Background

Second-generation high-carbon CoCrMo-alloy metal-on-metal total hip arthroplasty (THA) was introduced in the late 1980s following reports of early loosening, impingement, pronounced wear, and hypersensitivity in the first-generation metal-on-metal articulations. There has been inconsistent data that specifically addresses the clinical performance and longevity of second-generation metal-on-metal THA. The purpose of this study was to evaluate the survival of second-generation metal-on-metal primary THA and to assess the influence of demographic factors on implant survival in a large patient cohort.

Aims: The purpose of our retrospective case-series study was to determine factors that inßuence the long-term outcome of high tibial osteotomy (HTO). Methods: Between 1984 and 1990, 164 patients received an HTO for medial unicompartmental OA associated with varus deformity of the knee. All the HTOs were performed with a modiþed technique of Weber and Coventry. 39 knees in 35 patients were assessed at an average time of 13.5 years by an independent clinician. Patients were evaluated by the Clinical Rating System of the Knee Society, and underwent a complete radiological exam. Results: The results of the function score from patients with no further treatment were good to excellent in 71.5% of the cases and fair in only 10.7%. There were 17.8% poor results. There was a progression in radiological evidence of arthrosis after 10 to 15 years compared to the mid-term results after three to þve years. Patients with a previous meniscectomy had a statistically signiþcant worse function score (p=0.05) than patients who underwent HTO only because of malalignment induced OA. When the size of the osteotomy wedge was bigger than 20¡, there was a signiþcantly worse function score (p=0.049). Conclusion: The long-term results of this study conþrm, that treatment of varus gonarthrosis with HTO generally yield a long time (mean time of survival was 11.5 years) of pain-reduction and a good function for most of the patients.