty were analyzed. Anteroposterior offset (APO) and femoral anteversion were measured on both the operated and non-operated sides. Sagittal tilt of the
Version of the
Purpose: While the durability of most uncemented femoral stems remains unknown, it is the aim of this study to demonstrate Echelon Primary
Introduction. Varus positioning of cemented ‘composite beam’ stems is associated with increased risks of aseptic loosening and stem fracture. We investigated whether the incidence of varus malalignment of the Exeter polished, double taper design in a multicentre prospective study adversely affected outcome after total hip replacement (THR). Materials & Methods. A multicentre prospective study of 1189 THR was undertaken to investigate whether there is an association between surgical outcome and
INTRODUCTION. Historically, the clinical performance of novel implants was usually reported by designer surgeons who were the first to acquire clinical data. Regional and national registries now provide rapid access to survival data on new implants and drive ODEP ratings. To assess implant performance, clinical and radiological data is required in addition to implant survival. Prospective, multi-surgeon, multi-centre assessments have been advocated as the most meaningful. We report the preliminary results of such a study for the MiniHip™femoral component and Trinity™ acetabular component (Corin Ltd, UK). METHODS. As part of a non-designer, multi-surgeon, multi-centre prospective surveillance study to assess the MiniHip™stem and Trinity™ cup, 535 operations on 490 patients were undertaken. At surgery, the average age and BMI of the study group was 58.2 years (range 21 to 76 years) and 27.9 (range 16.3 to 43.4) respectively. Clinical (Harris Hip Score, HHS) and radiological review have been obtained at 6 months, 3 and 5 years. Postal Oxford Hip Score (OHS) and EuroQol- 5D (EQ5D) score have been obtained at 6 months and annually thereafter. To date, 23 study subjects have withdrawn or lost contact, 11 have died, and 9 have undergone revision surgery. By the end of March 2018, 6 month, 1, 2, 3, 4, and 5 year data had been obtained for 511, 445, 427, 376, 296 and 198 subjects respectively. RESULTS. Implant revision rate is 1.68% (9/535), with revision for any reason as an endpoint; four of the nine involved the revision of the femoral component. At the 5-year time point, mean OHS had improved from 21.3 to 42.5 (p<0.01), EQ5D from 0.42 to 0.82 (p<0.01), and HHS from 51.6 to 92.5 (p<0.01). Radiological analysis is ongoing, and thus far has revealed more variation in stem alignment than is usually observed for more conventional length femoral components. This may indicate that optimal alignment of calcar loading short stems is different to that of longer, medullary canal aligned implants, consistent with the neck-stabilised design of the MiniHip™ stem. No other significant radiological findings were noted. During surgery, 31 calcar fractures were sustained, of which 20 were treated with cerclage wiring, 1 with femoral grafting and the remainder required no treatment. None of the hips with calcar fractures have been revised to date. DISCUSSION. The clinical and radiological performance of the MiniHip™
Introduction: Modular metaphyseal-diaphyseal
We describe the association between post-operative
The fully hydroxyappatite (HA) coated tapered collarless
We identified five (2.3%) fractures of the stem in a series of 219 revision procedures using a cementless, cylindrical, extensively porous-coated, distally-fixed
Several implants have a proven track record of durability and function in patients over many years. As manufacturers' patents expire it is understandable that cheaper generic copies would be considered. There is currently no established, independent method of determining design equivalence between generic and branded orthopaedic implants. We acquired 10 boxed, as manufactured components consisting of the generic OptiStem XTR model (n=5) and branded Exeter (n=5)
We report on 397 consecutive revision total hip
replacements in 371 patients with a mean clinical and radiological follow-up
of 12.9 years (10 to 17.7). The mean age at surgery was 69 years
(37 to 93). A total of 28 patients (8%) underwent further revision,
including 16 (4%) femoral components. In all 223 patients (56%,
233 hips) died without further revision and 20 patients (5%, 20
hips) were lost to follow-up. Of the remaining patients, 209 (221
hips) were available for clinical assessment and 194 (205 hips)
for radiological review at mean follow-up of 12.9 years (10 to 17.7). The mean Harris Hip Score improved from 58.7 (11 to 92) points
to 80.7 (21 to 100) (p <
0.001) and the mean Merle d’Aubigné and
Postel hip scores at final follow-up were 4.9 (2 to 6), 4.5 (2 to
6) and 4.3 (2 to 6), respectively for pain, mobility and function.
