Aims.
Aims. For this retrospective cohort study, patients aged ≤ 30 years
(very young) who underwent total hip arthroplasty (THA) were compared
with patients aged ≥ 60 years (elderly) to evaluate the rate of
revision arthroplasty, implant survival, the indications for revision,
the complications, and the patient-reported outcomes. Patients and Methods. We retrospectively reviewed all patients who underwent primary
THA between January 2000 and May 2015 from our institutional database.
A total of 145 very
Aims. Dual mobility (DM) implants have been shown to reduce the dislocation rate after total hip arthroplasty (THA), but there remain concerns about the use of cobalt chrome liners inserted into titanium shells. The aim of this study was to assess the clinical outcomes, metal ion levels, and periprosthetic femoral bone mineral density (BMD) at mid-term follow-up in
Aims. We carried out a further study of the long-term results of the
cemented Exeter femoral component in patients under the age of 40
with a mean follow-up of 13.6 years (10 to 20). Patients and Methods. We reviewed our original cohort of 104 cemented Exeter stems
in 78 consecutive patients with a mean age of 31 years (16 to 39).
Only one patient was lost to radiological follow-up. Results. A total of six patients (eight hips) had died for reasons unrelated
to their surgery. There had been one further periprosthetic fracture
from a fall and one fractured femoral stem. No revisions for aseptic
loosening were undertaken during the whole study period. Overall, 11 hips had progressive radiolucent lines in one or
more zones. The Kaplan Meier survival percentages at ten and 17 years were
97.1% (95% confidence interval (CI) 91.3 to 99.1) and 92.1% (95%
CI 74.1 to 97.8) with revision for any reason as the endpoint, and
100% at both ten and 17 years with aseptic loosening (95% CI 83.8
to 100) as the endpoint. No additional hips were classified as radiologically
loose. Conclusion. The Exeter femoral component continues to function satisfactorily
in
Aims. The aim of this study was to describe temporal trends and survivorship of total hip arthroplasty (THA) in very
Revision total hip replacement (THR) for young
patients is challenging because of technical complexity and the potential
need for subsequent further revisions. We have assessed the survivorship,
functional outcome and complications of this procedure in patients
aged <
50 years through a large longitudinal series with consistent treatment
algorithms. Of 132 consecutive patients (181 hips) who underwent
revision THR, 102 patients (151 hips) with a mean age of 43 years
(22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26)
post-operatively. We attempted to restore bone stock with allograft
where indicated. Using further revision for any reason as an end point,
the survival of the acetabular component was 71% (. sd. 4)
and 54% (. sd. 7) at ten- and 20 years. The survival of the
femoral component was 80% (. sd. 4) and 62% (. sd. 6)
at ten- and 20 years. Complications included 11 dislocations (6.1%),
ten periprosthetic fractures (5.5%), two deep infections (1.1%),
four sciatic nerve palsies (2.2%; three resolved without intervention,
one improved after exploration and freeing from adhesions) and one
vascular injury (0.6%). The mean modified Harris Hip Score was 41
(10 to 82) pre-operatively, 77 (39 to 93) one year post-operatively
and 77 (38 to 93) at the latest review. This overall perspective on the mid- to long-term results is
valuable when advising
Aims. Modular dual mobility (DM) prostheses in which a cobalt-chromium liner is inserted into a titanium acetabular shell (vs a monoblock acetabular component) have the advantage of allowing supplementary screw fixation, but the potential for corrosion between the liner and acetabulum has raised concerns. While DM prostheses have shown improved stability in patients deemed ‘high-risk’ for dislocation undergoing total hip arthroplasty (THA), their performance in
