Purpose: Hip prosthesis for sequelar developmental dysplasia of the hip is a therapeutic challenge because of the anatomic deformity and the young age of the patients. The purpose of this work was to report results obtained using a non-cemented femoral stem with an intramedullar design and a prosthetic neck custom-made to match individual anatomy observed on preoperative computerised tomographic. Material and methods: This study included 257 hips with a mean follow-up of 5.6 years. Mean age at implantation was 55 years (range 17–78). The computed tomography study assessed: dislocation according to Crowe, leg length discrepancy, and acetabular anteversion and diameter. The cup was not cemented and was inserted with an anchor hook in the obturator foramen for implantation in the paleoacetabulum. The medullary canal was prepared using a blunt reamer shaped like the definitive prosthesis. The prosthetic neck was designed individually to match the lever arm and anteverion. Results: There were 174 cases of dysplasia and 83 dislocations (39% grade 1, 30% grade 2, 14% grade 3 and 17% grade 4). Mean lengthening was 39 mm. The mean ante-verion was 28±16° and the mean anteroposterior diameter of the acetabulum was 51 mm. The Harris clinical score improved from 58 points preoperatively to 93 points at last follow-up. The follow-up x-rays showed osteointegration in 88% of the cases with osteolysis in 5% and one stem impaction. The prosthesis had to be changed for six hips: two for infection, one for dislocation and two for nonfixation. The 11-year survival rate was 97%. Discussion and conclusion: This study illustrates the anatomic sequelae observed in patients with developmental dysplasia of the hip and demonstrates a surgical solution for these problems. There is no correlation between dislocation and the degree of anteversion so it is difficult to assess the difficulty of inserting a non-cemented stem without preoperative computed tomography. The good 11-year survival is encouraging for this young and active population

The purpose of this study is to evaluate the clinical and radiographic results of 20 patients(27 hips) who underwent primary bipolar hemiarthroplasty with non-cemented femoral stem and biarticular cup from January 1989 to April 1999 who were followed for more than nine years. Average follow up was 13.4 years(range: 9~19 years). The type of non-cemented femoral stem was Harris-Galante type in ten hips, Multilock porous coated stem in seven hips, and Multilock porous and tricalcium phosphate coated stem in ten hips. The etiology of osteonecrosis of the femoral head was idiopathic in eleven hips, alcohol abuse in twelve hips and steroid administration in four hips. According to Ficat’s grading system, all twenty-seven hips were in stage. Clinically, we evaluated the Harris Hip scores. We also evaluated the radiographic measurements around the femoral stems and the bipolar cups. The average Harris Hip score improved from 57.2 points to 89 points; and 2(7.4%)hips were associated with thigh pain and 5(18.5%) hips with groin pain. Around the femoral stem there was progressive radiolucent line more than 1mm in width in 1(3.7%) hip, and osteolysis was present in 9(33.3%) hips. On evaluation of radiographs for stability of fixation, we found that 21 hips(77.8%) showed osseous ingrowth, 5 hips(18.5%) showed stable fibrous ingrowth and one hip(3.7%) showed unstable fixation. The osteolysis around the acetabulum was found in 9 hips(33.3%). Two hips showed evidence of migration of the bipolar cup. Five hips(18.5%) showed acetabular cartilage erosion more than 1mm. Seven hips(25.9%) required conversion to total hip arthroplasties, and in two hips, femoral stems were revised. The causes of failure of bipolar cup was central migration in 2 hips, and dissociation of femoral head, extensive osteolysis, and unknown groin pain after trauma in one each. Two bipolar cups were converted to acetabular cup at revision of the femoral stem. The overall failure rate of the primary operation was 26%. The survivorship of non-cemented femoral stem was 92.6% and 74% in bipolar cup at minimum 9 years follow up. The current study demonstrated favorable results after bipolar hemiarthroplasties with non-cemented femoral stems. However, the osteolysis around the femoral stems and the acetabular cup emerged as main causes of need for surgical revision