Radiographs showed no lucencies around 186 (90.7%) femoral stems
with stable bony ingrowth seen in 199 stems (97%). The survival
of the S-ROM
Introduction: We describe the association between postoperative
Introduction. The orthopaedic market offers more than two hundred different hip
Introduction: Fractures of the
Purpose. In an effort to increase the durability of cemented total hip arthroplasties (THA),
Introduction. Varus malpositioning of
Aim: The objective of this study was to compare the initial stability of an uncemented curved long
In computer simulations, the shape of the range of motion (ROM) of a stem with a cylindrical neck design will be a perfect cone. However, many modern stems have rectangular/oval-shaped necks. We hypothesized that the rectangular/oval stem neck will affect the shape of the ROM and the prosthetic impingement. Total hip arthroplasty (THA) motion while standing and sitting was simulated using a MATLAB model (one stem with a cylindrical neck and one stem with a rectangular neck). The primary predictor was the geometry of the neck (cylindrical vs rectangular) and the main outcome was the shape of ROM based on the prosthetic impingement between the neck and the liner. The secondary outcome was the difference in the ROM provided by each neck geometry and the effect of the pelvic tilt on this ROM. Multiple regression was used to analyze the data.Aims
Methods
The generation of wear particles at the primary articulating interface of total hip arthroplasty is well documented. Particles may also be generated at the stem/cement interface in cemented prostheses. An investigation of explanted Capital
Abstract: Between 1997 to 200, 230 patients underwent primary cemented total hip replacement using the ULTIMA Cobalt alloy, collarless
Aims. Although good clinical outcomes have been reported for monolithic tapered, fluted, titanium stems (TFTS), early results showed high rates of subsidence. Advances in stem design may mitigate these concerns. This study reports on the use of a current monolithic TFTS for a variety of indications. Methods. A multi-institutional retrospective study of all consecutive total hip arthroplasty (THA) and revision total hip arthroplasty (rTHA) patients who received the monolithic TFTS was conducted. Surgery was performed by eight fellowship-trained arthroplasty surgeons at four institutions. A total of 157 hips in 153 patients at a mean follow-up of 11.6 months (SD7.8) were included. Mean patient age at the time of surgery was 67.4 years (SD 13.3) and mean body mass index (BMI) was 28.9 kg/m. 2. (SD 6.5). Outcomes included intraoperative complications, one-year all-cause re-revisions, and subsidence at postoperative time intervals (two weeks, six weeks, six months, nine months, and one year). Results. There were eight intraoperative complications (4.9%), six of which were intraoperative fractures; none occurred during stem insertion. Six hips (3.7%) underwent re-revision within one year; only one procedure involved removal of the prosthesis due to infection. Mean total subsidence at latest follow-up was 1.64 mm (SD 2.47). Overall, 17 of 144 stems (11.8%) on which measurements could be performed had >5 mm of subsidence, and 3/144 (2.1%) had >10 mm of subsidence within one year. A univariate regression analysis found that additional subsidence after three months was minimal. A multivariate regression analysis found that subsidence was not significantly associated with periprosthetic fracture as an indication for surgery, the presence of an extended trochanteric osteotomy (ETO), Paprosky classification of
To assess whether prosthetic
Introduction and Aims: The use of porous coated
For successful long-term result of non-cemented total hip arthroplasty (THA), direct biological bond between bone and implant through bony ingrowth into the implant is essential. To facilitate strong bond between bone and implant, hydroxyapatite (HA) or hydroxyapatite and tricalcium phosphate (HA-TCP) coated implants have been developed. Early clinical results of HA coated implants were reported very satisfactorily. However, the long-term effects of HA or HA-TCP coating on implants were still controversial. We evaluated the effect of hydroxyapatite and tricalcium phosphate (HA-TCP) coating on fibermetal coated
Aim: To develop an accurate and reproducible validated digital technique for the two-dimensional measurement of longitudinal
This was a retrospective study of all AML uncemented femoral prostheses and Duraloc cups in a consecutive series of patients treated between 1990 and 1995. Patients were evaluated clinically using the Merle Score. Radiological parameters included osseo-integration, subsidence and wear. Failure was defined as removal of implants or revision. The 8 to 10-year results show a 99% survival rate. One patient was revised for
Introduction. Modern cementless press fit stems rely on early fixation and stability for osteointegration and longterm success with early migration increasing the risk of failure. The Ein Bild Roentegen Analyse Femoral Component Analysis (EBRA-FCA) methods allow accurate measurement of
The survivorship of the Corin
Purpose: To evaluate the outcome of the Elite Plus
Aims. Periprosthetic fracture (PF) after primary total hip arthroplasty
(THA) is an uncommon but potentially devastating complication. This
study aims to investigate the influence of cemented stem designs
on the risk of needing a revision for a PF. Patients and Methods. We analysed data on 257 202 primary THAs with cemented stems
