We have evaluated the difference in the migration patterns over two years of two cementless stems in a randomised, controlled trial using radiostereophotogrammetric analysis (RSA). The implants studied were the Furlong HAC stem, which has good long-term results and the Furlong Active stem, which is a modified version of the former designed to minimise stress concentrations between the implant and bone, and thus to improve fixation. A total of 23 Furlong HAC and 20 Furlong Active stems were implanted in 43 patients. RSA examinations were carried out immediately post-operatively and at six, 12 and 24 months post-operatively. The subsidence during the first year in the Furlong HAC stem, was approximately one-third that of the Furlong Active stem, the measured mean subsidence of the femoral head at six months being 0.27 mm (95% confidence interval (CI) 0.03 to 0.51) and 0.99 mm (95% CI 0.38 to 1.60), respectively (p = 0.03). One Active stem continued to subside during the second year. All hips, regardless of the type of stem were clinically successful as judged by the Oxford hip score and a derived pain score without any distinction between the two types of stem. The initial stability of the Furlong Active stem was not as good as the established stem which might compromise osseo-integration to the detriment of long-term success. The changes in the geometry of the stem, to minimise stress have affected the attainment of initial stability

This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged <  50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. This represents an update of previous reports of the same cohort at ten and 16 years, which were reported in 2004 and 2009, respectively. We describe the survival, radiological and functional outcomes at a mean follow-up of 21 years (17 to 25). Of the surviving 34 THAs, one underwent femoral revision for peri-prosthetic fracture after 21 years, and one patient (one hip) was lost to follow-up. Using aseptic loosening as the end-point, 12 hips (31.5%) needed acetabular revision but none needed femoral revision, demonstrating 100% survival (95% confidence interval 89 to 100). In young patients with high demands, the Furlong HAC–coated femoral component gives excellent long-term results. Cite this article: Bone Joint J 2015;97-B:749–54

Continued controversy exists between cemented versus uncemented hemiarthroplasty for an intracapsular hip fracture. To assist in resolving this controversy, 400 patients were randomised between a cemented polished tapered stem hemiarthroplasty and an uncemented Furlong hydroxyapatite coated hemiarthroplasty. Follow-up was by a nurse blinded to the implant used for up to three years from surgery. Results indicate no difference in the pain scores between implants but a tendency to an improved regain of mobility for those treated with the cemented arthroplasty (1.2 score versus 1.7 at 6 months, p=0.03). There was no difference in early mortality but a tendency to a higher later mortality for the uncemented implants (29% versus 24% at one year, p=0.3). Later peri-prosthetic fracture was more common in the uncemented group (3% versus 1.5%). Revision arthroplasty was required for 2% of cemented cases and 3% of uncemented cases. Surgery for an uncemented hemiarthroplasty was 5 minutes shorter but these patients were more likely to need a blood transfusion (14% versus 7%). Three patients in the cemented group had a major adverse reaction to bone cement leading to their death. These results indicated that a cemented stem hemiarthroplasty give marginally improved regain of mobility in comparison to a contemporary uncemented hemiarthroplasty. An uncemented hemiarthroplasty still has a place for those considered to be at a high risk of bone cement implantation syndrome

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 femoral stems in young active individuals. Patients/Materials & Methods. 33 Patients under 50 years of age underwent 38 total hip arthroplasties using the JRI Furlong HAC-coated femoral stem. The retrospective evaluation of the prospectively collected data of the cohort at 17 to 25 years is presented. Results. Of the surviving 34 arthroplasties, 1 hip underwent revision of the stem for peri-prosthetic fracture after 21 years and 1 patient was lost to follow-up. Using aseptic loosening as the end-point, 12 hips (31.5%) needed acetabular revisions but none needed revision of the femoral stem demonstrating 100% survival at a mean of 21 years (95% confidence interval 89% to 100%). Discussion. The excellent survival of the femoral stems can be attributed to various factors. The HAC-coating is present throughout the length of the Furlong stem resulting in bonding along the entirety of the implant. This, further supplemented by the modulus of elasticity of titanium helps the whole proximal femur to function as one unit minimizing the impact of varus or valgus mal-positioning. Furthermore, following osteo-integration, a sealing effect is created in the proximal femur preventing distal migration of the wear particles, which are known to cause osteolysis. The 12 patients that needed revisions for aseptic loosening in our study were confined to the acetabular side. This is a lesser invasive procedure compared to extraction and reconstruction of femoral stems. Conclusion. In young patients with high demands, the Furlong HAC–coated femoral stem gives excellent long-term results