To investigate the effect of bilateral total hip replacement for patients with ankylosed hip joints caused by late ankylosing spondylitis (AS) and to discuss its related pre- and post-operation rehabilitation problems. Data of 20 patients with ankylosed hip joints caused by late AS undergone total hip replacement (40 hips) were reviewed. Among the total 14 patients (28 hips) undergone bilateral total hip replacement, other 6 patients (12 hips) undergone twice operations. We used Harris score, assessment of the joint pain, range of motion to make sure the curative effect of the operative strategy. The mean duration of follow-up was 3. 8 years, all hip joints function was improved, and the flexion deformity of the involved hips were disappeared. The range of hip flexion were 75°–105°(average 86. 2°), and the range of hip extension were 5°–15°(average 8. 7°), the average Harris score was from 32.8 pre-operation improved to 88.2 post-operation, the patients experienced no pain on their hips, the pain of the knee and the lower back complained before the treatment were obviously relieved. Bilateral total hip replacement is an effective treatment for ankylosed hip joint caused by late ankylosing spondylitis, early rehabilitation intervention is useful for the functional recovery of the joints. Bipolar Hemiarthroplasty Using Non-cemented Femoral Stem in Non-traumatic Osteonecrosis of the Femoral Head Nine to Nineteen years Follow-up

Purpose: We report our experience with 10 cases of osteotomy performed at the same time as total hip arthroplasty. Material and methods: This series included ten knees in ten patients, mean age 63 years. The knees were divided into two groups: five with tibial deviations in one or two planes (three callus deformities, one congenital varus, and one coxalgia sequela) and six mono- or biplanar femoral deviations (three callus deformities, two congenital valgus, and one coxalgia sequela). The principal extra-articular deviation was greater than 10° in all cases. A total knee arthroplasty preserved the posterior cruciate ligament in nine cases with a non-cemented femoral stem implant and cemented tibial implant with or with out a stem. The tibial osteotomies were all in the proximal metaphysis. The femoral osteotomy was in the distal metaphysis in four cases, subtro-chanteric with derotation in one and in the diaphysis with derotation in one. The correction osteotomy was performed before the prosthesis bone cut. Complementary osteosynthesis was used in all cases. Results: Minimal follow-up was 12 months with a mean of 19.6 months. Bone healing was achieved in all cases. Complete weight bearing was achieved at a mean 2.5 months. The mean postoperative HSS score was 76. Results were excellent in four knees, good in four, fair in one and poor in one. Mean joint amplitude was 105°. Radiographically, complete tibial correction was obtained for three knees (two biplanar corrections); for two knees the biplanar correction was incomplete in one plane. Among the four biplanar femoral deviations, complete correction was achieved in three and incomplete frontal correction in one, with two varus overcorrections in the frontal plane on the single plane deviations. Discussion: We used this method to avoid intra-articular correction of extra-articular deviations, a source of complications. Conclusion: Combining osteotomy with total knee arthroplasty during the same operation for patients with major axial deviation and degenerative joint disease provides satisfactory results in 80% of the cases

Introduction: The non-cemented CBC femoral stem has been used in total hip arthroplasty (THA) since 1997. This shaft exists in a standard and a lateralised version. The concept behind the design of the implant focuses on proximal anchoring and load introduction. Migration within the first two years after surgery is confirmed to be a good predictive value for early failure of the femoral component in THA. With respect to the different load transformation of the two stem types clinical outcome and migration were investigated. Material and Methods: Prospective follow-up study of 170 patients (52% female) who received 172 non-cemented CBC femoral stems. THA was performed in eight European clinics between March 2001 and April 2005. 127 standard and 45 lateral CBC stems were implanted. 106 cases fulfilled the criteria having a series of four X-rays during a minimum period of two years. After a mean follow-up of 32.1 months in 106 patients migration was analysed using the EBRA system. The mean age at surgery was 66.9 years (range, 39.1–85.2 years). Mean body mass index was 27.8 kg/m2 (range, 16.3–42.6 kg/m2). Results: The average subsidence is − 0.63 mm (− 0.36 mm lateral, − 0.75 mm standard group), 7.6% of the stems showed a subsidence of > 2 mm. None of the lateralised stems migrated > 3 mm, but there is no statistical significance between the groups. There is no evidence of association of high stem migration (> 2 mm) and lower scores. The HHS increased from a preoperative mean of 51 to 96 points after 5 years follow-up. At last follow-up patients with a standard stem had a flexion, external rotation and total ROM value of 105°, 29°, and 220°, respectively. Patients with a lateralised stem reached values of 115°, 36°, and 237°, respectively. Interestingly, 93% of patients with a lateral stem indicated putting on socks “easy”, compared to 81% in the standard group, although the BMI of patients with a lateralised stem was significantly (p=0.014) higher. No thigh pain was reported after 5 years follow-up. No revisions had taken place. Conclusion: The prism-shaped geometry of the ribs promotes good osteointegration. The standard stems showed higher migration values compared to the lat-eralised stem, statistically not significant. Patients with a lateralised femoral component showed better results for ROM, flexion, external rotation, putting on socks. Putting on socks “easy” was positively correlated with a higher flexion angle. All patients undergoing THA showed significant improvements in postoperative functioning and activity level after the implantation of a CBC stem. None of the stems had to be revised

