The use of
Conventional uncemented femoral implants provide
dependable long-term fixation in patients with a wide range of functional
requirements. Yet challenges associated with proximal–distal femoral
dimensional mismatch, preservation of bone stock, and minimally
invasive approaches have led to exploration into alternative implant designs.
Short stem designs focusing on a stable metaphyseal fit have emerged
to address these issues in total hip replacement (THR). Uncemented
metaphyseal-engaging
Aims. The aim of this study was to compare the mid-term patient-reported outcome, bone remodelling, and migration of a
Aims. The aim of this study was to compare early functional and health
related quality of life outcomes (HRQoL) in patients who have undergone
total hip arthroplasty (THA) using a bone conserving short stem
femoral component and those in whom a conventional length uncemented
component was used. Outcome was assessed using a validated performance
based outcome instrument as well as patient reported outcome measures
(PROMs). Patients and Methods. We prospectively analysed 33 patients whose THA involved a contemporary
proximally porous coated tapered
We compared the clinical and radiological outcomes
of two cementless femoral stems in the treatment of patients with
a Garden III or IV fracture of the femoral neck. A total of 70 patients (70
hips) in each group were enrolled into a prospective randomised
study. One group received a short anatomical cementless stem and
the other received a conventional cementless stem. Their mean age
was 74.9 years (50 to 94) and 76.0 years (55 to 96), respectively
(p = 0.328). The mean follow-up was 4.1 years (2 to 5) and 4.8 years
(2 to 6), respectively. Perfusion lung scans and high resolution
chest CTs were performed to detect pulmonary microemboli. At final follow-up there were no statistically significant differences
between the short anatomical and the conventional stems with regard
to the mean Harris hip score (85.7 (66 to 100) versus 86.5
(55 to 100); p = 0.791), the mean Western Ontario and McMaster Universities
Osteoarthritis Index (17 (6 to 34) versus 16 (5
to 35); p = 0.13) or the mean University of California, Los Angeles
activity score (5 (3 to 6) versus 4 (3 to 6); p
= 0.032). No patient with a
Aims. The aim of this study was to determine the stability of a new
short femoral stem compared with a conventional femoral stem in
patients undergoing cementless total hip arthroplasty (THA), in
a prospective randomized controlled trial using radiostereometric
analysis (RSA). Patients and Methods. A total of 53 patients were randomized to receive cementless
THA with either a
Aims. Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods. From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter
The Exeter V40 femoral stem is the most implanted stem in the National Joint Registry (NJR) for primary total hip arthroplasty (THA). In 2004, the 44/00/125 stem was released for use in ‘cement-in-cement’ revision cases. It has, however, been used ‘off-label’ as a primary stem when patient anatomy requires a smaller stem with a 44 mm offset. We aimed to investigate survival of this implant in comparison to others in the range when used in primary THAs recorded in the NJR. We analyzed 328,737 primary THAs using the Exeter V40 stem, comprising 34.3% of the 958,869 from the start of the NJR to December 2018. Our exposure was the stem, and the outcome was all-cause construct revision. We stratified analyses into four groups: constructs using the 44/00/125 stem, those using the 44/0/150 stem, those including a 35.5/125 stem, and constructs using any other Exeter V40 stem.Aims
Methods
We reviewed retrospectively the outcome of the treatment by impaction grafting of periprosthetic femoral fractures around loose stems in 106 patients with Vancouver type-B2 and type-B3 fractures. Eighty-nine patients had a cemented revision with impaction grafting and a long or
We present a series of 35 patients (19 men and
16 women) with a mean age of 64 years (36.7 to 75.9), who underwent
total hip replacement using the ESKA dual-modular
The aim of this study was to compare the pattern of initial fixation and changes in periprosthetic bone mineral density (BMD) between patients who underwent total hip arthroplasty (THA) using a traditional fully hydroxyapatite (HA)-coated stem (T-HA group) and those with a newly introduced fully HA-coated stem (N-HA group). The study included 36 patients with T-HA stems and 30 with N-HA stems. Dual-energy X-ray absorptiometry was used to measure the change in periprosthetic BMD, one and two years postoperatively. The 3D contact between the stem and femoral cortical bone was evaluated using a density-mapping system, and clinical assessment, including patient-reported outcome measurements, was recorded.Aims
Methods
The aim of this study was to determine whether fixation, as opposed to revision arthroplasty, can be safely used to treat reducible Vancouver B type fractures in association with a cemented collarless polished tapered femoral stem (the Exeter). This retrospective cohort study assessed 152 operatively managed consecutive unilateral Vancouver B fractures involving Exeter stems; 130 were managed with open reduction and internal fixation (ORIF) and 22 with revision arthroplasty. Mean follow-up was 6.5 years (SD 2.6; 3.2 to 12.1). The primary outcome measure was revision of at least one component. Kaplan–Meier survival analysis was performed. Regression analysis was used to identify risk factors for revision following ORIF. Secondary outcomes included any reoperation, complications, blood transfusion, length of hospital stay, and mortality.Aims
Methods
We report the results of cancellous femoral impaction grafting with cement in revision hip arthroplasty in all patients from one centre who had undergone surgery more than five years previously. A total of 32 surgeons undertook femoral impaction grafting in 207 patients (226 hips). There were no deaths attributable to the revision surgery; 33 patients with 35 functioning hips died with less than five years’ follow-up. One patient was lost to follow-up. Two hips (1%) developed early postoperative infection. Of the 12 stems which underwent a further surgical procedure for aseptic failure, ten were for femoral fracture and two for loosening. Survivorship with any further femoral operation as the endpoint was 90.5% (confidence intervals, 82 to 98) and using femoral reoperation for symptomatic aseptic loosening as the endpoint, the survivorship was 99.1% (confidence intervals, 96 to 100) at 10 to 11 years. As a consequence of the experience in this series, we have modified our technique with an increased use of longer stems with impacted allograft. Long stems are indicated when the host bone around the tip of a
