Introduction

Cementless fixation is the current preferred method for acetabular reconstruction in total hip arthroplasty (THA). Despite promising long-term results among several designs, theoretic concerns regarding the high modulus of elasticity, low friction against bone and low volumetric porosity of contemporary cementless cups have spurred the introduction of novel porous surfaces that are designed to improve osseointegration and decrease aseptic loosening. Although several novel surfaces have been introduced into clinical use over the past decade, very little literature regarding their clinical and radiographic performance exists. The current study investigates the performance of one such novel surface, Tritanium (Stryker, Mahwah, NJ).

To report mid-term results of PJI treated with uncemented stems. : 80 hips of PJI after THA were treated with uncemented stems from 01/1993 to 12/2012 and followed prospectively. Selection occurred for one- (n=27) or two-stage (n=53) exchange according to the Liestal algorithm. Surgical approaches were transfemoral (n=58), transgluteal (n=9) or transtrochanteric (n=13). A monoblock (Wagner SL, n=58) or modular (Revitan, n=22) revision stem was implanted. On the acetabular side 44 Müller rings, 33 Burch-Schneider cages (combined with a cemented PE-cup) and 3 press-fit cups were used. Kaplan-Meier survival was calculated for endpoints (a) persistence of infection, (b) septic/aseptic stem loosening. Radiographs were analysed for (a) subsidence, (b) distal stem integration, (c) changes in cortical thickness, (d) proximal femur restoration, (e) radiolucency around stem/cup. Mean FU was 5.2 (2–15) years. PJI was eradicated in 77 of 80 hips (96%). 3 patients (all two-stage) had a treatment failure. 2 were treated successfully with an additional two-stage exchange. In the 3rd patient we were not able to control infection and exarticulation was performed. Furthermore, one stem was revised for aseptic loosening (5 years), 1 for a broken Wagner stem (7 years) and 1 for subsidence (8 months). Stem survival after 5 years was 93% (SD ±2.5 years). 2 cups were revised for aseptic loosening and 1 for recurrent dislocations. Subsidence ≥5mm was found in 6 hips and occurred always within 3 months after surgery independent of stem type (p=0.947) and approach (p=0.691). Proximal femoral remodelling after transfemoral approach was excellent or good in 71% (32 excellent, 9 good) with no difference between one-/two-stage exchanges (p=0.288). Initial distal stem integration was 65mm medial and 66mm lateral and increased to 8mm medial (p=0.716) and 10mm lateral (p<0.001). Cortical thickness was unchanged over the entire FU period (p=0.493). Radiolucencies were seen around 26 stems, only the stem revised after 5years was rated loose. Eradication of PJI was high using our established protocol even with uncemented revision stems. Mid-term survival was independent from one-/two-stage revision and comparable to results for aseptic loosening revision

Introduction. Up to date there are only few reports in literature on the long term survival of uncemented stems. As for cemented THA, 10 year survival of at least 90% is required for any THA. Materials and methods. We followed the first 354 consecutive implantations of an uncemented, straight femoral stem (CLS, Zimmer Inc, Warsaw, USA) in 326 patients. Mean time of follow-up evaluation was 17 years (range, 15-20 years). Results. At follow-up, 84 patients (88 hips) had died, and 12 (12 hips) were lost to follow-up. 34 hips underwent femoral revision: 8 for infection, 8 for periprosthetic fracture, 1 for traumatic loosening and 17 for aseptic loosening of the stem. Overall survival was 89% at 17 years (95%-confidence limits, 87%-92%), survival with femoral revision for aseptic loosening as an end point was 94% at 17 years (95%-confidence limits, 92%-95%). The mean Harris Hip Score at follow-up was 83 points. 220 hips were available for radiolographic evaluation. None of the femoral components showed signs of loosening. Radiolucent lines (<2mm) in Gruen zones 1 and 7 were present in 14.1% (31 hips) and 15.0% (33 hips) respectively. Radiolucencies in zones 2-6 were found in 0.5% (1 hip)-1,8% (4 hips) on ap x-rays. Only one case of distal osteolysis was found after a previous Wagner resurfacing. No case of severe femoral osteolysis was found. The only strong predictor for aseptic loosening was undersizing of the stem with a canal fill index of <75%. Conclusions. The long-term results for this uncemented stem are encouraging and compare favorably with those achieved in primary cemented total hip arthroplasty in this age group