Avascular femoral head necrosis in the context of gymnastics is a rare but serious complication, appearing similar to Perthes’ disease but occurring later during adolescence. Based on 3D CT animations, we propose repetitive impact between the main supplying vessels on the posterolateral femoral neck and the posterior acetabular wall in hyperextension and external rotation as a possible cause of direct vascular damage, and subsequent femoral head necrosis in three adolescent female gymnasts we are reporting on. Outcome of hip-preserving head reduction osteotomy combined with periacetabular osteotomy was good in one and moderate in the other up to three years after surgery; based on the pronounced hip destruction, the third received initially a total hip arthroplasty.Aims
Methods
Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment.Aims
Methods
Aims. We present the ten-year data of a cohort of patients, aged between
18 and 65 years (mean age 52.7 years; 19 to 64), who underwent total
hip arthroplasty. Patients were randomised to be treated with a
cobalt-chrome (CoCr) femoral head with an ultra-high molecular weight
polyethylene (UHMWPE), highly cross-linked polyethylene (XLPE) or
ceramic-on-ceramic (CoC) bearing surface. Patients and Methods. A total of 102 hips (91 patients) were randomised into the three
groups. At ten years, 97 hips were available for radiological and
functional follow-up. Two hips (two patients) had been revised (one
with deep infection and one for periprosthetic fracture) and three
were lost to follow-up. Radiological analysis was performed using
a validated digital assessment programme to give linear, directional
and volumetric wear of the two polyethylene groups. Results. There was a significantly reduced rate of steady-state linear
wear with XLPE (0.07 mm/yr) compared with UHMWPE (0.37 mm/yr) (p
= 0.001). Volumetric wear was also significantly reduced in the
XLPE group (29.29 mm. 3. /yr) compared with the UHMWPE group
(100.75mm. 3. /yr) (p = 0.0001). There were six patients
with UHMWPE who had non-progressive osteolysis and none in the XLPE
group. All three bearing groups had significant improvements in
12-item short form health survey scores, Western Ontario and McMaster
Universities Osteoarthritis Index score and Harris Hip Score. However,
the improvement in HSS was significantly less in the UHMWPE group
(p = 0.0188) than in the other two groups. At ten years, the rates of volumetric and linear wear in the
XLPE group remain low and predominantly below the estimated threshold
for osteolysis (1 mm/yr). The rate of linear wear in the XLPE group
was three times less than in the UHMWPE group at five-year follow-up
and five times less at ten years. The rate of volumetric wear was also
three times less in the XLPE group at ten years. Conclusion. While CoC also performs well, XLPE at ten years remains a safe
and excellent bearing option in
Acetabular labral tears and associated intra-articular
pathology of the hip have been recognised as a source of symptoms.
However, it is now appreciated that there is a relatively high prevalence
of asymptomatic labral tears. In this study, 70
We studied prospectively the long-term results of the Charnley Elite-Plus femoral stem in 184 consecutive
The term developmental dysplasia of the hip (DDH)
describes a spectrum of disorders that results in abnormal development
of the hip joint. If not treated successfully in childhood, these
patients may go on to develop hip symptoms and/or secondary osteoarthritis
in adulthood. In this review we describe the altered anatomy encountered
in adults with DDH along with the management options, and the challenges
associated with hip arthroscopy, osteotomies and arthroplasty for
the treatment of DDH in
This study reports the results of 38 total hip
arthroplasties (THAs) in 33 patients aged <
50 years, using the
JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component.
This represents an update of previous reports of the same cohort
at ten and 16 years, which were reported in 2004 and 2009, respectively.
