Aims. The stability of
We reviewed the long-term results at ten to 12 years of 118 total hip replacements in 109 patients using a second-generation hemispherical
Four hundred and fifteen patients with
Removal of well-fixed,
Introduction and Aims: We undertook this study to detemine the results of acetabular fixation using the Duraloc 300 uncemented acetabular component in patients with inflammatory joint disease and poor bone stock. Method: Fifty consecutive total hip replacements using a Duraloc 300 cup in patients with imflammatory joint disease were reviewed at an average of 8.2 years. Postoperative x-rays were analysed for cup placement and interface gaps. Follow-up films were analysed for lucent lines, osteolysis, wear and migration. Kaplan-Meier survivorship analysis was performed. Results: All components were found to be stable with no evidence of loosening or migration. One patient developed sepsis seven years post-surgery. There was no evidence of excessive wear or osteolysis. Conclusion: The Duraloc 300
The membranes surrounding seven loose cementless acetabular implants were shown to contain polyethylene particles, birefringent in polarised light. Three of these implants were made of titanium alloy and the membranes around these contained titanium particles as well. There was no metallosis around the four implants made of chromium-cobalt-steel alloy. Both titanium and polyethylene particles caused migration, adherence and phagocytosis of CD11b-positive, peroxidase-negative macrophages. There were no histological signs of activation of the specific immune response; neither interleukin-2 receptor-positive activated T cells nor PCA-1 plasmablasts/plasma cells were present in the tissues. In cases of simple loosening, resident mesenchymal fibroblast-like cells were active. In aggressive granulomatosis, there were many macrophages and multinucleated giant cells but little fibroblast reaction. The clinical relevance of the findings is that the use of cementless prostheses is not a guarantee against adverse tissue reactions.
Cementless acetabular fixation has demonstrated superior long-term durability in total hip replacement, but most series have studied implants with porous metal surfaces. We retrospectively evaluated the results of 100 consecutive patients undergoing total hip replacement where a non-porous Allofit component was used for primary press-fit fixation. This implant is titanium alloy, grit-blasted, with a macrostructure of forged teeth and has a biradial shape. A total of 81 patients (82 hips) were evaluated at final follow-up at a mean of 10.1 years (8.9 to 11.9). The Harris Hip Score improved from a mean 53 points (23 to 73) pre-operatively to a mean of 96 points (78 to 100) at final review. The osseointegration of all acetabular components was radiologically evaluated with no evidence of loosening. The survival rate with revision of the component as the endpoint was 97.5% (95% confidence interval 94 to 100) after 11.9 years. Radiolucency was found in one DeLee-Charnley zone in four acetabular components. None of the implants required revision for aseptic loosening. Two patients were treated for infection, one requiring a two-stage revision of the implant. One femoral stem was revised for osteolysis due to the production of metal wear debris, but the acetabular shell did not require revision. This study demonstrates that a non-porous titanium acetabular component with adjunct surface fixation offers an alternative to standard porous-coated implants.
We performed 114 consecutive primary total hip arthroplasties with a
Adult human cadaver pelves were tested to determine micromotion at the prosthesis-bone interface in
We report the use of a 15° face-changing cementless
acetabular component in patients undergoing total hip replacement
for osteoarthritis secondary to developmental dysplasia of the hip.
The rationale behind its design and the surgical technique used
for its implantation are described. It is distinctly different from
a standard cementless hemispherical component as it is designed
to position the bearing surface at the optimal angle of inclination,
that is, <
45°, while maximising the cover of the component by
host bone.
We have evaluated the results of total hip replacement in patients with congenital hip disease using 46 cemented all-polyethylene Charnley acetabular components implanted with the cotyloplasty technique in 34 patients (group A), and compared them with 47 metal-backed
Eighty-three patients (ninety hips) with well-fixed cementless socket retained during revision of a femoral component were reviewed. At revision, 33% of patients had acetabular osteolysis and 52% were grafted. At mean follow-up 9.6 years (5.5 – 15.9) after femoral revision and 14.8 years (7.1–20.2) after primary arthroplasty, survivorship was 96.5% (95% CI, 91.5% to 100%) at five years and 81%(95% CI, 61% to 99%) at ten years after femoral revision. Revision of a
We performed 52 total hip replacements in 52 patients using a
The last two decades have seen remarkable technological advances in total hip arthroplasty (THA) implant design. Porous ingrowth surfaces and highly crosslinked polyethylene (HXLPE) have been expected to dramatically improve implant survivorship. The purpose of the present study was to evaluate survival of contemporary
Background. We have often experienced a change of the tone of the hammering sound during the press-fit implantation of
The cemented acetabular component has been essentially abandoned, due to the reliable and durable fixation provided by bone ingrowth into
Recent advancements in biomaterial technology have created novel options for acetabular fixation in primary total hip arthroplasty (THA). For example, cementless acetabular fixation has become the preferred option, however, there is continued debate concerning whether long-term survivorship is comparable to that of cemented component fixation. Many doubts previously associated with early cementless designs have been addressed with newer features such as improved locking mechanisms, enhanced congruity between the acetabular liner and the shell, and the inclusion of highly cross-linked ultra-high molecular weight polyethylene (UHMWPE). Additionally, there has been increased utilization of new porous metals, titanium mesh, and hydroxyapatite (HA) coated implants. However, several retrieval studies have indicated that porous-coated
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 EBRA, both proximal translation and sagittal rotation were
excellent diagnostic tests for detecting aseptic loosening. The
area under the receiver operating characteristic (ROC) curves was
0.94 and 0.93, respectively. The thresholds of 2.5 mm proximal translation
or 2° sagittal rotation (EBRA) in combination with radiolucency
criteria had a sensitivity of 93% and specificity of 88% to detect
aseptic loosening. The sensitivity, specificity, positive predictive
value and negative predictive value (NPV) of radiolucency criteria
were 41%, 100%, 100% and 68% respectively. Manual measurements of
both proximal translation and sagittal rotation were very good diagnostic tests.
The area under the ROC curve was 0.86 and 0.92 respectively. However,
manual measurements had a decreased specificity compared with EBRA.
Radiolucency criteria had a poor sensitivity and NPV of 41% and
68% respectively. Conclusion. This study shows that EBRA and manual migration measurements
can be used as accurate diagnostic tools to detect aseptic loosening
of