Background: Total Hip Replacements in younger active patients continues to pose a major challenge. Surface replacement techniques, designed to preserve bone stock do not yet have proven long term results. Early cemented designs in this population had high failure rates. Concept of fixation of total hip prosthesis by bony in-growth rather than by cement is an attempt to decrease the incidence of loosening. Ceramic joint surfaces produce minimal wear debris. Objectives: A medium term follow-up of clinical and radiological results of the JRI Furlong hydroxyapatite coated prosthesis with ceramic bearing surfaces in young active patients. Methods: A retrospective analysis of 43 JRI Furlong Hip Replacements (mean age 32 Yrs) in 33 patients is presented. The minimum follow-up was 60 months. Functional assessment was done using the Harris Hip Score. Radiolucency around the femoral stem according to Gruen (zone 1-7) and the acetabulum as described by Charnly and De Lee (zone 1–3) is documented. A fully coated femoral component along with the press –fit HA coated CSF cup with a 28mm ceramic insert was used. All cups were routinely augmented with screws. Results: The mean Harris Hip score was 90 (46–96). 4 patients had a score less than 80. 84.2% were completely pain free. Acetabular radioleucencies were noted in 32 hips (72 %).28 cups had radiolucent lines (RLL) in zone 2, 2 cups in zone 1 and 1 cup in zone 3. In 10 patients (23%) the lucent area measured > 2mm at the cup bone interface. No hips had RLL in more than two zones. 4 stems had RLL > 2 mm involving the Gruen zone 7. 90 % showed a distinct osteoblastic reaction at the tip of the femoral component. There was no calcar resorption, endosteal cavitation or ectopic ossification. There were no instances of ceramic fractures and no hips were revised. Discussion: The JRI Furlong hip gives good functional results in young patients in the medium term. Although of concern, there was no co-relation between the presence of acetabular RLL and functional outcome. The RLLs were not thought to be progressive. The RLLs can be explained by backside wear or by fretting of the screws by the ceramic liner. Long term follow up of the CSF cup will be required to determine if these radio-lucent lines are an early sign of failure at the interface or whether they simply represent stable in- growth of fibrous tissue in this highly stressed region

Objective. In many institutions, serial casting and splinting requires many weeks of treatment and frequently results in surgery. This study evaluated the results of neonatal clubfoot correction with the Furlong method. This method was created by Furlong M.B. and Lawn G.W. in New York and was published in Archives of Pediatrics in 1960. Materials and Methods. This study reviews 95 neonates with 128 severe clubfeet (initial Pirani score 4,0 or more). Patients with arthrogrypotic clubfeet and other syndromes were not included. Age at presentation ranged from 4 hours to 18 days. All patients had no previous treatment. The cast application with extra space above the foot was performed as follows: a special elastic pad was placed on the dorsal aspect of the foot and fixed with a cotton bandage. Then plaster cast was applied with knee flexion 110–120 degrees. After the cast was set, the elastic pad was removed, leaving a reserve space on the dorsal aspect of the foot. The cast was changed every 3–7 days. Typical corrective maneures were performed. Foot displacement into dorsiflexion occured spontaneously as an active motion and also with manipulations. Abduction braces or knee-flexed splints were applied after the complete foot correction. Pirani score and foot dorsiflexion angle were documented during each step of correction. Results. A detailed rating system (with radiologic criteria) was used for result evaluatiion. Correction was successful in all but 5 patients. 90 % required less than 6 casts. There were 12 recurrences and they were related with compliance with the abduction brace, but not with age or number of casts required for correction. Only 13 patients required surgery (6 posterior releases, 6 posteromedial releases and 1 complete subtalar release). Mean follow-up was 12 years. 23% of feet were evaluated as excellent, 71 %- as good and 6%- as poor results. Conclusion. The Furlong method is succesful in obtaining initial correction in the idiopathic clubfoot patient. This method corrects the neonatal congenital clubfoot in 85% without any surgery