We describe the survival, radiological and functional outcomes at
a mean follow-up of 21 years (17 to 25). Of the surviving 34 THAs,
one underwent femoral revision for peri-prosthetic fracture after
21 years, and one patient (one hip) was lost to follow-up. Using
aseptic loosening as the end-point, 12 hips (31.5%) needed acetabular
revision but none needed femoral revision, demonstrating 100% survival
(95% confidence interval 89 to 100). In
Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed.Aims
Methods
In 2004 we described the ten-year prospective results of 38 total hip replacements using the Furlong hydroxyapatite-ceramic-coated femoral component in 35 patients <
50 years old. We have now reviewed the surviving 35 arthroplasties in 33 patients at a mean of 16 years (10.3 to 19.9). The mean age of the surviving patients at the time of operation was 41.3 years (26.0 to 49.0). Of these, eight have undergone revision of their acetabular component for aseptic loosening. None of the femoral components has had revision for aseptic loosening giving a survival rate of 100% at 16 years (95% confidence interval 89% to 100%). The Furlong hydroxyapatite-ceramic-coated femoral component gives excellent long-term survival in
We compared the medium-term clinical and radiological results of hybrid total hip replacement (THR) with metal-on-metal Birmingham hip resurfacing (BHR) in two groups of 54
Between June 1991 and January 1995, 42 hydroxyapatite-coated CAD-CAM femoral components were inserted in 25 patients with inflammatory polyarthropathy, 21 of whom had juvenile idiopathic arthritis. Their mean age was 21 years (11 to 35). All the patients were reviewed clinically and radiologically at one, three and five years. At the final review at a mean of 11.2 years (8 to 13) 37 hips in 23 patients were available for assessment. A total of four femoral components (9.5%) had failed, of which two were radiologically loose and two were revised. The four failed components were in patients aged 16 years or less at the time of surgery. Hydroxyapatite-coated customised femoral components give excellent medium- to long-term results in skeletally-mature
We describe the clinical and radiological results of 38 total hip replacements (THR) using the JRI Furlong hydroxyapatite-ceramic (HAC)-coated femoral component in patients younger than 50 years. The mean age at the time of operation was 42 years (22 to 49) and the mean length of follow-up was ten years (63 to 170 months). All patients receiving a Furlong HAC THR were entered into the study regardless of the primary pathology including patients who had undergone previous hip surgery. The mean Harris hip score improved from 44 before operation to 92 at the last postoperative review. After 12 years the cumulative surivival for the stem was 100% (95% confidence interval 89 to 100). No femoral component was revised. Our results show that the Furlong HAC implant gives excellent long-term results in
The reported prevalence of an asymptomatic slip
of the contralateral hip in patients operated on for unilateral slipped
capital femoral epiphysis (SCFE) is as high as 40%. Based on a population-based
cohort of 2072 healthy adolescents (58% women) we report on radiological
and clinical findings suggestive of a possible previous SCFE. Common
threshold values for Southwick’s lateral head–shaft angle (≥ 13°)
and Murray’s tilt index (≥ 1.35) were used. New reference intervals
for these measurements at skeletal maturity are also presented. At follow-up the mean age of the patients was 18.6 years (17.2
to 20.1). All answered two questionnaires, had a clinical examination
and two hip radiographs. There was an association between a high head–shaft angle and
clinical findings associated with SCFE, such as reduced internal
rotation and increased external rotation. Also, 6.6% of the cohort
had Southwick’s lateral head–shaft angle ≥ 13°, suggestive of a
possible slip. Murray’s tilt index ≥ 1.35 was demonstrated in 13.1%
of the cohort, predominantly in men, in whom this finding was associated
with other radiological findings such as pistol-grip deformity or
focal prominence of the femoral neck, but no clinical findings suggestive
of SCFE. This study indicates that 6.6% of
Intertrochanteric osteotomy may postpone the need for total hip replacement (THR). In
The treatment of hip dysplasia should be customised
for patients individually based on radiographic findings, patient
age, and the patient’s overall articular cartilage status. In many
patients, restoration of hip anatomy as close to normal as possible
with a PAO is the treatment of choice. Cite this article:
We report the clinical and radiological outcomes
of a series of contemporary cementless ceramic-on-ceramic total hip
replacements (THRs) at ten years in patients aged ≤ 55 years of
age. Pre- and post-operative activity levels are described. A total
of 120 consecutive ceramic cementless THRs were performed at a single
centre in 110 patients from 1997 to 1999. The mean age of the patients
at operation was 45 years (20 to 55). At ten years, four patients
had died and six were lost to follow-up, comprising ten hips. The
mean post-operative Harris hip score was 94.7 (55 to 100). Radiological
analysis was undertaken in 90 available THRs of the surviving 106
hips at final review: all had evidence of stable bony ingrowth,
with no cases of osteolysis. Wear was undetectable. There were four
revisions. The survival for both components with revision for any
cause as an endpoint was 96.5% (95% confidence interval 94.5 to
98.7). The mean modified University of California, Los Angeles activity
level rose from a mean of 6.4 (4 to 10) pre-operatively to 9.0 (6
to 10) at the ten-year post-operative period. Alumina ceramic-on-ceramic bearings in cementless primary THR
in this series have resulted in good clinical and radiological outcomes
with undetectable rates of wear and excellent function in the demanding
younger patient group at ten years. 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.
