The purpose of this study was to determine the sensitivity, specificity
and predictive values of previously reported thresholds of proximal
translation and sagittal rotation of cementless acetabular components
used for revision total hip arthroplasty (THA) at various times
during early follow-up. Migration of cementless acetabular components was measured retrospectively
in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup)
in two groups of patients. In Group A, components were recorded
as not being loose intra-operatively at re-revision THA (52 components/48
patients) and Group B components were recorded to be loose at re-revision
(42 components/36 patients).Aims
Patients and Methods
Aims. The primary outcome was investigating differences in wear, as measured by femoral head penetration, between cross-linked vitamin E-diffused polyethylene (vE-PE) and cross-linked polyethylene (XLPE) acetabular component liners and between 32 and 36 mm head sizes at the ten-year follow-up. Secondary outcomes included
Aims. The most frequent indication for revision surgery in total hip arthroplasty (THA) is aseptic loosening. Aseptic loosening is associated with polyethylene liner wear, and wear may be reduced by using vitamin E-doped liners. The primary objective of this study was to compare proximal femoral head penetration into the liner between a) two cross-linked polyethylene (XLPE) liners (vitamin E-doped (vE-PE)) versus standard XLPE liners, and b) two modular femoral head diameters (32 mm and 36 mm). Methods. Patients scheduled for a THA were randomized to receive a vE-PE or XLPE liner with a 32 mm or 36 mm metal head (four intervention groups in a 2 × 2 factorial design). Head penetration and
Aims. The objective of this study was to compare the two-year migration and clinical outcomes of a new cementless hydroxyapatite (HA)-coated titanium acetabular shell with its previous version, which shared the same geometrical design but a different manufacturing process for applying the titanium surface. Methods. Overall, 87 patients undergoing total hip arthroplasty (THA) were randomized to either a Trident II HA or Trident HA shell, each cementless with clusterholes and HA-coating. All components were used in combination with a cemented Exeter V40 femoral stem. Implant migration was measured using radiostereometric analysis (RSA), with radiographs taken within two days of surgery (baseline), and at three, 12, and 24 months postoperatively. Proximal
Aims. Vitamin E-infused highly crosslinked polyethylene (VEPE) has been introduced into total hip arthroplasty (THA) with the aim of further improving the wear characteristics of moderately and highly crosslinked polyethylenes (ModXLPE and HXLPE). There are few studies analyzing the outcomes of vitamin E-infused components in cemented arthroplasty, though early
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.
We hypothesised that the removal of the subchondral
bone plate (SCBP) for cemented acetabular component fixation in
total hip arthroplasty (THA) offers advantages over retention by
improving the cement-bone interface, without jeopardising implant
stability. We have previously published two-year follow-up data
of a randomised controlled trial (RCT), in which 50 patients with
primary osteoarthritis were randomised to either retention or removal
of the SCBP. The mean age of the retention group (n = 25, 13 males)
was 70.0 years (. sd. 6.8). The mean age in the removal group
(n = 25, 16 males) was 70.3 years (. sd. 7.9). Now we have
followed up the patients at six (retention group, n = 21; removal
group, n = 20) and ten years (retention group: n = 17, removal group:
n = 18), administering clinical outcome questionnaires and radiostereometric
analysis (RSA), and determining the presence of radiolucent lines
(RLLs) on conventional radiographs. RSA demonstrated similar translation
and rotation patterns up to six years. Between six and ten years,
proximal
Total hip arthroplasty was performed in 45 hips of 44 patients who had pyogenic arthritis of the hip during childhood. The average age of the patients was 36.4 years (range 19 to 50). The interval between active infection and arthroplasty ranged from 11 to 40 years, and average follow-up was 65.4 months (range 58 to 80). Specimens of tissue taken before and during operation gave negative cultures in all hips, and no patient had reactivation of infection. The mean functional rating of the hips was 58 points before operation and 90 at the final review. Complications were seen in 11 cases (24%), loosening of components occurred in six (13%) and one hip had to be revised for
Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an uncemented shell without modular DM options. In these circumstances, a monoblock DM cup, designed for cementing, can be cemented into an uncemented acetabular shell. The goal of this study was to describe the implant survival, complications, and radiological outcomes of this construct. We identified 64 patients (65 hips) who had a single-design cemented DM cup cemented into an uncemented acetabular shell during revision THA between 2018 and 2020 at our institution. Cups were cemented into either uncemented cups designed for liner cementing (n = 48; 74%) or retained (n = 17; 26%) acetabular components. Median outer head diameter was 42 mm. Mean age was 69 years (SD 11), mean BMI was 32 kg/m2 (SD 8), and 52% (n = 34) were female. Survival was assessed using Kaplan-Meier methods. Mean follow-up was two years (SD 0.97).Aims
Methods
