Showing papers on "Harris Hip Score published in 2002"

Treatment of osteonecrosis with autologous bone marrow grafting.

Abstract: Core decompression with bone graft is used frequently in the treatment of osteonecrosis of the femoral head. Many different techniques have been described. In the current series, grafting was done with autologous bone marrow obtained from the iliac crest of patients operated on for osteonecrosis of the hip. The results of a prospective study of 189 hips in 116 patients treated with core decompression and autologous bone marrow grafting are reported. Patients were followed up from 5 to 10 years. The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The bone marrow was harvested with the patient under general anesthesia. The usual sites were the anterior iliac crests. The aspirated marrow was reduced in volume by concentration and injected into the femoral head after core decompression with a small trocar. When patients were operated on before collapse (Stage I and Stage II), hip replacement was done in nine of the 145 hips. Total hip replacement was necessary in 25 hips among the 44 hips operated on after collapse (Stage III and Stage IV). To measure the number of progenitor cells transplanted, the fibroblast colony forming unit was used as an indicator of the stroma cell activity. Patients who had the greater number of progenitor cells transplanted in their hips had better outcomes.

Arthroplasty of the hip. Leg length is not important.

Abstract: Discrepancy in leg length after total hip replacement has been associated with patient dissatisfaction. We prospectively studied 200 consecutive patients undergoing unilateral Charnley hip replacements to identify whether there is a demonstrable association between such disparity and postoperative function. Radiological measurements between defined points on the pelvis and femur of the operated hip were compared with the same points on the contralateral joint. A lengthening index was derived and statistical analysis used to compare this with validated functional outcome scores (Harris hip score and the SF36 Health Survey) and patient satisfaction. Our results showed no statistical association between leg-length discrepancy after hip arthroplasty and functional outcome or patient satisfaction.

Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results.

Abstract: Background: We assessed the role of acute total hip arthroplasty in a selected group of patients with a displaced acetabular fracture and complicating features that greatly diminished the likelihood of a favorable outcome after open reduction and internal fixation. Methods: Between 1985 and 1997, fifty-seven patients underwent an acute total hip arthroplasty for a displaced acetabular fracture. Patients were followed for a mean of 8.1 years (range, two to twelve years). The mean time from the injury to the arthroplasty was six days (range, one to twenty days). The mean age of the patients at the time of the arthroplasty was sixty-nine years (range, twenty-six to eighty-nine years). Indications for the acute arthroplasty included intra-articular comminution as well as full-thickness abrasive loss of the articular cartilage, impaction of the femoral head, and impaction of the acetabulum that involved >40% of the joint surface and included the weight-bearing region. Results: At the time of the latest follow-up, the mean Harris hip score was 89 points (range, 69 to 100 points); forty-five patients (79%) had an excellent or good outcome. There were six cases of heterotopic bone formation, including one of symptomatic grade-IV ossification. During the initial six postoperative weeks, the acetabular cups subsided an average of 3 mm medially and 2 mm vertically. All of the cups then stabilized, and none were loose at the latest follow-up evaluation. Six patients had excessive medialization of the cup, but none had late loosening or osteolysis. Nine cups (16%) had notable polyethylene wear, but none were revised. No cup or stem had late clinical or radiographic evidence of loosening. There were three late procedures: one for revision of a malaligned cup because of recurrent dislocations, one for removal of hardware from the greater trochanter, and one for excision of heterotopic bone. Conclusions: In selected patients with a displaced acetabular fracture that has a low likelihood of a favorable outcome after fracture treatment, an acute total hip arthroplasty may provide an alternative means with which to achieve a painless, mobile hip. These complex procedures are best undertaken by a surgical team with substantial experience with both acetabular trauma and hip arthroplasty.

Cementless total hip arthroplasty with a tapered, rectangular titanium stem and a threaded cup: a minimum ten-year follow-up.