Aims. The Birmingham Hip Resurfacing (BHR) arthroplasty has been used as a surgical treatment of coxarthrosis since 1997. We present 20-year results of 234 consecutive BHRs performed in our unit. Methods. Between 1999 and 2001, there were 217 patients: 142 males (65.4%), mean age 52 years (18 to 68) who had 234 implants (17 bilateral). They had patient-reported outcome measures collected, imaging (radiograph and ultrasound), and serum metal ion assessment. Survivorship analysis was performed using Kaplan-Meier estimates. Revision for any cause was considered as an endpoint for the analysis. Results. Mean follow-up was 20.9 years (19.3 to 22.4). Registry data revealed that 19 hips (8.1%) had been revised and 26 patients (12%) had died from causes unrelated to the BHR. Among the remaining 189 hips, 61% were available for clinical follow-up at 20 years (n = 115) and 70% of patients had biochemical follow-up (n = 132). The cumulative implant survival rate at 20 years for male patients was 96.5% (95% confidence interval (CI) 93.5 to 99.6), and for female patients 87% (95% CI 79.7 to 94.9). The difference was statistically significant (p = 0.029). The mean Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, and Forgotten Joint Score were 45 (29 to 48), 89 (43 to 100), and 84 (19 to 100), respectively. The mean scores for each of the five domains of the EuroQol five-dimension three-level questionnaire were 1.2, 1.0, 1.2, 1.3, and 1.1, and mean overall score 82.6 (50 to 100). Ultrasound showed no pseudotumour. Mean cobalt and chromium levels were 32.1 nmol/l (1 to 374) and 45.5 nmol/l (9 to 408), respectively. Conclusion. This study shows that BHRs provide excellent survivorship and functional outcomes in
Since wear and loosening of the ultra-high-molecular-weight polyethylene cup are factors which limit the life of an arthroplasty we have attempted to identify factors associated with either low wear (0.02 mm/year or less) or high wear (0.2 mm/year or more). In a series of 1434 Charnley low-friction arthroplasties (1092 patients) 190 (13.2%) showed low wear while 149 (10.4%) showed high wear. We used chi-squared test to assess the significance of various factors. The significant factors of the low-wear group were female gender (p = 0.042), rheumatoid arthritis (p = 0.014), Charnley grade C (p = 0.03) and varus position of the stem (p = 0.003). The use of acetabular cement pressurisation (p = 0.07) and medialisation of the cup (p = 0.07) approached significance. In the high-wear group there was a predominance of men (p = 0.042) with osteoarthritis (p = 0.006) as the underlying hip pathology, and the stem in a valgus position (p = 0.023). Support of the cup by the rim of the acetabulum approached significance (p = 0.07). There was no statistical significance between the two groups for revision for aseptic loosening of the stem or fracture of the stem (p = 0.49). There was a highly significant difference (p <
0.0001) between the two groups for revision for wear and aseptic loosening of the cup, 5.3% compared with 39%. Changes in the cup geometry are probably sufficient to explain the increasing incidence of loosening and revisions with the increasing depth of penetration of the cup. There is much to be gained from the use of a low-wearing ceramic-ultra-high-molecular-weight combination. Tissue reaction to the polyethylene particles cannot be the cause of aseptic loosening of the stem.
The incidence and long-term outcome of undisplaced fatigue fractures of the femoral neck treated conservatively were examined in Finnish military conscripts between 1970 and 1990. From 106 cases identified, 66 patients with 70 fractures were followed for a mean of 18.3 years (11 to 32). The original medical records and radiographs were studied and physical and radiological follow-up data analysed for evidence of risk factors for this injury. The development of avascular necrosis and osteoarthritis was determined from the follow-up radiographs and MR scans. The impact of new military instructions on the management of hip-related pain was assessed following their introduction in 1986. The preventive regimen (1986) improved awareness and increased the detected incidence from 13.2 per 100 000 service-years (1970 to 1986) to 53.2 per 100 000 (1987 to 1990). No patient developed displacement of the fracture or avascular necrosis of the femoral head, or suffered from adverse complications. No differences were found in MRI-measured hip joint spaces at final follow-up. The mean Harris Hip Score was 97 (70 to 100) and the Visual Analogue Scale 5.85 mm (0 to 44). Non-operative treatment, including avoidance of or reduced weight-bearing, gave favourable short- and long-term outcomes. Undisplaced fatigue fractures of the femoral neck neither predispose to avascular necrosis nor the subsequent development of osteoarthritis of the hip.