We followed up 82 patients who under went 92 Furlong Hydroxyapatite coated uncemented femoral stem, and threaded acetabular component. All hips had a 28mm ceramic heads. These hips were inserted between the periods 1989–1992. The mean age of the patients at the time of surgery was 54(31–67). At the ten year follow up there were 64 patients with 70 hips. 5 hips were revised. 3 for acetabular component loosening, 2 for infection. 8 patients died from unrelated causes, 3 refused to attend but filled in the Oxford hip score by mail, 2 were lost to follow up. At 10 years follow-up the mean age was 64(41–77) years. The Oxford, and the Harris hip scores were used to Asses the patients clinically, and a standard AP pelvis X-Ray showing both hips was performed. Clinically we found that the mean Harris hip score was 90 (51 – 100), the mean Oxford hip score 20 (12 – 45). Radiographic assessment showed good component fixation with uniform bone growth around the components. The average angle of the Acetabular component was 52 (40– 60). 21 hips showed polyethylene wear in the acetabular component, 5 had more than 2mm wear, and 1 had more than 3mm of poly wear. 36 (52%) of the hips showed proximal calcar remodelling. We conclude that the Furlong HA coated THR is an excellent THR for the young patient who has a higher activity demand with a cumulative survival rate of 94.29% (CI ±5.2)

We followed up 83 patients who under went 92 Furlong Hydroxyapatite coated femoral stem, threaded acetabular component, and 28mm ceramic heads. These hips were inserted between the periods 1989–1992 The Average age of the patients at the time of surgery was 54 years with an age range 31–67. And were followed up at 5,7,10 years respectively. At the ten year follow up there were 64 patients with 70 hips. 5 hips were revised. 3 for acetabular component loosening, 2 for infection. 8 died from unrelated causes, 3 refused to attend but filled in the Oxford hip score by mail, 2 were lost to follow up. At the time of follow-up the average age was 64 years with an age range ( 41 – 77). The Oxford, and the Harris hip scores were used to Asses the patients clinically, and a standard AP pelvis X-Ray showing both hips was performed. Clinically we found. The average Harris hip score 90 ( 51 – 100), the average Oxford hip score 20 ( 12 – 45 ). Radiographic assessment showed good component fixation with uniform bone growth around the components. The average angle of the Acetabular component was 52 ( 40– 60 ). 4 cups showed loose zones mainly in zone1. 21 hips showed polyethylene wear 6 had more than 2.5 mm wear. 52% of the hips showed proximal calcar remodelling, only 7 stems showed loose zones mainly in zone 1. We conclude that the Furlong HA coated THR is an excellent THR for the young patient who has a higher activity demand with a survival rate of 93.9% excluding deaths and patients who refused to attend at ten years follow up

Introduction: There are more than 60 different hip prostheses currently available for total hip replacement (THR). Cemented prostheses make up about 90 to 95% of current total UK market. The cost of THR prosthesis varies widely with some prostheses cost 5 times more than others. Furlong Stainless steel cemented is a low-cost prosthesis that has been used in few hospitals in UK and Europe. There is no published data to report its survival and performance. Aim: To evaluate the outcome of a low-cost THR prosthesis (Furlong stainless steel) that has been in use in our hospital since 1993. Patients and Methods: we retrospectively reviewed 142 THR performed between 1993 and 2001. The average age was 72 and osteoarthritis was the primary pathology in 92%. Operations were performed by different grades of surgeons. 25 patients were dead at the time of the study. Results: 4 cases underwent revision (2.8%) with survival rate of 97.2%. 6 cases of dislocation, 17 cases of heterotopic calcifications, 5 cases of DVT and one neurological injury. 88% reported no pain and 79.6% were satisfied. Conclusions: The results of this study compare favourably with Furlong Titanium cemented prosthesis and other popular THR prostheses (e.g. Charnley). It is rational to continue using this prosthesis, which appears to be cost effective