Purpose: The purpose of this work was to study the radiological outcome more than seven years after implantation of 89 anatomic non-cemented femoral stems with hydroxyapatite coating around the metaphyseal circumference. Material: These 81 patients underwent primary arthroplasty (89 hips) between 1991 and 1994 for joint degeneration or necrosis: 48 men and 33 women, mean age 59 years (range 41–78). The inclusion criteria for this study were physical examination and complete radiographic work-up in the second half of 2001. Mean follow-up was nine years (range 7–10). Methods: All x-rays were analysed by four independent surgeons who used the Engh and Massin criteria. The evaluators, who had not participated in patient care, made their assessment on the basis of the last follow-up clinical report and x-rays. They search for radiographic evidence of stem stability and bony integration as well as signs of osteolysis using the Gruen criteria. Results: At last follow-up only one femoral stem was painful, but stable. This stem was revised at seven years. Six cups had been changed due to polyethylene wear with iliac osteolysis but without femoral participation. There were no other reoperations. Polyethylene wear was observed in about one-half the hips (44 hips) and was considered severe (1–2 mm) in nine cases. There were no lucent lines nor reactive lines in the metaphyseal area (zones 1 and 7) but 16% of the hips presented reactive lines along the lower, smooth, part of the stem. Endosteal ossification was observed in zones 2 and 6 in 72% of the hips, and less often (13%) in zones 9 and 13. Five hips (5.6%) exhibited bony growth at the tip of the stem producing a thickening in zone 5; these were the only cases with cortical thickening excepting the revised stem (thickening in zones 2 and 6). There was no case of cortical narrowing. Calcar atrophy was observed in 42 hips (47%) with five showing a “drop” aspect. Four hips exhibited osteolysis of the proximal femur in zone 1A, but there were no images of distal osteolysis of the femur. Discussion: This independent analysis of 89 x-ray files demonstrated that endosteal growth is frequent in the isthmic region. The radiological tolerance was good for this stem (no cortical changes) but there were modifications of the calcar which were difficult; it could be speculated that certain of these modifications might correspond to localised osteolysis at the lowest part of the joint, migration point of polyethyene debris. The role of hydroxyapatite in the observed absence of distal osteolysis is noteworthy. Conclusion: At nine years follow-up, the absence of osteolysis of the distal femur despite usual polyethylene wear allows the conclusion that hydoxyapatite coating of the metaphyseal circumference creates an effective barrier against wear debris