We aim to report the clinical and radiological outcome of consecutive primary hip arthroplasties using the JRI-Furlong HAC coated femoral and acetabular components. We reviewed 586 consecutive cementless primary THA in 542 patients with a minimum 12-18 year follow-up, performed at one institution between 1986 and 1994. Twenty-eight (32 THA) were lost to follow-up. Clinical outcome was measured using Harris, Charnley and Oxford scores. Quality of life using EuroQol. EQ-5D. Radiographs were systematically analysed. The mean age was 75.2 years. Dislocation occurred in 12 patients (three recurrent). Re operations were performed in 11 patients (1.9%). Four acetabular and one stem revisions were performed for aseptic loosening. Other re-operations were for infection (two), periprosthetic fractures (two), cup malposition (one), revision of worn liner (two). The mean Harris and Oxford scores were 89 (79–96) and 18.4 (12–32) respectively. The Charnley score was 5.7 for pain, 5.3 for movement and 5.4 for mobility. Acetabular radiolucencies were present in 54 hips (9.7%). The mean linear polythene wear was 0.06 mm/year. Stable stem by bony ingrowth was identified in all hips excluding one femoral revision case. Mean stem subsidence was 2.2mm (0.30–3.4mm). Radiolucencies were present around 37 (6.6%) stems. EQ- 5D description scores and health thermometer scores were 0.81 (0.71–0.89) and 86 (64–95). With an end point of definite or probable loosening, survival at 12 years was 96.1% for acetabular and 98.3% for femoral components. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 97.2%. The results of this study support the continued use of a fully coated prosthesis and documents the durability of the HAC coated components. In our clinical experience, the Furlong prosthesis revealed encouraging radiographic stability over a long-term period

Introduction. We aim to report the clinical and radiological outcome of consecutive primary hip arthroplasties using the JRI-Furlong HAC coated femoral and acetabular components. Methods. We reviewed 586 consecutive cementless primary THA in 542 patients, with a minimum 12-year follow-up to 18 years, performed at one institution between 1986 and 1994. Twenty eight (32 THA) were lost to follow-up. Clinical outcome was measured using Harris, Charnley and Oxford scores. Quality of life using EuroQol EQ-5D. Radiographs were systematically analysed. Results. The mean age was 75.2 yrs. Dislocation occurred in 12 patients (3 recurrent). Re-operations were performed in 11 patients (1.9%). Four acetabular and one stem revisions were performed for aseptic loosening. Other re-operations were for infection (2), periprosthetic fractures (2), cup malposition (1), revision of worn liner (2). The mean Harris and Oxford scores were 89 (79- 96) and 18.4 (12-32) respectively. The Charnley score was 5.7 for pain, 5.3 for movement and 5.4 for mobility. Acetabular radiolucencies were present in 54 hips (9.7%). The mean linear polythene wear was 0.06mm/year. Stable stem by bony ingrowth was identified in all hips excluding one femoral revision case. Mean stem subsidence was 2.2mm (0.30- 3.4mm). Radiolucencies were present around 37 (6.6%) stems. EQ-5D description scores and health thermometer scores were 0.81 (0.71-0.89) and 86 (64-95). With an end point of definite or probable loosening, survival at 12 years was 96.1% for acetabular and 98.3% for femoral components. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 97.2%. Conclusion. The results of this study support the continued use of a fully coated prosthesis and documents the durability of the HAC coated components. In our clinical experience, the Furlong prosthesis revealed encouraging radiographic stability over a long term period

We report the clinical and radiological outcome of consecutive primary hip arthroplasties using the JRI-Furlong Hydroxyapatite ceramic (HAC) coated acetabular components. We reviewed 412 consecutive cementless primary THA using fully coated acetabular shell in 392 patients—with a minimum 12 to 18 year follow-up—performed at two institutions between 1986 and 1994. Twenty (22 THA) were lost prior to 12-year follow-up, leaving 372 patients (390 THA) available for study. Fully HAC coated stems were used in all patients. The clinical outcome was measured using Harris, Charnley and Oxford hip scores and the quality of life using EuroQol EQ-5D. Radiographs were systematically analysed for implant position, loosening, migration, osteolysis. Polythene wear was digitally measured. The radiographic stability of the acetabular component was determined by Enghs criteria. The mean age was 74.4 years. The mean Harris and Oxford scores were 87 (78– 97) and 19.1 (12–33) respectively. The Charnley score was 5.6 (5-6) for pain, 5.2 (4–6) for movement and 5.3 (4–6) for mobility. Migration of acetabular component was seen in four hips. Acetabular radiolucencies were present in 54 hips (9.7%). The mean linear polythene wear was 0.06mm/year. Mean inclination was 48.4° (38–65). Radiolucencies were present around 37 (6.6%) stems. Dislocation occurred in 10 patients (three recurrent). Re-operations were performed in nine patients (1.9%). Four acetabular revisions were performed for aseptic loosening. Other re-operations were for infection (three), periprosthetic fractures (one), cup malposition (one) and revision of worn liner (three). Mean EQ-5D description scores and health thermometer scores were 0.81 (0.71–0.89) and 86 (64–95). With an end point of definite or probable loosening, the probability of survival at 12 years was 97.1% for acetabular component. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 96.2%. The results of this study support the continued use of a fully coated prosthesis and documents the durability of the HAC coated components. In our clinical experience, the Furlong prosthesis revealed encouraging radiographic stability over a long-term period