Large-head metal-on-metal (MoM) total hip replacements
(THR) have given rise to concern. Comparative studies of small-head
MoM THRs over a longer follow-up period are lacking. Our objective
was to compare the incidence of complications such as infection,
dislocation, revision, adverse local tissue reactions, mortality
and radiological and clinical outcomes in small-head (28 mm) MoM
and ceramic-on-polyethylene (CoP) THRs up to 12 years post-operatively. A prospective cohort study included 3341 THRs in 2714 patients.
The mean age was 69.1 years (range 24 to 98) and 1848 (55.3%) were
performed in women, with a mean follow-up of 115 months (18 to 201).
There were 883 MoM and 2458 CoP bearings. Crude incidence rates
(cases/1000 person-years) were: infection 1.3 In conclusion, we found similar results for small-head MoM and
CoP bearings up to ten years post-operatively, but after ten years
MoM THRs had a higher risk of all-cause revision. Furthermore, the
presence of an adverse response to metal debris seen in the small-head
MOM group at revision is a cause for concern. Cite this article:
There are no recent studies comparing cable with
wire for the fixation of osteotomies or fractures in total hip replacement
(THR). Our objective was to evaluate the five-year clinical and
radiological outcomes and complication rates of the two techniques.
We undertook a review including all primary and revision THRs performed
in one hospital between 1996 and 2005 using cable or wire fixation.
Clinical and radiological evaluation was performed five years post-operatively.
Cables were used in 51 THRs and wires in 126, and of these, 36 THRs
with cable (71%) and 101 with wire (80%) were evaluated at follow-up.
The five-year radiographs available for 33 cable and 91 wire THRs
revealed rates of breakage of fixation of 12 of 33 (36%) and 42
of 91 (46%), respectively. With cable there was a significantly
higher risk of metal debris (68% In conclusion, we found a higher incidence of complications and
a trend towards increased infection and foreign-body reaction with
the use of cables.
We conducted a longitudinal study including patients with the same type of primary hybrid total hip replacement and evaluated patient activity and femoral osteolysis at either five or ten years post-operatively. Activity was measured using the University of California, Los Angeles scale. The primary outcome was the radiological assessment of femoral osteolysis. Secondary outcomes were revision of the femoral component for aseptic loosening and the patients’ quality of life. Of 503 hip replacements in 433 patients with a mean age of 67.7 years (30 to 91), 241 (48%) were seen at five and 262 (52%) at ten years post-operatively. Osteolytic lesions were identified in nine of 166 total hip replacements (5.4%) in patients with low activity, 21 of 279 (7.5%) with moderate activity, and 14 of 58 (24.1%) patients with high activity. The risk of osteolysis increased with participation in a greater number of sporting activities. In multivariate logistic regression adjusting for age, gender, body mass index and the inclination angle of the acetabular component, the adjusted odds ratio for osteolysis comparing high In conclusion, of patients engaged in high activity, 24% had developed femoral osteolysis five to ten years post-operatively.