and 390 linked first revisions for PF recorded in the National Joint
Registry (NJR) of England, Wales and Northern Ireland to determine
if a cemented
The aim of this study was to asses the results of total hip replacements using the Elite Plus
A reduced femoral offset in total hip replacement has been thought to be disadvantageous. We reviewed the results of 54 consecutive primary total hip replacements in 49 patients (mean age of 68 years) performed between August 1990 and December 1994, with a mean follow-up of 8.8 years (. sd. 2.1). The mean pre-operative femoral offset for these hips was 41 mm (. sd. 7.4). All patients received a low-offset Charnley stem and a polyethylene cup inserted by a single surgeon. At their latest follow-up, surviving patients had a significant improvement in the performance of their hip. Three had undergone revision, one each for deep infection, recurrent dislocation and late pain with subluxation. No hips had been revised, or were at risk of revision, for aseptic loosening. The mean annual linear rate of wear was 0.2 mm (. sd. 0.08) for the whole group. There was no correlation between the pre-operative femoral offset and the post-operative rate of wear. Our survivorship estimate was 91% when revision for any reason was taken as an end-point, but 100% if aseptic loosening was considered as the end-point. Our study demonstrates that a low-offset
Background. There is increasing impetus to use rapid recovery care pathways when treating patients undergoing total hip arthroplasty (THA). The direct anterior (DA) approach is a muscle sparing technique that is believed to support these new pathways. Implants designed for these approaches are available in both collared and collarless variations and understanding the impact each has is important for providing the best treatment to patients. Purpose/Aim of Study. This study aims to examine the role of implant design on implant fixation and patient recovery. Materials and Methods. Patients (n=50) with unilateral hip OA who were undergoing primary DA THA surgery were recruited pre-operatively to participate in this prospective randomized controlled trial. All patients were randomized to receive either a collared (n=25) or collarless (n=25) cementless, fully hydroxyapatite coated
Aim To assess whether prosthetic
We performed a case–control study to compare
the rates of further surgery, revision and complications, operating time
and survival in patients who were treated with either an uncemented
hydroxyapatite-coated Corail bipolar
Non-cemented tapered wedge
We report a series of 668 patients (699 hips) with an average follow up of 10.5 years (range, 10–11 years) following THR using a cemented custom-made titanium
Introduction and Aims: This paper presents a treatment plan for
Introduction. Many patients who had previous proximal femoral osteotomies develop deformities that may not be amenable to total hip replacement (THR) with standard off-the-shelf
Purpose: Using the finite element analysis, the authors analyze the effect of the articulating material properties of the total hip arthroplasty to stress and micro-motion of the proximal femur and the
Hydroxyapatite-coated standard anatomical and customised
INTRODUCTION:. Short
Purpose: The purpose of this study is to evaluate the clinical and radiological results of the total hip arthroplasty using the CLS stem, of which we were able to follow up for 15~20 years after operations. Materials and Methods: Among 104 patients who underwent the total hip arthroplasty using the CLS stem from 1988 to August 1993, we evaluated the clinical and radiological results of 65 hips of 51 patients, which were able to be followed up for more than 15 years. The average age at the operation was 45 years old (22~62 years old) and the average follow-up duration was 17 years and 2 months (15 years~20 years 5 months). The majority of preoperative diagnoses was avascular necrosis of femoral head with 52 cases (80%), followed by osteoarthritis with 7 cases (11%) and the other 6 cases. Used as acetabular components were 15 cases of the Expansion cup, 26 cases of the HG II cup, 11 cases of the CLW cup, 2 cases of the Spherical cup and 11 cases of Bipolar cup (54 cases of the total hip arthroplasty and 11cases of bipolar hemiarthroplasty). Results: No
Modern prosthetic stem construction strives to achieve the attractive goals of stress shielding prevention and optimal osteointegration. PhysioLogic stem is a new generation composite isoelastic
Purpose. Investigating the effects of
We have carried out a prospective, randomised study designed to compare the long-term stability of the stem of cementless femoral implants with differing surface configurations. A total of 50 hips (46 patients) was randomised into two groups, according to whether the medullary stem had been grit blasted (GB) or coated with hydroxyapatite (HA). Both femoral prostheses were of the same geometrical design. We used Ein Bild Roentgen Analyse femoral component analysis (EBRA-FCA) to assess the stability of the stem. The mean follow-up was for 8.66 years. The mean migration of the stem was 1.26 mm in the HA group compared with 2.57 mm in the GB group (Mann-Whitney U test, p = 0.04). A mixed model ANOVA showed that the development of subsidence was statistically different in the two groups during the first 24 months. After this subsidence increased in both groups with no difference between them. Our results indicate that, with the same design of stem, HA coating enhanced the stability of the
Aims. To assess the early subsidence rate of the