We describe the findings at six years in an ongoing prospective clinicoradiological and metal ion study in a cohort of 26 consecutive male patients with unilateral Birmingham Hip Resurfacing arthroplasties with one of two femoral head sizes (50 mm and 54 mm). Their mean age was 52.9 years (29 to 67). We have previously shown an early increase in the 24-hour urinary excretion of metal ions, reaching a peak at six months (cobalt) and one year (chromium) after operation. Subsequently there is a decreasing trend in excretion of both cobalt and chromium. The levels of cobalt and chromium in whole blood also show a significant increase at one year, followed by a decreasing trend until the sixth year.
This is a longitudinal study of the daily urinary output and the concentrations in whole blood of cobalt and chromium in patients with metal-on-metal resurfacings over a period of four years. Twelve-hour urine collections and whole blood specimens were collected before and periodically after a Birmingham hip resurfacing in 26 patients. All ion analyses were carried out using a high-resolution inductively-coupled plasma mass spectrometer. Clinical and radiological assessment, hip function scoring and activity level assessment revealed excellent hip function. There was a significant early increase in urinary metal output, reaching a peak at six months for cobalt and one year for chromium post-operatively. There was thereafter a steady decrease in the median urinary output of cobalt over the following three years, although the differences are not statistically significant. The mean whole blood levels of cobalt and chromium also showed a significant increase between the pre-operative and one-year post-operative periods. The blood levels then decreased to a lower level at four years, compared with the one-year levels. This late reduction was statistically significant for chromium but not for cobalt. The effects of systemic metal ion exposure in patients with metal-on-metal resurfacing arthroplasties continue to be a matter of concern. The levels in this study provide a baseline against which the
Polyethylene wear debris can cause osteolysis
and the failure of total hip arthroplasty. We present the five-year
wear rates of a highly cross-linked polyethylene (X3) bearing surface
when used in conjunction with a 36 mm ceramic femoral head. This was a prospective study of a cohort of 100 THAs in 93 patients.
Pain and activity scores were measured pre- and post-operatively.
Femoral head penetration was measured at two months, one year, two
years and at five years using validated edge-detecting software
(PolyWare Auto). At a mean of 5.08 years (3.93 to 6.01), 85 hips in 78 patients
were available for study. The mean age of these patients was 59.08
years (42 to 73, the mean age of males (n = 34) was 59.15 years,
and females (n = 44) was 59.02 years). All patients had significant
improvement in their functional scores (p <
0.001). The steady
state two-dimensional linear wear rate was 0.109 mm/year. The steady
state volumetric wear rate was 29.61 mm3/year. No significant
correlation was found between rate of wear and age (p = 0.34), acetabular
component size (p = 0.12) or clinical score (p = 0.74). Our study shows low steady state wear rates at five years in
X3 highly cross-linked polyethylene in conjunction with a 36 mm
ceramic femoral head. The linear wear rate was almost identical
to the osteolysis threshold of 0.1 mm/year recommended in the literature. Cite this article:
We report a prospective study of the use of intramedullary bone blocks to improve the fixation of a matt-finish femoral stem in Charnley low-friction arthroplasties. There were 379 patients (441 hips), but at a minimum follow-up of ten years there were 258 arthroplasties in 221 patients including some which had been revised. The mean age at surgery was 41 years (17 to 51) and the mean follow-up was 13.4 years (1 to 20 including the early revisions). Nine stems (3.5%) had been revised for aseptic loosening, but there were no stem fractures. Survivorship of stems was 99.2% at ten years and 94.35% at 15 and 20 years. We found that the patient’s gender, the position of the stem and the experience of the surgeon all influenced the outcome. Our findings suggest that using our method of stem fixation, follow-up of over 11 years was needed to reveal the effects of endosteal cavitation of the femur, and of over 13 years to assess any divergence between the clinical and the radiological outcomes of stem fixation.