Abstract: Background: We report the results of cementless total hip arthroplasty with a tapered, rectangular titanium stem that was introduced in 1979 and continues to be used today with only minor changes. The aim of the design is to achieve primary stability to resist rotational and axial forces through precision rasping and press-fit implantation of a tapered, rectangular femoral component. Methods: Between October 1986 and November 1987, 208 total hip arthroplasties with insertion of a tapered, rectangular titanium stem and a threaded cup without cement were performed in 200 consecutive patients (average age, sixty-one years; range, twenty-two to eighty-four years). Results: At the time of the latest follow-up, fifty-one patients (fifty-two hips) had died and sixteen patients had been lost to follow-up, leaving 133 patients. Twelve hips had been revised, two in patients who subsequently died, leaving 123 living patients without revision. The median follow-up time was 120.7 months. Five cups needed revision surgery because of aseptic loosening; two, because of massive polyethylene wear; one, because of posttraumatic migration; and one, because of breakage. Three femoral stems were revised: one because of malpositioning (the reoperation was done five days after implantation); one, because of infection; and the third, after multiple failed acetabular revisions. The mean Harris hip score for the patients who did not have revision was 85.4 points (range, 46 to 100 points) at the time of the latest follow-up. Four patients (3%) complained of thigh pain that was not associated with another disorder. According to the criteria of Engh et al., all femoral implants were graded as stable bone-ingrown. The probability of survival of both the femoral and the acetabular component at ten years, with any revision as the end point, was 0.92 (95% confidence interval, 0.88 to 0.97). The probability of survival of the cup was 0.93 (95% confidence interval, 0.89 to 0.97), and that of the stem was 0.99 (95% confidence interval, 0.97 to 1.00). Conclusions: The results of arthroplasty with a tapered, rectangular titanium stem combined with a conical threaded cup inserted without cement were excellent at a minimum of ten years. Our data suggest that femoral stem fixation continues to be secure, while the threaded cup is prone to aseptic loosening.

Survival and polyethylene wear of porous-coated acetabular components in patients less than fifty years old: results at nine to fourteen years.

Abstract: Background: Younger patients (those who are less than fifty years old) have been shown to have a high rate of failure of cemented acetabular components following total hip arthroplasty. In this report, we present the results associated with the use of an uncemented acetabular component in young patients who were evaluated at a minimum of nine years postoperatively. Methods: Between December 1984 and December 1989, the senior author performed 174 primary total hip arthroplasties with use of a single design of porous-coated acetabular component. Seventy-one of these procedures were performed in fifty-six patients who were younger than fifty years old. Fifty-six of the seventy-one hips were available for radiographic and clinical analysis after a mean duration of follow-up of eleven years. All hips had been treated with a Harris-Galante-I porous-coated acetabular component that had been placed with a line-to-line fit and fixed with a mean of four screws. Clinical analysis was performed with use of the Harris hip score. Standardized anteroposterior radiographs were analyzed with regard to migration, radiolucent lines, pelvic osteolysis, and two-dimensional linear wear of the polyethylene. Results: No metal shell was revised because of aseptic loosening, and no shell was loose at the time of the latest follow-up. A nonprogressive radiolucent line was seen in one zone in ten hips (18%) and in two zones in six hips (11%). No hip had a radiolucent line in all three zones. Pelvic osteolysis was noted in thirteen hips (23%); the osteolysis was observed in the ischium in eleven hips and around the screws in two. Survivorship analysis revealed that the probability of survival of the metal shell was 98% (95% confidence interval, 96.9% to 99.9%) at ten years. The mean rate of linear polyethylene wear (and standard deviation) was 0.15 ± 0.10 mm/yr (range, 0.02 to 0.59 mm/yr). The wear rate was significantly increased in patients with an excellent Harris hip score (p = 0.004) and a younger age (less than thirty-eight years) (p = 0.026). With the numbers available, no relationship could be detected between the wear rate and the gender or weight of the patient, the polyethylene thickness, the abduction angle, or the femoral neck length. Conclusions: The fixation and survival of porous-coated acetabular metal shells in patients less than fifty years old was excellent after a mean duration of follow-up of eleven years. The high rate of linear polyethylene wear and the high prevalence of pelvic osteolysis are of serious concern in this patient population. Continued follow-up will be necessary to evaluate the influence of these findings on the longevity of the fixation of this prosthesis.