Background. Highly cross-linked polyethylene (HCLPE) was introduced to reduce wear and osteolysis in total hip arthroplasty (THA). There is no reported data regarding wear rates and clinical performance of Crossfire HCLPE (Stryker, Mahwah, New Jersey) in young and active patients. The purpose of this prospective study is to assess minimum 10-year wear rates and survivorship of Crossfire in young and active patients. Material and Methods. Between January 2001 to December 2003, 52 consecutive THAs (43 patients; 26 males and 17 females), 55 years and younger, with an average University of California Los Angeles activity (UCLA) score of 7.3 ± 1.5 (5 – 10) at the time of surgery were prospectively followed. The mean age of patients was 47.4 ± 7.8 years old (range 24 to 55 years). Indication for surgery included osteoarthritis in all cases. All operations were performed by the senior surgeon via a posterolateral approach. All components were non-cemented SecurFit femoral stem, 28 mm Cobalt-Chromium (Co-Cr) femoral head, and Trident PSL cup with Crossfire HCLPE acetabular liner (Stryker, Mahwah, New Jersey). At minimum 10-years follow-up (mean 11.5 ± 0.94 years), wear rates were assessed using the Roman software. Hospital for Special Surgery (HSS) scores and survivorship data were analyzed. Results. Good to excellent clinical results were seen with HSS score of 38.1 ± 4.7. The mean linear wear was 0.019 ± 0.018 mm/year (range 0 to 0.082). There were no revisions for osteolysis or loosening, periprosthetic infection or dislocation in this cohort. Kaplan-Meier survivorship was 100% for all failures. Conclusion. This is the first study to demonstrate that metal on Crossfire performs very well with excellent survivorship and wear rates at a minimum 10-year follow-up in young and active patients. Oxidation concern with Crossfire has not caused any clinical problems up to 10 years

Background. Highly cross-linked polyethylene (HCLPE) was introduced to reduce wear and osteolysis in total hip arthroplasty (THA). There is no reported data regarding wear rates and clinical performance of Crossfire HCLPE (Stryker, Mahwah, New Jersey) in young and active patients. The purpose of this prospective study is to assess minimum 10-year wear rates and survivorship of Crossfire in young and active patients. Material and Methods. Between January 2001 to December 2003, 52 consecutive THAs (43 patients; 26 males and 17 females), 55 years and younger, with an average University of California Los Angeles activity (UCLA) score of 7.3 ± 1.5 (5 – 10) at the time of surgery were prospectively followed. The mean age of patients was 47.4 ± 7.8 years old (range 24 to 55 years). Indication for surgery included osteoarthritis in all cases. All operations were performed by the senior surgeon via a posterolateral approach. All components were non-cemented SecurFit femoral stem, 28 mm Cobalt-Chromium (Co-Cr) femoral head, and Trident PSL cup with Crossfire HCLPE acetabular liner (Stryker, Mahwah, New Jersey). At minimum 10-years follow-up (mean 11.5 ± 0.94 years), wear rates were assessed using the Roman software. Hospital for Special Surgery (HSS) scores and survivorship data were analyzed. Results. Good to excellent clinical results were seen with HSS score of 38.1 ± 4.7. The mean linear wear was 0.019 ± 0.018 mm/year (range 0 to 0.082). There were no revisions for osteolysis or loosening, periprosthetic infection or dislocation in this cohort. Kaplan-Meier survivorship was 100% for all failures. Conclusion. This is the first study to demonstrate that metal on Crossfire performs very well with excellent survivorship and wear rates at a minimum 10-year follow-up in young and active patients. Oxidation concern with Crossfire has not caused any clinical problems up to 10 years

Proximally-coated non-cemented tapered femoral stems have demonstrated excellent long-term clinical results. However, there is sparse literature reporting the incidence of failure of osteointegration in patients with this stem design. The aim of this study is to report this incidence and identify factors which may increase its risk. 206 elective primary total hip arthroplasties were performed consecutively with a single stem design over a three-year period. All patients were evaluated clinically and radiographically. Radiographic parameters were analyzed for any potential risk factors that may predispose to failure of osteointegration. Three of 206 hips failed to osteointegrate and subsequently underwent revision surgery, for an incidence of 1.5%. The average time to revision was 1.2 years. The presenting complaint was persistent pain and radiographs revealed a progressive linear lucency at the proximal implant-bone interface in all three patients. Each patient had been implanted with a large-sized stem that had achieved a diaphyseal fit radiographically. This cohort had a statistically lower canal-flare index (p < 0.05) when compared to the rest of the study group. At the time of surgery, all stems were found to be loose and were easily removed. Failure of osteointegration in this type of stem is an uncommon but serious complication that may necessitate revision surgery. Risk factors predisposing to a failure to osteointegrate are a mismatch between the patient’s proximal femoral geometry and the stem, specifically a large stem in a Dorr type C femur, leading to a diaphyseal rather than a metaphyseal wedge