Aims. The aim of this study was to determine the outcome of all primary total hip arthroplasties (THAs) and their subsequent revision procedures in patients aged under 50 years performed at our institution. Methods. All 1,049 primary THAs which were undertaken in 860 patients aged under 50 years between 1988 and 2018 in our tertiary care institution were included. We used cemented implants in both primary and revision surgery. Impaction bone grafting was used in patients with acetabular or femoral bone defects. Kaplan-Meier analyses were used to determine the survival of primary and revision THA with the endpoint of revision for any reason, and of revision for aseptic loosening. Results. The mean age of the patients at the time of the initial THA was 38.6 years (SD 9.3). The mean follow-up of the THA was 8.7 years (2.0 to 31.5). The rate of survival for all primary THAs, acetabular components only, and femoral components only at 20 years’ follow-up with the endpoint of revision for any reason, was 66.7% (95% confidence interval (CI) 60.5 to 72.2), 69.1% (95% CI 63.0 to 74.4), and 83.2% (95% CI 78.1 to 87.3), respectively. A total of 138 revisions were performed. The mean age at the time of revision was 48.2 years (23 to 72). Survival of all subsequent revision procedures, revised acetabular, and revised femoral components at 15 years’ follow-up with the endpoint of revision for any reason was 70.3% (95% CI 56.1 to 80.7), 69.7% (95% CI 54.3 to 80.7), and 76.2% (95% CI 57.8 to 87.4), respectively. A Girdlestone excision arthroplasty was required in six of 860 patients (0.7%). Conclusion. The long-term outcome of cemented primary and subsequent revision THA is promising in these
The number of revision arthroplasties being performed in the elderly is expected to rise, including revision for infection. The primary aim of this study was to measure the treatment success rate for octogenarians undergoing revision total hip arthroplasty (THA) for periprosthetic joint infection (PJI) compared to a younger cohort. Secondary outcomes were complications and mortality. Patients undergoing one- or two-stage revision of a primary THA for PJI between January 2008 and January 2021 were identified. Age, sex, BMI, American Society of Anesthesiologists grade, Charlson Comorbidity Index (CCI), McPherson systemic host grade, and causative organism were collated for all patients. PJI was classified as ‘confirmed’, ‘likely’, or ‘unlikely’ according to the 2021 European Bone and Joint Infection Society criteria. Primary outcomes were complications, reoperation, re-revision, and successful treatment of PJI. A total of 37 patients aged 80 years or older and 120 patients aged under 80 years were identified. The octogenarian group had a significantly lower BMI and significantly higher CCI and McPherson systemic host grades compared to the younger cohort.Aims
Methods
Joint registries typically use revision of an implant as an endpoint and report survival rates after a defined number of years. However, reporting lifetime risk of revision may be more meaningful, especially in younger patients. We aimed to assess lifetime risk of revision for patients in defined age groups at the time of primary surgery. The New Zealand Joint Registry (NZJR) was used to obtain rates and causes of revision for all primary total hip arthroplasties (THAs) performed between January 1999 and December 2016. The NZJR is linked to the New Zealand Registry of Births, Deaths and Marriages to obtain complete and accurate data. Patients were stratified by age at primary surgery, and lifetime risk of revision calculated according to age, sex, and American Society of Anesthesiologists (ASA) classification. The most common causes for revision were also analyzed for each age group.Aims
Methods
Aims. This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. Methods. We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018. Results. Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient’s comorbidities. The periprosthetic fracture patients showed radiological evidence of change in bone stock around the femoral stem, which may have contributed to the fractures; this was reflected in change of the canal flare index at the proximal femur. Two patients (two hips) were lost to follow-up. Using aseptic loosening as the endpoint, 16 patients (18 hips; 48%) needed acetabular revision. None of the femoral components were revised for aseptic loosening, demonstrating 100% survival. The estimate of the cumulative proportion surviving for revisions due to any cause was 0.97 (standard error 0.03). Conclusion. In