We have compared prospectively the incidence of loosening of 20
We analysed revised Mathys isoelastic polyacetal
Introduction. Trunnion wear has been reported as a cause for failure of modern total hip replacement implants. While there are several reports on the prevalence of trunnion corrosion with specific stem designs, little is known about the prevalence of this problem across other
Traditional techniques for the insertion of
We report the initial results of an ongoing randomised, prospective study on migration of the Exeter and Elite Plus
We report an unusual complication of late dislocation of a total hip replacement. The
We reviewed the outcome of prosthesis-to-bone fixation of the rough titanium
We report the clinical and operative details of seven cases of fracture of the
We describe the results at five years of a prospective study of a new tri-tapered polished, cannulated, cemented
We have examined 26 retrieved, failed titanium-alloy
The medium term results of the JRI Furlong Total hip replacement have been very impressive to date. We report the longest prospective series to date of a hydroxyapatite coated femoral prosthesis (Joint Replacement Instrumentation limited, London, UK) at 15–21 years follow up. We describe the long term clinical and radiological
Introduction: This study investigates the influence of surgical approach on the early migration of a cemented Total Hip Replacement (THR), assessed by Roentgen Stereo-photogrammetric Analysis (RSA). Rapid early migration has been correlated with premature implant failure. Method: 46 patients awaiting THR were allocated into Posterior Approach (PA) and Lateral Approach (LA) groups. RSA was used to assess post-operative stem position and migration at 1 year. Post-operative gait was examined for a subgroup of patients. Results: There was no difference in initial stem position within the medulla. Significant differences in distal migration were found; (LA 0.78±0.07mm and PA 1.27±0.15mm), p<
0.01. Posterior head migration for the PA group (0.78±0.18mm) was twice that for the LA group (0.46±0.08mm), p<
0.05. The PA group showed greater medial migration of the prosthesis tip (0.62±0.24mm), compared to the LA group (0.11±0.08mm), p<
0.05. During gait, the legs of the PA group were relatively internally rotated when compared to those of the LA group. Discussion: The PA implants rotate internally and into valgus further than the LA implants. The starting positions of the prostheses were the same with similar cement and prostheses characteristics. We can infer that surgical approach and therefore muscle function have a significant effect upon component migration. During gait, the PA group has relatively internally rotated legs, probably due to short external rotator weakness. Hence, the internally rotating torque on the
This study examined the effect of surgical approach on the 1year migration of the Exeter stem, using Roentgen Stereophotogrammetric Analysis (RSA). There is evidence that implants with increased early migration, particularly those moving into internal rotation, are likely to have a higher failure rate. A total of 46 patients awaiting THR were allocated into 2 groups. Both groups underwent an Exeter Total Hip replacement, one through the Posterior Approach (PA), and the other through the Hardinge Approach (HA). RSA was used to assess post-operative stem position and migration at 1 year. Post-operative gait analysis and clinical evaluation was used to assess a subgroup of patients. There was no difference in the initial stem position of each group within the femoral canal. Significant differences in migration were found for migration of the head distally and posteriorly and for the tip medially. During gait, the legs of the PA group were relatively internally rotated when compared to those of the HA group. Relative to the supporting bone, the PA implants internally rotate and also rotate into valgus further than the HA implants. The starting position of the prostheses was the same and the cement and prosthesis characteristics were similar. From this, we can infer that surgical approach and therefore muscle function, have a large influence on component migration. During gait, the PA group had internally rotated legs compared to the HA group. This is probably due to short external rotator weakness in the PA group. As a result the internally rotating component of the posteriorly directed joint reaction force on the
Introduction: We report our experience with the ZMR Hip System (Zimmer Inc.). The system accommodates a number of femoral fixation philosophies including spline, porous and taper stem options. The tapered stem is designed to achieve a distal wedge fit and also allow bone on-growth via the corundumized titanium alloy surface. The modular mid-stem junction allows a selection of body designs to be selected providing significant intra-operative flexibility and version adjustment. Method: This study considers 64 cases performed in 63 patients with a mean age at the time of surgery of 70 years (range 55–89) utilising the taper stem design. The indication for revision surgery was aseptic loosening in 33 patients (Paprosky types II – 12, IIIA-10, IIIB-11) 22 peri-prosthetic fractures (Vancouver types B2-15, B3-7), 8 for infection and 4 patients with instability. Results: The cohort had a minimum three-year follow-up with a mean of 50 months (range 36–72) and clinical assessment included Oxford score and thigh pain assessment. Engh’s criteria was utilised in the radiological evaluation when considering femoral component fixation.
