This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years’ follow-up.Aims
Methods
Oxidised zirconium (OxZi) has been developed
as an alternative bearing surface for femoral heads in total hip arthroplasty
(THA). This study has investigated polyethylene wear, functional
outcomes and complications, comparing OxZi and cobalt–chrome (CoCr)
as part of a three-arm, multicentre randomised controlled trial.
Patients undergoing THA from four institutions were prospectively
randomised into three groups. Group A received a CoCr femoral head
and highly cross-linked polyethylene (XLPE) liner; Group B received
an OxZi femoral head and XLPE liner; Group C received an OxZi femoral
head and ultra-high molecular weight polyethylene (UHMWPE) liner.
At five years, 368 patients had no statistically significant differences
in short-form-36 (p = 0.176 mental, p = 0.756 physical), Western
Ontario and McMaster Universities Osteoarthritis Index (p = 0.847),
pain scores
(p = 0.458) or complications. The mean rate of linear wear was 0.028
mm/year (standard deviation ( Cite this article:
We present the extended follow-up (≥ 20 years)
of a series of fully hydroxyapatite-coated femoral components used in
72 primary total hip replacements (THRs). Earlier results of this
cohort have been previously published. All procedures were performed
between 1986 and 1991. The series involved 45 women and 15 men with
12 bilateral procedures. Their mean age at the time of surgery was
60 years (46 to 80) and the mean duration of follow-up was 22.5
years (20 to 25). At final follow-up, the mean Merle d’Aubigné and
Postel hip scores were 5.5 (4.5 to 6), 3.8 (3.5 to 5) and 3.3 (3.0
to 5.0) for pain, mobility and function, respectively. Of the patients
92% were very satisfied at the time of final follow-up. There were seven revisions: six of the acetabular component for
aseptic loosening and one of both the stem and the acetabular component
for loosening due to deep infection. The survival of this prosthesis
at 22.5 years with revision for any reason as the endpoint was 91.7%
(95% confidence interval (CI) 84 to 99). Survival with aseptic loosening
of the stem as the endpoint was 100% (95% CI 90 to 100). This prosthesis provides pain relief in the long term. Survival
of this component is comparable to the best results for primary
THR with any means of fixation. Cite this article:
We report the findings of an independent review
of 230 consecutive Birmingham hip resurfacings (BHRs) in 213 patients
(230 hips) at a mean follow-up of 10.4 years (9.6 to 11.7). A total
of 11 hips underwent revision; six patients (six hips) died from
unrelated causes; and 13 patients (16 hips) were lost to follow-up.
The survival rate for the whole cohort was 94.5% (95% confidence
interval (CI) 90.1 to 96.9). The survival rate in women was 89.1%
(95% CI 79.2 to 94.4) and in men was 97.5% (95% CI 92.4 to 99.2).
Women were 1.4 times more likely to suffer failure than men. For
each millimetre increase in component size there was a 19% lower
chance of a failure. The mean Oxford hip score was 45.0 (median
47.0, 28 to 48); mean University of California, Los Angeles activity
score was 7.4 (median 8.0, 3 to 9); mean patient satisfaction score
was 1.4 (median 1.0, 0 to 9). A total of eight hips had lysis in
the femoral neck and two hips had acetabular lysis. One hip had
progressive radiological changes around the peg of the femoral component.
There was no evidence of progressive neck narrowing between five
and ten years. Our results confirm that BHR provides good functional outcome
and durability for men, at a mean follow-up of ten years. We are
now reluctant to undertake hip resurfacing in women with this implant.
We report the long-term results of revision total
hip replacement using femoral impaction allografting with both uncemented
and cemented Freeman femoral components. A standard design of component
was used in both groups, with additional proximal hydroxyapatite
coating in the uncemented group. A total of 33 hips in 30 patients received
an uncemented component and 31 hips in 30 patients a cemented component.
The mean follow-up was 9.8 years (2 to 17) in the uncemented group
and 6.2 years (1 to 11) in the cemented group. Revision procedures
(for all causes) were required in four patients (four hips) in the
uncemented group and in five patients (five hips) in the cemented
group. Harris hip scores improved significantly in both groups and
were maintained independently of the extent of any migration of
the femoral component within the graft or graft–cement mantle.
We prospectively evaluated the long-term outcome of 158 consecutive patients who underwent revision total hip replacement using uncemented computer-assisted design-computer-assisted manufacture femoral components. There were 97 men and 61 women. Their mean age was 63.1 years (34.6 to 85.9). The mean follow-up was 10.8 years (10 to 12). The mean Oxford, Harris and Western Ontario and McMaster hip scores improved from 41.1, 44.2 and 52.4 pre-operatively to 18.2, 89.3 and 12.3, respectively (p <
0.0001, for each). Six patients required further surgery. The overall survival of the femoral component was 97% (95% confidence interval 94.5 to 99.7). These results are comparable to those of previously published reports for revision total hip replacement using either cemented or uncemented components.