Since 1986 the JRI Furlong hydroxyapatite coated femoral stem has been in use at our institution. We present the results of the first 100 hips performed on 86 patients by or under the direct supervision of one surgeon (JANS). The Furlong stem was used in conjunction with a ceramic head and CCI cemented UHDP cup. AT the time of surgery the mean age of the patients was 69 (range 45–94 years). One patient has undergone excision arthroplasty for suspected infection at which time the femoral component was found to be well bonded. At latest review, all patients were accounted for. 48 patients had died with no death directly related to surgery and no revisions or planned revision of the femoral component at the time of death. Of the 38 surviving patients (44 hips), the mean Merle d’Aubigné & Postel score was 5.8 for pain, 5.7 for movement and 4.9 for function at 13 to 16.5 years follow up (mean 14.0). No femoral component showed radiological evidence of loosening. Five acetabular components have been revised for aseptic loosening with the femoral component found to be well bonded at the time of revision and therefore left in situ. In this series of hydroxyapatite coated femoral stems the overall revision rate is 1% with no cases of aseptic loosening. This hydroxyapatite coated prosthesis, at long term follow up has superior survival figures to other types of femoral components

Cementless total hip replacements (THR) have a theoretical advantage over cemented designs in that bone lysis and probably aseptic loosening are less common complications. NICE guidelines suggest that prosthesis should have an aseptic loosening rate of < 10% at 10 years. Long-term follow-up of the Joint Replacement Instrumentation (JRI) Hydroxyapatite coated (HAC) Furlong system is gradually emerging following its first clinical application in 1985. A retrospective study was performed to identify all patients having undergone a primary JRI HAC THR under a single Consultant at Barnsley Foundation Hospital NHS Trust between 1985 and 1995. This identified 124 joints in 106 patients (52% males). All living patients were sent a modified Oxford Hip Score questionnaire; case notes were also reviewed to identify any revision surgeries. Median age at operation was 54.0 years. 17 patients (16%) had died at the time of this study. Median follow-up was 13.7 years (range 9.4–18.5 years). For 30 patients (24.2%) it was impossible to gather data on the survival of the hip. Mean survival of all hips followed up was 16.2 years. Twenty-four hips (19.4%) required revision surgery; the median time to this surgery was 10.2 years, mean 8.2 years. Reasons included aseptic loosening of the stem in one patient at 12.7 years, aseptic loosening of the cup in 7 patients (range 10.2–17.4 years), worn polythene insert in 4 patients, infective loosening in 3 patients and recurrent dislocations in 2 patients. The remainder of revisions were for unknown reasons. The Oxford Hip Score postal questionnaire was returned by 79% of patients. Mean score was 12.6/45 but 88% of patients reported overall satisfaction with the hip. In summary, there were no revision surgeries at ten-year follow-up for aseptic loosening

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 femoral stem, which may have contributed to the fractures; this was reflected in change of the canal flare index at the proximal femur. Two patients (two hips) were lost to follow-up. Using aseptic loosening as the endpoint, 16 patients (18 hips; 48%) needed acetabular revision. None of the femoral components were revised for aseptic loosening, demonstrating 100% survival. The estimate of the cumulative proportion surviving for revisions due to any cause was 0.97 (standard error 0.03). Conclusion. In young patients with high demands, the Furlong HAC-coated femoral component gives excellent long-term results. Cite this article: Bone Jt Open 2024;5(4):286–293