Background: A total new double-threaded cone-shaped modular
Since 1986 the JRI Furlong hydroxyapatite coated
Summary Statement. In young, active patients cementless THR demonstrates excellent prosthetic stability by RSA and outstanding clinical outcomes at 5 years using a tapered titanium
Introduction: Proximal bone loss in patients undergoing femoral hip revision surgery is a challenging and complex problem, as it is often impossible to implant a proximally anchored prosthesis in such cases. Fluted tapered cementless prosthesis stems, such as the Link MP reconstruction prosthesis represent a distal fixation option, allowing axial and rotational control of the implant in the femoral diaphysis. The manufacturer of the MP hip stem recommends a distal femoral implant/bone anchorage of at least 80 mm to gain implant stability. However, there are no in vivo studies showing that this fixation length is achieved in clinical practice and that this distance is needed for clinical satisfying results. Therefore, the aim of this study was to assess the distal femoral fixation length of the MP reconstruction prosthesis by using computer assisted tomography (CT). Patients and Methods: To evaluate stem anchorage of the MP reconstruction stem, we performed CT-scans on 14 patients at a median follow-up of 12 months (IQR 12–25) after surgery. All CT-scans were separately analysed by 2 blinded radiologists. Clinical outcome was assessed by VAS for pain and Harris Hip Score (HHS) both at 12 (IQR 12–25) and 68 (IQR 61–73) months after surgery. Results: We found the CT-scans of good quality and almost free from disturbing metal artefacts, which made it easy to interpret the images. Intraclass correlation between the measurements of the two blinded radiologists was 0.935 corresponding to an outstanding inter-rater reliability. The median length of
Method. 286 patients underwent total hip arthroplasty with a cemented titanium femoral implant (Ultima, Johnson & Johnson) between July 1995 and July 2001. The acetabular component was either a porous coated cup or a cemented all-polyethylene cup. A 28mm cobalt chromium head was used in all patients. Patients were prospectively evaluated with clinical examination, Harris hip scores and radiographic assessment. Analysis of the data was performed. Results. Of the 286 patients, 11 patients were excluded from analysis for reasons including incomplete data (8) and death (3). The remaining 275 patients were comprised of 118 males and 157 females with an average age of 70.8 years (55–89 years). The average follow up was 10.5 years (1.03–14.23). The median follow up was 10 years. 177 cemented all-polyethylene and 98 porous coated acetabular cups were used. The average Harris hip scores were 34.4 and 81.25 for preoperative and last follow up visit respectively. 11 stems were revised (aseptic loosening 9, infection 2). Radiographic assessment showed vertical subsidence in 30 patients (10.9%) (>5mm in 6 and < 5mm in 24 patients). Complete cement-bone radiolucency was noted in 11 stems (4%). Radiolucent lines covering < 50% of cement-bone interface were noted in 18 stems (6.5%). There were no cases of cement fracture. Kaplan-Meier survivorship was 91% at 10 years & 89.8% at 12 years. Conclusions. This prospective study represents the largest reported cohort of patients with a cemented titanium alloy