This study reports the mid-term results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head (LDH) ceramic-on-ceramic (CoC) bearing. Of the 276 hips (246 patients) included in this study, 264 (96%) were reviewed at a mean of 67 months (48 to 79) postoperatively. Procedures were performed with a mini posterior approach. Clinical and radiological outcomes were recorded at regular intervals. A noise assessment questionnaire was completed at last follow-up.Aims
Patients and Methods
Severe acetabular bone loss and pelvic discontinuity (PD) present particular challenges in revision total hip arthroplasty. To deal with such complex situations, cup-cage reconstruction has emerged as an option for treating this situation. We aimed to examine our success in using this technique for these anatomical problems. We undertook a retrospective, single-centre series of 35 hips in 34 patients (seven male, 27 female) treated with a cup-cage construct using a trabecular metal shell in conjunction with a titanium cage, for severe acetabular bone loss between 2011 and 2015. The mean age at the time of surgery was 70 years (42 to 85) and all patients had an acetabular defect graded as Paprosky Type 2C through to 3B, with 24 hips (69%) having PD. The mean follow-up was 47 months (25 to 84).Aims
Patients and Methods
Post-operative migration of cemented acetabular components as
measured by radiostereometric analysis (RSA) has a strong predictive
power for late, aseptic loosening. Also, radiolucent lines predict
late loosening. Migration has been reduced by systemic bisphosphonate
treatment in randomised trials of hip and knee arthroplasty. Used
as a local treatment, a higher local dose of bisphosphonate can
be achieved without systemic exposure. We wished to see if this
principle could be applied usefully in total hip arthroplasty (THA). In this randomised placebo-controlled, double-blinded trial with
60 participants, we compressed gauze soaked in bisphosphonate solution
(ibandronate) or saline against the acetabular bone bed immediately
before cementing the acetabular component. RSA, classification of
radiolucent lines, the Harris Hip Score (HHS) and the Western Ontario McMasters
Universities Osteoarthritis Index (WOMAC) were carried out at three-,
six-, 12-, and 24-month follow-up.Aims
Patients and Methods
Pelvic discontinuity with associated bone loss is a complex challenge in acetabular revision surgery. Reconstruction using ilio-ischial cages combined with trabecular metal acetabular components and morsellised bone (the component-cage technique) is a relatively new method of treatment. We reviewed a consecutive series of 26 cases of acetabular revision reconstructions in 24 patients with pelvic discontinuity who had been treated by the component-cage technique. The mean follow-up was 44.6 months (24 to 68). Failure was defined as migration of a component of >
5 mm. In 23 hips (88.5%) there was no clinical or radiological evidence of loosening at the last follow-up. The mean Harris hip score improved significantly from 46.6 points (29.5 to 68.5) to 76.6 points (55.5 to 92.0) at two years (p <
0.001). In three hips (11.5%) the construct had migrated at one year after operation. The complications included two dislocations, one infection and one partial palsy of the peroneal nerve. Our findings indicate that treatment of pelvic discontinuity using the component-cage construct is a reliable option.
A contact patch to rim (CPR) distance of <
10 mm has been
associated with edge-loading and excessive wear. However, not all
arthroplasties with a low CPR distance show problems with wear.
Therefore, CPR distance may not be the only variable affecting the
post-operative metal ion concentrations. We used multiple logistic regression to determine what variables
differed between the patients who had high and low cobalt (CoS)
and chromium (CrS) serum ion concentrations within a cohort of patients
with low (<
10 mm) CPR distances. A total of 56 patients treated
with unilateral hip resurfacing arthroplasty (HRA) had CoS and CrS
ion studies performed more than one year after surgery. The mean
age of the patients at the time of surgery was 51.7 years (29 to
70), with 38 women (68%) and 18 men (32%).Aims
Patients and Methods
The aim of this study was to compare the survivorship and radiographic
outcomes at ten-year follow-up of three prospective consecutive
series of patients each of which received a different design of
cementless femoral components for total hip arthroplasty (THA). In Cohort 1, 91 consecutive patients (100 hips) underwent THA
with a cementless porous-coated anatomic femoral stem (PCA) between
October 1983 and January 1986. In Cohort 2, 86 consecutive patients
(100 hips) underwent THA with an extensively porous-coated cementless
femoral stem (Prodigy) between June 1994 and October 1997. In Cohort
3, 88 consecutive patients (100 hips) underwent THA with a proximally
porous-coated triple-tapered cementless stem (Summit) between April
2002 and October 2003. All three groups underwent prospective clinical
and radiographic evaluation.Aims
Patients and Methods
Impaction bone grafting for the reconstitution
of bone stock in revision hip surgery has been used for nearly 30 years.
Between 1995 and 2001 we used this technique in acetabular reconstruction,
in combination with a cemented component, in 304 hips in 292 patients
revised for aseptic loosening. The only additional supports used
were stainless steel meshes placed against the medial wall or laterally
around the acetabular rim to contain the graft. All Paprosky grades
of defect were included. Clinical and radiographic outcomes were
collected in surviving patients at a minimum of ten years after
the index operation. Mean follow-up was 12.4 years ( Cite this article:
We report on the outcome of the Exeter Contemporary flanged cemented
all-polyethylene acetabular component with a mean follow-up of 12
years (10 to 13.9). This study reviewed 203 hips in 194 patients.