Introduction. Primary mechanical stability is important with uncemented THR because early migration is reduced, leading to more rapid osseointegration between the implant and bone. Such primary mechanical stability is provided by the design features of the device. The aim of this study was to compare the migration patterns of two uncemented hip stems, the Furlong Active and the Furlong HAC stem; the study was designed as a randomised control trial. The implants were the Furlong HAC, which is an established implant with good long term results, and the Furlong Active, which is a modified version of the Furlong HAC designed to minimise stress concentrations between the implant and bone, and thus to improve fixation. Materials and methods. The migration of 43 uncemented femoral components for total hip replacement was measured in a randomised control trial using Roentgen Stereophotogrammetric Analysis (RSA) over two years. Twenty-three Furlong HAC and twenty Furlong Active stems were implanted into 43 patients. RSA examinations were carried out post-operatively, and at six months, 12 months and 24 months post-operatively. The patients stood in-front of a purpose made calibration frame which contained accurately positioned radio-opaque markers. From the obtained images, the 3-D positions of the prosthesis and the host bone were reconstructed. Geometrical algorithms were used to identify the components of the implant. These algorithms allowed the femoral component to be studied without the need to attach markers to the prosthesis. The migration was calculated relative to the femoral coordinate system representing the anterior-posterior (A-P), medial-lateral (M-L) and proximal-distal (P-D) directions respectively. Distal migration was termed subsidence. Results. Both stems subsided significantly during the first six months following surgery but almost all stems did not progressively subside thereafter. The Furlong Active stem experienced approximately three times the amount of subsidence of the Furlong HAC stem; this difference was significant (p = 0.02). There was one subsidence outlier (four standard deviations from the mean) for the Furlong Active stem between one and two years post-operatively. Both the stems migrated laterally and rotated into valgus. Lateral migration was greater for the Furlong Active stem; at 12 and 24 months there was a significant migration of the Furlong Active head laterally of 0.51 mm (p = 0.012) and 0.58 mm (p = 0.013) respectively. There was no significant difference in clinical scores between the implants at any RSA examination post-operatively. Discussion. The initial fixation of the Furlong Active stem was not as good as the established stem making it less likely to integrate effectively with the bone. In this study, the theoretical design of a hip replacement to minimise the stress concentration between the implant and bone and thus improve fixation actually resulted in worse implant fixation. Stems designed theoretically to improve fixation may not achieve this. Therefore we recommend that new devices should be tested using Roentgen Stereophotogrammetric Analysis. Acknowledgments This work was funded by the Furlong Charitable Research Foundation

In 2004 we described the ten-year prospective results of 38 total hip replacements using the Furlong hydroxyapatite-ceramic-coated femoral component in 35 patients < 50 years old. We have now reviewed the surviving 35 arthroplasties in 33 patients at a mean of 16 years (10.3 to 19.9). The mean age of the surviving patients at the time of operation was 41.3 years (26.0 to 49.0). Of these, eight have undergone revision of their acetabular component for aseptic loosening. None of the femoral components has had revision for aseptic loosening giving a survival rate of 100% at 16 years (95% confidence interval 89% to 100%). The Furlong hydroxyapatite-ceramic-coated femoral component gives excellent long-term survival in young and active patients

Aims. Debate continues about whether it is better to use a cemented or uncemented hemiarthroplasty to treat a displaced intracapsular fracture of the hip. The aim of this study was to attempt to resolve this issue for contemporary prostheses. Methods. A total of 400 patients with a displaced intracapsular fracture of the hip were randomized to receive either a cemented polished tapered stem hemiarthroplasty or an uncemented Furlong hydroxyapatite-coated hemiarthroplasty. Follow-up was conducted by a nurse blinded to the implant at set intervals for up to one year from surgery. Results. A total of 115 patients died in the year after surgery. There was a tendency towards a slightly higher mortality in those treated with the uncemented prosthesis after one year (64 vs 51; p = 0.18). For the survivors, there was no significant difference in pain score at any of the time intervals. Patients treated using the cemented hemiarthroplasty recovered mobility better than those treated with the uncemented hemiarthroplasty (mean decrease in mobility score at one year: 1.7 vs 1.1, SD 1.9; p = 0.008). There was a tendency to more periprosthetic fractures in the uncemented group (five vs two cases; p = 0.45), but overall the need for further surgery was similar in both groups (nine vs seven cases). There were four perioperative deaths in the cemented group. Conclusion. These results indicate that a contemporary cemented hemiarthroplasty gives better results than an uncemented hemiarthroplasty for patients with a displaced intracapsular fracture of the hip. When the condition of the patient permits, a cemented hemiarthroplasty should be used. Cite this article: Bone Joint J. 2020;102-B(1):11–16