In vivo comparison of hip separation after metal-on-metal or metal-on-polyethylene total hip arthroplasty

Abstract: Background: Twenty subjects were analyzed in vivo with use of video fluoroscopy to determine if the femoral head separates from the acetabular component during normal gait and to determine if the amount of separation differs between metal-on-metal and metal-on-polyethylene total hip prostheses. Methods: Ten subjects had been treated with a metal-on-metal total hip arthroplasty and ten, with a metal-on-polyethylene total hip arthroplasty. All of the prostheses were implanted by the same surgeon utilizing the same surgical technique, and all were judged to be clinically successful (a Harris hip score of >90 points). Each subject walked with a normal gait on a level treadmill while under fluoroscopic surveillance. The two-dimensional fluoroscopic videotapes were then converted into three-dimensional images with use of a computer-automated model-fitting technique. Each implant was analyzed at various flexion angles to assess the amount of femoral head sliding. Results: No femoral head sliding was observed in the subjects with a metal-on-metal implant, whereas all ten subjects with a metal-on-polyethylene implant had sliding that was greater than our threshold value of 0.75 mm. The average amount of femoral head sliding in these subjects was 2.0 mm, and the sliding was observed during the swing phase of gait. The sliding was typically seen medially while the femoral head remained in contact with the acetabular component superolaterally. Conclusions: Femoral head sliding commonly occurred following traditional metal-on-polyethylene total hip arthroplasty but not after metal-on-metal arthroplasty. These kinematic data may be of value in future hip-simulation studies to better duplicate wear patterns observed in retrieval analyses, assist in the understanding of the lubrication and wear rates of metal-on-metal designs, and facilitate designing of prosthetic components that minimize wear and optimize hip kinematics.

Patient expectation and satisfaction in revision total hip arthroplasty

Abstract: Sixty-six consecutive revision total hip arthroplasty patients were asked about their expectations regarding future pain and walking ability. Expectations were high, regardless of background factors: 92% expected to have much less pain, and 82% expected the same walking ability as after the primary arthroplasty or a much improved walking ability. Of the patients, 56% stated a non–surgeon-related origin of expectations, 7% were uncertain, and 37% said expectations derived from the surgeon. At 1 year, Harris hip score had increased from a median 45 to 77 points, but only 69% and 55% said that their expectations had been fulfilled to a very large or rather large extent regarding pain and walking ability. The only predictor of fulfilled expectations was absence of complications (odds ratio, 4.8; 95% confidence interval, 1.1-20.8). Patient satisfaction was only moderate; 63% were very or rather satisfied with a moderate correlation (0.46-0.47) between satisfaction and fulfilled expectations. Patients with a poor preoperative hip condition generally were more satisfied (odds ratio, 5.0; 95% confidence interval, 1.4-17.9), and the most important reason probably was an improved walking ability ( r = 0.64). Patient dissatisfaction may originate from unrealistic expectations. At preoperative consultation, it is recommended that the surgeon discuss the revision patient's expectations, especially regarding future walking ability, and inform the patient about the fundamental prognostic differences between revision and primary hip arthroplasty. Copyright 2002, Elsevier Science (USA). All rights reserved.

Comparison of total hip arthroplasty performed with and without cement : a randomized trial.

Abstract: Background: This study was designed to compare the fixation of a Mallory-Head total hip prosthesis with and without cement. Methods: Two hundred and fifty patients with osteoarthritis of the hip were randomized to receive a Mallory-Head total hip prosthesis designed for insertion with cement or the same prosthesis designed for insertion without cement. Neither the patient nor the outcomes assessor was aware of the type of prosthesis. Outcomes were assessed with respect to mortality, revision arthroplasty, health-related quality of life (evaluated with the Harris hip score, Merle d'Aubigne and Postel hip score, McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the time trade-off technique), and the six-minute-walk test. Patients were seen at three, six, and twelve months and yearly thereafter. Results: The prosthesis was inserted with cement in 124 patients and without cement in 126 patients. The mean age of the patients was sixty-four years, 48% were female, and the mean duration of follow-up was 6.3 years. There were thirteen revisions in the group that had fixation with cement and six in the group that had fixation without cement (p = 0.11), and more femoral components were revised in the group that had fixation with cement (twelve versus one; p = 0.002). All health-related quality-of-life measures improved postoperatively in both groups. Conclusions: In this randomized trial, the group that had the cemented Mallory-Head hip prostheses required more revisions of the femoral component than did the group with the cementless Mallory-Head prostheses, which was perhaps related to the titanium-alloy femoral stem. Our findings are specific to the implants evaluated in this study.