We present the 10- to 17-year results of 112 computer-assisted design computer-assisted manufacture femoral components. The total hip replacements were performed between 1992 and 1998 in 111 patients, comprising 53 men and 58 women. Their mean age was 46.2 years (24.6 to 62.2) with a mean follow-up of 13 years (10 to 17). The mean Harris Hip Score improved from 42.4 (7 to 99) to 90.3 (38 to 100), the mean Oxford Hip Score from 43.1 (12 to 59) to 18.2 (12 to 51) and the mean Western Ontario MacMasters University Osteoarthritis Index score from 57.0 (7 to 96) to 11.9 (0 to 85). There was one revision due to failure of the acetabular component but no failures of the femoral component. There were no revisions for aseptic loosening. The worst-case survival in this cohort of custom femoral components at 13.2 years follow-up was 98.2% (95% confidence interval 95 to 99). Overall survival of this series of total hip replacements was 97.3% (95% confidence interval 95 to 99). These results are comparable with the best medium- to long-term results for femoral components used in primary total hip replacement with any means of fixation.
We have evaluated the results of total hip replacement in patients with congenital hip disease using 46 cemented all-polyethylene Charnley acetabular components implanted with the cotyloplasty technique in 34 patients (group A), and compared them with 47 metal-backed cementless acetabular components implanted without bone grafting in 33 patients (group B). Patients in group A were treated between 1988 and 1993 and those in group B between 1990 and 1995. The mean follow-up for group A was 16.6 years (12 to 18) and the mean follow-up for group B was 13.4 years (10 to 16). Revision for aseptic loosening was undertaken in 15 hips (32.6%) in group A and in four hips (8.5%) in group B. When liner exchange was included, a total of 13 hips were revised in group B (27.7%). The mean polyethylene wear was 0.11 mm/yr (0.002 to 0.43) and 0.107 mm/yr (0 to 0.62) for groups A and B, respectively. Polyethylene wear in group A was associated with linear osteolysis, and in group B with expansile osteolysis. In patients with congenital hip disease, when 80% cover of the implant can be obtained, a cementless acetabular component appears to be acceptable and provides durable fixation. However, because of the type of osteolysis arising with these devices, early exchange of a worn liner is recommended before extensive bone loss makes revision surgery more complicated.
Peri- and sub-prosthetic fractures, or pathological fractures below an existing well-fixed femoral component, with or without an ipsilateral knee replacement, present a difficult surgical challenge. We describe a simple solution, in which a custom-made prosthesis with a cylindrical design is cemented proximally to the stem of an existing, well-fixed femoral component. This effectively treats the fracture without sacrificing the good hip. We describe five patients with a mean age of 73 years (60 to 81) and a mean follow-up of 47 months (6 to 108). The mean overlap of the prosthesis over the femoral component was 7.5 cm (5.5 to 10). There have been no mechanical failures, no new infections and no re-operations. We suggest that in highly selected cases, in which conventional fixation is not feasible, this technique offers a durable option and avoids the morbidity of a total femoral replacement.
We prospectively studied 217 patients who underwent 234 Elite Plus total hip arthroplasties. At a mean of 6.4 (SD 0.7) years post-operatively, 39 patients had died and 22 were either lost to follow-up or had no radiographs available. Clinical (Oxford hip score) and radiological assessments were performed on 156 patients (168 hip arthroplasties) who had a mean age of 67.7 (SD 9.7) years at operation. In the assessed group, 26 of 159 (16.4%) of femoral stems which had not already been revised and 19 of 159 (11.9%) of acetabular cups were definitely loose. In total, 52 of 168 (31%) of hips had either been revised or had definite evidence of loosening of a component. We could not establish any relationship between clinical and radiological outcomes. Despite the fact that the clinical outcome and rate of revision for the Elite Plus appeared to meet international standards, our findings give us cause for concern. We believe that joint registries should include radiological surveillance in order to provide reliable information about medium-term outcomes for hip prostheses.
We describe the survival at ten years of 100 femoral components of the Freeman hip prosthesis. It is proximally hydroxyapatite (HA)-coated and was fixed without cement. Radiological assessment identified radiolucent lines (RLLs) and
We have compared the survival and radiological outcome at ten years after total hip replacement using two techniques for preparing the femoral canal. The same prosthesis was used throughout and all operations were performed by the same surgical team. In technique 1 the canal was over-reamed by 2 mm and in technique 2 it was reamed to the same size as the prosthesis. Technique 1 was performed on 92 patients and technique 2 on 97 patients. The survival at ten years was 97.2% (90.6 to 99.2) for technique 1 and 98.8% (92.9 to 99.8) for technique 2. Vertical migration was greater in technique 1 (1.8 mm versus 1.0 mm at five years; p = 0.36). There were significantly more
We studied 185 total hip replacements and related the identification of radiolucent lines (RLLs) at two years to the later development of
We reviewed a consecutive series of 527 uninfected hip replacements in patients resident in the UK which had been implanted from 1981 to 1993. All had the same basic design of femoral prosthesis, but four fixation techniques had been used: two press-fit, one HA-coated and one cemented. Review and radiography were planned prospectively. For assessment the components were retrospectively placed into two groups: those which had failed from two years onwards by aseptic femoral loosening and those in which the femoral component had survived without revision or recommendation for revision. All available radiographs in both groups were measured to determine vertical migration and examined by two observers to agree the presence of radiolucent lines (RLLs),