Aims. To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia. Methods. We reviewed patients with severe hip dysplasia, defined as Severin IVb or V (lateral centre-edge angle (LCEA) < 0°), who underwent TOA with a structural bone allograft between 1998 and 2019. A medical chart review was conducted to extract demographic data, complications related to the osteotomy, and modified Harris Hip Score (mHHS). Radiological parameters of hip dysplasia were measured on pre- and postoperative radiographs. The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan–Meier product-limited method, and a multivariate Cox proportional hazard model was used to identify predictors for failure. Results. A total of 64 patients (76 hips) were included in this study. The median follow-up period was ten years (interquartile range (IQR) five to 14). The median mHHS improved from 67 (IQR 56 to 80) preoperatively to 96 (IQR 85 to 97) at the latest follow-up (p < 0.001). The radiological parameters improved postoperatively (p < 0.001), with the resulting parameters falling within the normal range in 42% to 95% of hips. The survival rate was 95% at ten years and 80% at 15 years. Preoperative Tönnis grade 2 was an independent risk factor for TOA failure. Conclusion. Our findings suggest that TOA with structural bone allografting is a viable surgical option for correcting severely dysplastic acetabulum in adolescents and
Aims. Spinopelvic pathology increases the risk for instability following total hip arthroplasty (THA), yet few studies have evaluated how pathology varies with age or sex. The aims of this study were: 1) to report differences in spinopelvic parameters with advancing age and between the sexes; and 2) to determine variation in the prevalence of THA instability risk factors with advancing age. Methods. A multicentre database with preoperative imaging for 15,830 THA patients was reviewed. Spinopelvic parameter measurements were made by experienced engineers, including anterior pelvic plane tilt (APPT), spinopelvic tilt (SPT), sacral slope (SS), lumbar lordosis (LL), and pelvic incidence (PI). Lumbar flexion (LF), sagittal spinal deformity, and hip user index (HUI) were calculated using parameter measurements. Results. With advancing age, patients demonstrate increased posterior APPT, decreased standing LL, decreased LF, higher pelvic incidence minus lumbar lordosis (PI-LL) mismatch, higher prevalence of abnormal spinopelvic mobility, and higher HUI percentage. With each decade, APPT progressed posteriorly 2.1°, LF declined 6.0°, PI-LL mismatch increased 2.9°, and spinopelvic mobility increased 3.8°. Significant differences were found between the sexes for APPT, SPT, SS, LL, and LF, but were not felt to be clinically relevant. Conclusion. With advancing age, spinopelvic biomechanics demonstrate decreased spinal mobility and increased pelvic/hip mobility. Surgeons should consider the higher prevalence of instability risk factors in elderly patients and anticipate changes evolving in spinopelvic biomechanics for
Aims. Hyaline cartilage has a low capacity for regeneration. Untreated osteochondral lesions of the femoral head can lead to progressive and symptomatic osteoarthritis of the hip. The purpose of this study is to analyze the clinical and radiological long-term outcome of patients treated with osteochondral autograft transfer. To our knowledge, this study represents a series of osteochondral autograft transfer of the hip with the longest follow-up. Methods. We retrospectively evaluated 11 hips in 11 patients who underwent osteochondral autograft transfer in our institution between 1996 and 2012. The mean age at the time of surgery was 28.6 years (8 to 45). Outcome measurement included standardized scores and conventional radiographs. Kaplan-Meier survival curve was used to determine the failure of the procedures, with conversion to total hip arthroplasty (THA) defined as the endpoint. Results. The mean follow-up of patients treated with osteochondral autograft transfer was 18.5 years (9.3 to 24.7). Six patients developed osteoarthritis and had a THA at a mean of 10.3 years (1.1 to 17.3). The cumulative survivorship of the native hips was 91% (95% confidence interval (CI) 74 to 100) at five years, 62% (95% CI 33 to 92) at ten years, and 37% (95% CI 6 to 70) at 20 years. Conclusion. This is the first study analyzing the long-term results of osteochondral autograft transfer of the femoral head. Although most patients underwent conversion to THA in the long term, over half of them survived more than ten years. Osteochondral autograft transfer could be a time-saving procedure for