Salter innominate osteotomy for the treatment of developmental dysplasia of the hip in children: results of seventy-three consecutive osteotomies after twenty-six to thirty-five years of follow-up.

Abstract: Background: Reorientation of the acetabulum may be necessary in the treatment of an unstable hip in children with developmental dysplasia of the hip. In 1961, Salter described the innominate osteotomy for stabilizing the reduced hip in the position of function by redirection of the acetabulum as one piece. In the present study, we describe our long-term results with this procedure. Methods: We reviewed the cases of sixty-one patients who had seventy-three Salter innominate osteotomies. At the time of the operation, the mean age of the patients was 4.1 years (range, 1.3 to 8.8 years). Radiographs made preoperatively, postoperatively, and at the time of the most recent follow-up visit were evaluated. Clinical evaluation was performed with use of the Merle d'Aubigne and Postel system as well as the Harris hip score. Results: The mean duration of follow-up was 30.9 years (range, 26.2 to 35.4 years). There were seven true revisions (one acetabuloplasty, one triple osteotomy, and five total hip arthroplasties). With true revision as the end point, the cumulative survival rate at 35.3 years was 0.90. Fifteen of the seventy-three hips were considered a failure, which was defined as a revision or a Harris hip score of <70 points and/or a Merle d'Aubigne and Postel score of <13 points. The long-term clinical outcome was significantly influenced by the grade of dislocation on the radiographs made at the first examination (p = 0.0388) and on those made immediately preoperatively (p < 0.0001), the postoperative summarized hip factor (the radiographic grade of dysplasia) (p = 0.0002), the preoperative (p = 0.0392) and postoperative (p = 0.0072) grades of avascular necrosis of the femoral head, and the technique of reduction (p < 0.0001). Conclusions: When an acetabulum can be most closely restored to a normal configuration without the development of avascular necrosis, good long-term results (lasting for more than thirty years) can be expected. When open reduction is necessary, it is preferable to perform it separately prior to the Salter innominate osteotomy. The grade of dislocation at the time of the first examination and immediately preoperatively, the grade of avascular necrosis of the femoral head, and the adequacy of surgical correction are important prognostic factors for the long-term clinical result.

Eccentric rotational acetabular osteotomy for acetabular dysplasia: follow-up of one hundred and thirty-two hips for five to ten years.

Abstract: Background: Eccentric rotational acetabular osteotomy for the operative treatment of acetabular dysplasia consists of a spherical but eccentric osteotomy and rotation of the acetabulum that moves the center of rotation of the head of the femur medially and distally. No bone graft is needed. The reorientation of the acetabular fragment not only improves acetabular coverage but also restores the center of rotation of the subluxated hip. The purpose of this paper was to describe eccentric rotational acetabular osteotomy for the treatment of acetabular dysplasia and to evaluate its clinical and radiographic outcomes. Methods: We performed this procedure consecutively in 132 hips in 126 patients with dysplasia of the hip. Eighteen hips had no osteoarthritis, fifty-three had early osteoarthritis, and sixty-one had advanced osteoarthritis. Seven patients were male, and 119 were female. The average age was 36.5 years at the time of the index operation, and the average duration of follow-up was 7.5 years. Twenty-three hips in twenty-two patients were also treated with intertrochanteric valgus osteotomy to further improve joint congruency at the time of the acetabular osteotomy. Results: The average preoperative Harris hip score of 71 points improved to an average score of 89 points at the time of the latest follow-up. The average center-edge angle improved from 0° to 36°. An apparent change in the stage of the arthritis was observed in seven hips (5%), one of which had had early-stage disease and six of which had had advanced disease preoperatively. Conclusions: Eccentric rotational acetabular osteotomy appears to be a good treatment option for young patients with either early or advanced hip osteoarthritis secondary to dysplasia.

Total hip replacement with a cementless acetabular component and a cemented femoral component in patients younger than fifty years of age.