129 hips in 122 patients are still A retrospective review was undertaken of a consecutive series
of 203 routine primary cemented total hip arthroplasties (THA) in
194 patients.Aims
Patients and Methods
In this retrospective study we evaluated the
proficiency of shelf autograft in the restoration of bone stock
as part of primary total hip replacement (THR) for hip dysplasia,
and in the results of revision arthroplasty after failure of the primary
arthroplasty. Of 146 dysplastic hips treated by THR and a shelf
graft, 43 were revised at an average of 156 months, 34 of which
were suitable for this study (seven hips were excluded because of
insufficient bone-stock data and two hips were excluded because
allograft was used in the primary THR). The acetabular bone stock
of the hips was assessed during revision surgery. The mean implant–bone
contact was 58% (50% to 70%) at primary THR and 78% (40% to 100%)
at the time of the revision, which was a significant improvement
(p <
0.001). At primary THR all hips had had a segmental acetabular
defect >
30%, whereas only five (15%) had significant segmental
bone defects requiring structural support at the time of revision.
In 15 hips (44%) no bone graft or metal augments were used during
revision. A total of 30 hips were eligible for the survival study. At a
mean follow-up of 103 months (27 to 228), two aseptic and two septic
failures had occurred. Kaplan-Meier survival analysis of the revision
procedures demonstrated a ten-year survival rate of 93.3% (95% confidence
interval (CI) 78 to 107) with clinical or radiological failure as
the endpoint. The mean Oxford hip score was 38.7 (26 to 46) for
non-revised cases at final follow-up. Our results indicate that the use of shelf autografts during
THR for dysplastic hips restores bone stock, contributing to the
favourable survival of the revision arthroplasty should the primary
procedure fail. Cite this article:
A retrospective study was conducted to investigate
the changes in metal ion levels in a consecutive series of Birmingham
Hip Resurfacings (BHRs) at a minimum ten-year follow-up. We reviewed
250 BHRs implanted in 232 patients between 1998 and 2001. Implant
survival, clinical outcome (Harris hip score), radiographs and serum chromium
(Cr) and cobalt (Co) ion levels were assessed. Of 232 patients, 18 were dead (five bilateral BHRs), 15 lost
to follow-up and ten had been revised. The remaining 202 BHRs in
190 patients (136 men and 54 women; mean age at surgery 50.5 years
(17 to 76)) were evaluated at a minimum follow-up of ten years (mean
10.8 years (10 to 13.6)). The overall implant survival at 13.2 years
was 92.4% (95% confidence interval 90.8 to 94.0). The mean Harris
hip score was 97.7 (median 100; 65 to 100). Median and mean ion
levels were low for unilateral resurfacings (Cr: median 1.3 µg/l,
mean
1.95 µg/l (<
0.5 to 16.2); Co: median 1.0 µg/l, mean 1.62 µg/l
(<
0.5 to 17.3)) and bilateral resurfacings (Cr: median 3.2 µg/l,
mean 3.46 µg/l (<
0.5 to 10.0); Co: median 2.3 µg/l, mean 2.66
µg/l (<
0.5 to 9.5)). In 80 unilateral BHRs with sequential ion
measurements, Cr and Co levels were found to decrease significantly
(p <
0.001) from the initial assessment at a median of six years
(4 to 8) to the last assessment at a median of 11 years (9 to 13),
with a mean reduction of 1.24 µg/l for Cr and 0.88 µg/l for Co.
Three female patients had a >
2.5 µg/l increase of Co ions, associated with
head sizes ≤ 50 mm, clinical symptoms and osteolysis. Overall, there
was no significant difference in change of ion levels between genders
(Cr, p = 0.845; Co, p = 0.310) or component sizes (Cr, p = 0.505;
Co, p = 0.370). Higher acetabular component inclination angles correlated
with greater change in ion levels (Cr, p = 0.013; Co, p = 0.002).
Patients with increased ion levels had lower Harris hip scores (p
= 0.038). In conclusion, in well-functioning BHRs the metal ion levels
decreased significantly at ten years. An increase >
2.5 µg/l was
associated with poor function. Cite this article:
We compared the five- to seven-year clinical and radiological results of the metal-on-metal Birmingham hip resurfacing with a hybrid total hip arthroplasty in two groups of 54 hips, matched for gender, age, body mass index and activity level. Function was excellent in both groups, as measured by the Oxford hip score, but the Birmingham hip resurfacings had higher University of California at Los Angeles activity scores and better EuroQol quality of life scores. The total hip arthroplasties had a revision or intention-to-revise rate of 8%, and the Birmingham hip resurfacings of 6%. Both groups demonstrated impending failure on surrogate end-points. Of the total hip arthroplasties, 12% had polyethylene wear and osteolysis under observation, and 8% of Birmingham hip resurfacings showed migration of the femoral component. Polyethylene wear was present in 48% of the hybrid hips without osteolysis. Of the femoral components in the Birmingham hip resurfacing group which had not migrated, 66% had radiological changes of unknown significance.