Aims. To evaluate how abnormal proximal femoral anatomy affects different femoral version measurements in
Aims. The Birmingham Hip Resurfacing (BHR) was introduced in 1997 to address the needs of
Aims. This study investigates the use of the metabolic equivalent of task (MET) score in a
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. 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 short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment.Aims
Methods
Aims. Surgical treatment of
Aims. Adverse local tissue reactions associated with abnormal wear considerably slowed down the general use of metal-on-metal (MoM) hip resurfacing arthroplasty (HRA), now limited to a few specialized centres. In this study, we provide the clinical results of 400 consecutive MoM HRAs implanted more than 20 years ago in one such centre. Methods. A total of 355 patients (400 hips) were treated with Conserve Plus HRA between November 1996 and November 2000. There were 96 female (27%) and 259 male patients (73%). Their mean age was 48.2 years (SD 10.9). The University of California, Los Angeles (UCLA) hip scores and 12-item Short Form Survey (SF-12) quality of life scores were reported. Survivorship was assessed using Kaplan-Meier analyses. Results. The mean follow-up was 16.5 years (0.1 to 24.0), including 34 patients (37 hips) who died. The mean UCLA hip scores were 9.3 (2 to 10), 9.1 (3 to 10), 9.0 (3 to 10), and 6.9 (2 to 10) for pain, walking, function, and activity, respectively. The mean SF-12 scores were 48.4 (16.0 to 62.1) for the physical component and 48.5 (10.5 to 66.5) for the mental component, and did not differ from those of the general population of the USA. A total of 60 hips in 55 patients were revised. Using revision for any indication as the endpoint, the Kaplan-Meier survivorship was 83.5% at 20 years. A diagnosis of developmental dysplasia (hazard ratio (HR) 2.199 (95% confidence interval (CI) 1.140 to 4.239); p = 0.019) and a low BMI (HR 0.931 (95% CI 0.873 to 0.994); p = 0.032) were risk factors for revision. Female sex was a risk factor only because of hip dysplasia and small component size. There were no cases of metal sensitivity associated with revision surgery. Radiological analysis showed persistent fixation in all but one hip. Conclusion. The 83.5% 20-year survivorship of this initial series surpasses that of total hip arthroplasties in use 20 years ago in these
Aims. Highly cross-linked polyethylene (HXLPE) has greatly improved the durability of total hip arthroplasty (THA) in
Cementless femoral stems must be correctly sized and well-seated to obtain satisfactory biological fixation. The change in sound that occurs during impaction of the femoral broach is said to indicate good fit, but this has not been widely studied. We set out to find whether the presence or absence of these sound changes could predict correct sizing. We recorded the sound generated during femoral broaching for 105 cementless total hip arthroplasties using the Corail stem. Four cases were excluded, leaving 101 recordings for analysis. There were 36 male patients and 65 female patients, with a mean age of 69.9 years (Aims
Patients and Methods
Uncemented metal acetabular components show good osseointegration, but material stiffness causes stress shielding and retroacetabular bone loss. Cemented monoblock polyethylene components load more physiologically; however, the cement bone interface can suffer fibrous encapsulation and loosening. It was hypothesized that an uncemented titanium-sintered monoblock polyethylene component may offer the optimum combination of osseointegration and anatomical loading. A total of 38 patients were prospectively enrolled and received an uncemented monoblock polyethylene acetabular (pressfit) component. This single cohort was then retrospectively compared with previously reported randomized cohorts of cemented monoblock (cemented) and trabecular metal (trabecular) acetabular implants. The primary outcome measure was periprosthetic bone density using dual-energy x-ray absorptiometry over two years. Secondary outcomes included radiological and clinical analysis.Aims
Methods
Aims. Despite advances in the treatment of paediatric hip disease, adolescent and
Aims. Hip resurfacing arthroplasty (HRA) is typically indicated for
Aims. The aim of this study was to analyze the effect of a lateral rim mesh on the survival of primary total hip arthroplasty (THA) in