The aim of this prospective cohort study was to evaluate the early migration of the TriFit cementless proximally coated tapered femoral stem using radiostereometric analysis (RSA). A total of 21 patients (eight men and 13 women) undergoing primary total hip arthroplasty (THA) for osteoarthritis of the hip were recruited in this study and followed up for two years. Two patients were lost to follow-up. All patients received a TriFit stem and Trinity Cup with a vitamin E-infused highly cross-linked ultra-high molecular weight polyethylene liner. Radiographs for RSA were taken postoperatively and then at three, 12, and 24 months. Oxford Hip Score (OHS), EuroQol five-dimension questionnaire (EQ-5D), and adverse events were reported.Aims
Methods
Short, bone-conserving femoral components are increasingly used in total hip arthroplasty (THA). They are expected to allow tissue-conserving implantation and to render future revision surgery more straightforward but the long-term data on such components is limited. One such component is the global tissue-sparing (GTS) stem. Following the model for stepwise introduction of new orthopaedic implants, we evaluated early implant fixation and clinical outcome of this novel short-stem THA and compared it to that of a component with established good long-term clinical outcome. In total, 50 consecutive patients ≤ 70 years old with end-stage symptomatic osteo-arthritis were randomized to receive THA with the GTS stem or the conventional Taperloc stem using the anterior supine intermuscular approach by two experienced hip surgeons in two hospitals in the Netherlands. Primary outcome was implant migration. Patients were followed using routine clinical examination, patient reported outcome using Harris Hip Score (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), EuroQol five-dimension questionnaire (EQ5D), and Roentgen Stereophotogrammetric Analysis (RSA) at three, six, 12, and 24 months. This study evaluated the two-year follow-up results.Aims
Methods
The aim of this study was to report the initial results of the
Exeter V40 stem, which became available in 2000. A total of 540 total hip arthroplasties (THAs) were performed
in our unit using this stem between December 2000 and May 2002.
Our routine protocol is to review patients postoperatively and at
one, five, and ten years following surgery.Aims
Patients and Methods
Modular or custom-made femoral components have been preferred
for total hip arthroplasty (THA) in patients with a history of Perthes’
disease because of the distortion in the anatomy of the proximal
femur. However, it has not been established whether a monobloc cementless
stem will fit the distorted proximal femur or whether the results
of the procedure are satisfactory in this group of patients. We reviewed 68 consecutive patients who had undergone THA for
childhood Perthes’ disease between June 2003 and December 2008.
There were 35 men and 33 women with a mean age of 48 years (16 to
73) at the time of index arthroplasty. Their mean body mass index
was 24.4 (18.3 to 32.9). Of the 68 hips, 32 were classified as Stulberg
class III and 36 as class IV. The mean pre-operative shortening
of the affected leg was 17.2 mm (5 to 34). The minimum follow-up
was five years (mean 8.5 years; 5.2 to 10).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
Many different lengths of stem are available
for use in primary total hip replacement, and the morphology of
the proximal femur varies greatly. The more recently developed shortened
stems provide a distribution of stress which closely mimics that
of the native femur. Shortening the femoral component potentially
comes at the cost of decreased initial stability. Clinical studies
on the performance of shortened cemented and cementless stems are promising,
although long-term follow-up studies are lacking. We provide an
overview of the current literature on the anatomical features of
the proximal femur and the biomechanical aspects and clinical outcomes
associated with the length of the femoral component in primary hip
replacement, and suggest a classification system for the length
of femoral stems. Cite this article:
Revision of a cemented hemiarthroplasty of the
hip may be a hazardous procedure with high rates of intra-operative complications.
Removing well-fixed cement is time consuming and risks damaging
already weak bone or perforating the femoral shaft. The cement-in-cement
method avoids removal of intact cement and has shown good results
when used for revision total hip arthroplasty (THA). The use of
this technique for the revision of a hemiarthroplasty to THA has
not been previously reported. A total of 28 consecutive hemiarthroplasties (in 28 patients)
were revised to a THA using an Exeter stem and the cement-in-cement
technique. There were four men and 24 women; their mean age was
80 years (35 to 93). Clinical and radiographic data, as well as
operative notes, were collected prospectively and no patient was
lost to follow-up. Four patients died within two years of surgery. The mean follow
up of the remainder was 70 months (25 to 124). Intra-operatively
there was one proximal perforation, one crack of the
femoral calcar and one acetabular fracture. No femoral components
have required subsequent revision for aseptic loosening or are radiologically loose. Four patients with late complications (14%) have since undergone
surgery (two for a peri-prosthetic fracture, and one each for deep
infection and recurrent dislocation) resulting in an overall major
rate of complication of 35.7%. The cement-in-cement technique provides reliable femoral fixation
in this elderly population and may reduce operating time and rates
of complication. Cite this article:
