In acetabular dysplasia, fixation of the
We investigated patient characteristics and outcomes of Vancouver type B periprosthetic fractures treated with femoral component revision and/or osteosynthesis. The study utilized data from the Swedish Hip Arthroplasty Register (SHAR) and information from patient records. We included all primary total hip arthroplasties (THAs) performed in Sweden since 1979, and undergoing further surgery due to Vancouver type B periprosthetic femoral fracture between 2001 and 2011. The primary outcome measure was any further reoperation between 2001 and 2013. Cross-referencing with the National Patient Register was performed in two stages, in order to identify all surgical procedures not recorded on the SHAR.Aims
Patients and Methods
To assess the effect of improved methods of femoral cementing on the loosening rates in young patients, we reviewed 50 'second-generation' cemented hip arthroplasties in 44 patients aged 50 years or less. The femoral stems were all collared and rectangular in cross-section with rounded corners. The cement was delivered by a gun into a medullary canal occluded distally with a cement plug. A clinical and radiographic review was undertaken at an average of 12 years (10 to 14.8) and no patient was lost to follow-up. No femoral component was revised for aseptic loosening, and only one stem was definitely loose by radiographic criteria. By contrast, 11 patients had undergone revision for symptomatic aseptic loosening of the
Using dried bones which could be tilted and rotated, we assessed the accuracy of published radiographic methods for measuring the migration of prosthetic
We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless total hip arthroplasty. An Alloclassic SL stem had been implanted in all patients. A variety of cementless
The Ring plastic-on-metal total hip replacement was introduced with the intention of combining the advantages of the cemented low-friction arthroplasty with those of a cementless system. Fourteen hundred and eighty-eight of these procedures have been reviewed. The results of a two to seven-year follow-up, and of a group which has completed at least five years are presented. There was an excellent clinical result in 93% of the whole series, and in 87% of the five-year group. When graded on the Charnley scale there was an average score of 5.86 for pain, 5.96 for function and 5.9 for range of movement, which compares favourably with cemented replacements. The deep infection rate was zero, and the revision rate 1.5% for the whole series. Erosive problems occurred with the smaller
A high percentage of hips in patients with rheumatoid arthritis presenting for total joint replacement have protrusio deformity with extremely thin medial acetabular walls. Biomechanical principles suggest that, to prevent inward migration of the
We report the long-term outcome of 218 Charnley low-friction arthroplasties in 141 patients who were 40 years old or younger at the time of surgery. The minimum follow-up was ten years with a mean of 16 years. The probability of the femoral component surviving 20 years was 86% and of the
In 16 patients we used uncemented Lord prostheses at revision operations for aggressive granulomatosis after cemented hip arthroplasties; in 12 bone grafts also were used. In 13 hips the granulomatous lesions were multifocal, and in one the
Between February 1975 and August 1976, 195 total hip replacements using Stanmore components were performed; of these, 146 were in 135 patients who had not had previous hip surgery. At review 52 had died, but none of the others was lost to follow-up. Of the 52, two had had a second operation, one for infection and one for recurrent dislocation. In the remaining 83 patients (92 hips) five revisions were necessary: four for aseptic loosening, and one for stem fracture. The remaining 78 patients had little or no pain and little restriction of activity. After a follow-up period of at least nine years, the survival rate of the prosthesis was 95%. There had been migration of the femoral component in five cases and migration of the acetabular cup in one case, but no wear of the
In previous studies, we identified multiple factors influencing the survivorship of hip resurfacing arthroplasties (HRAs), such as initial anatomical conditions and surgical technique. In addition, the University of California, Los Angeles (UCLA) activity score presents a ceiling effect, so a better quantification of activity is important to determine which activities may be advisable or detrimental to the recovered patient. We aimed to determine the effect of specific groups of sporting activities on the survivorship free of aseptic failure of a large series of HRA. A total of 661 patients (806 hips) representing 77% of a consecutive series of patients treated with metal-on-metal hybrid HRA answered a survey to determine the types and amounts of sporting activities they regularly participated in. There were 462 male patients (70%) and 199 female patients (30%). Their mean age at the time of surgery was 51.9 years (14 to 78). Their mean body mass index (BMI) was 26.5 kg/m2 (16.7 to 46.5). Activities were regrouped into 17 categories based on general analogies between these activities. Scores for typical frequency and duration of the sessions were used to quantify the patients’ overall time spent engaging in sporting activities. Impact and cycle scores were computed. Multivariable models were used.Aims
Patients and Methods
Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a femoral neck fracture. This study aimed to assess the complication rates of THA with dual mobility components (THA-DMC) following a femoral neck fracture and to compare outcomes between THA-DMC, conventional THA, and hemiarthroplasty (HA). We performed a systematic review of all English language articles on THA-DMC published between 2010 and 2019 in the MEDLINE, EMBASE, and Cochrane databases. After the application of rigorous inclusion and exclusion criteria, 23 studies dealing with patients who underwent treatment for a femoral neck fracture using THA-DMC were analyzed for the rate of dislocation. Secondary outcomes included reoperation, periprosthetic fracture, infection, mortality, and functional outcome. The review included 7,189 patients with a mean age of 77.8 years (66.4 to 87.6) and a mean follow-up of 30.9 months (9.0 to 68.0).Aims
Methods
Glass ionomer cement (Ionocem) was developed for use in bone surgery and is reported to be notably biocompatible. Between 1991 and 1994 we performed revision operations for aseptic loosening of arthroplasties of the hip on 45 patients using this material in its granulate form (Ionogran) mixed with homologous bone as a bone substitute. Of these 45 patients, 42 were followed up for a mean of 42 months. Early reloosening of the
We describe six patients with aggressive granulomatous lesions around cementless total hip prostheses. Two patients previously had a cemented prosthesis in the same hip. The Lord prosthesis was used in five patients, the PCA in one. Both prostheses were made of chrome-cobalt alloy. Pain on weight-bearing occurred on average 3.2 years after the cementless arthroplasty, and at that time radiography revealed aggressive granulomatosis around the proximal femoral stem and the
Visualisation of periacetabular osteolysis by standard anteroposterior (AP) radiographs underestimates the extent of bone loss around a metal-backed
We performed a histological and histomorphometric examination in five cadaver specimens of the femoral and
Modular dual-mobility constructs reduce the risk of dislocation after revision total hip arthroplasty (THA). However, questions about metal ions from the cobalt-chromium (CoCr) liner persist, and are particularly germane to patients being revised for adverse local tissue reactions (ALTR) to metal. We determined the early- to mid-term serum Co and Cr levels after modular dual-mobility components were used in revision and complex primary THAs, and specifically included patients revised for ALTR. Serum Co and Cr levels were measured prospectively in 24 patients with a modular dual-mobility construct and a ceramic femoral head. Patients with CoCr heads or contralateral THAs with CoCr heads were excluded. The mean age was 63 years (35 to 83), with 13 patients (54%) being female. The mean follow-up was four years (2 to 7). Indications for modular dual-mobility were prosthetic joint infection treated with two-stage exchange and subsequent reimplantation (n = 8), ALTR revision (n = 7), complex primary THA (n = 7), recurrent instability (n = 1), and periprosthetic femoral fracture (n = 1). The mean preoperative Co and Cr in patients revised for an ALTR were 29.7 μg/l (2 to 146) and 21.5 μg/l (1 to 113), respectively.Aims
Patients and Methods
To analyse the value and accuracy of preoperative planning for total hip replacement (THR) we digitised electronically and compared the hand-sketched preoperative plans with the pre- and postoperative radiographs of 100 consecutive primary THRs. The correct type of prosthesis was planned in 98%; the agreement between planned and actually used components was 92% on the femoral side and 90% on the acetabular side. The mean (± SD) absolute difference between the planned and actual position of the centre of rotation of the hip was 2.5 ± 1.1 mm vertically and 4.4 ± 2.1 mm horizontally. On average, the inclination of the
The results of conventional hip replacement in young patients with osteoarthritis have not been encouraging even with improvements in the techniques of fixation and in the bearing surfaces. Modern metal-on-metal hip resurfacing was introduced as a less invasive method of joint reconstruction for this particular group. This is a series of 446 hip resurfacings (384 patients) performed by one of the authors (DJWM) using cemented femoral components and hydroxyapatite-coated uncemented
1. Prosthetic acetabular cups of the Charnley and McKee-Farrar designs were cemented into cadaveric pelves using different procedures for preparing the acetabulum. 2. The torsional moments needed to loosen these cups were measured. 3. The torsional moments so measured were found to be from about four to more than twenty times higher than the frictional moments measured in independent tests on the two designs of prosthesis. 4. It is argued that late looseness of the