Abstract: Background: We have been using hybrid total hip arthroplasty (a cementless acetabular component and a cemented stem) in young patients. The purpose of this study was to determine the prevalence of aseptic loosening, polyethylene wear, and osteolysis after the use of this technique. Methods: We studied a prospective consecutive series of sixty-four primary hybrid total hip replacements in fifty-five patients younger than fifty years old. There were forty-three men and twelve women; the average age at the time of the index operation was 43.4 years. The average duration of follow-up was 9.4 years. We used a cementless acetabular component without screw-holes and a cemented femoral component with a 22-mm head in all hips. Clinical follow-up with use of Harris hip ratings and radiographic follow-up were performed at six weeks; at three, six, and twelve months; and yearly thereafter. The sequential annual linear and volumetric wear rates were measured, and bone-remodeling and osteolysis were assessed. Results: The mean preoperative Harris hip score was 44 points, which increased to 95 points at the time of final follow-up. No hip had aseptic loosening. One hip (2%) was revised because of late infection. The average linear wear (and standard deviation) was 0.96 ± 0.066 mm, with an average annual rate of 0.096 ± 0.013 mm. The average volumetric wear was 364.7 ± 25.2 mm3, with an average annual rate of 43.4 ± 3.5 mm3. Six hips (9%) had an osteolytic lesion of <1 cm in diameter in the calcar femorale (zone 7). Conclusions: Our results show that a hybrid arthroplasty with a cementless acetabular component and a smooth cemented femoral component (Ra, 0.6 mm) is effective for primary total hip replacement in young patients. Although there was no aseptic loosening and a low prevalence of osteolysis at the latest follow-up evaluation, the high rates of linear and volumetric wear of the polyethylene liner in these young patients remain a concern.

Core decompression in early stages of femoral head osteonecrosis--an MRI-controlled study.

Abstract: We treated 45 hips with idiopathic necrosis of the femoral head stages I–III with core decompression. Average age of patients was 41 (27–68) years and average follow-up 68.9 (31–120) months. In 30 hip joints in stage I, 29 showed no radiographic progression and a complete remission of the changes consistent with necrosis on MRI at the last follow-up. In 27 patients the clinical result – based on the Harris Hip Score (HHS) assessment – was excellent (average HHS 91.9 points). Of nine hips in stage II, four had received a total hip arthroplasty, one had deteriorated to stage IV, and four were still classified as stage II (average HHS 95 points). Of six hips in stage III, three had received a total hip arthroplasty and three had deteriorated to stage IV (average HHS 73 points).

Medium-term results of the ABG total hip arthroplasty in young patients.

Abstract: A total of 66 patients (71 hips) <65 years old (average age, 55.4 years; range, 26–65 years) received a proximally hydroxyapatite-coated femoral prosthesis with a hemispheric metal-backed, hydroxyapatite-coated acetabular cup (ABG hip, Howmedica International, Staines, UK), with an average follow-up of 4.8 years (range, 2–7 years). All operations were performed by 1 surgeon in a district general hospital. The average preoperative Harris hip score and Merle d'Aubigne score were 59.8 and 9.6, which rose to 92.7 and 16.3 at the longest follow-up. Most patients were satisfied with the outcome, with only 2 patients complaining of intermittent thigh pain. Survivorship analysis predicted a survival rate of 96.87% at 7 years. There were 2 revisions, one to reposition an acetabular cup and one for an undersized femoral component. Radiographic changes were consistent with bone remodeling. There were no radiolucencies around the acetabular cup, but we noted eccentric polyethylene wear in 37 (60%) inserts ranging from 0.4 to 4 mm (annual wear average, 0.25 mm/y; range, 0.063–0.76 mm/y). There were no loose femoral stems. Osseointegration was achieved in all cases, with only 1 case developing endosteal cavitation in Gruen zone 2. Cancellous densification was found to be mainly in zones 2 and 6 (67.2% and 55.7%), extending distally in zones 3 and 5 (52.4% and 50.8%). Hypertrophy of the femoral shaft was less prominent and was noted mostly distally, in zones 3, 4, and 5 (11.4%, 18.3%, and 18.3%), extending proximally in zones 2 and 6 (8.1% and 13.1%). The ABG hip can achieve excellent results in the medium term, but polyethylene wear of the acetabular insert should be noted with concern.

Exchange impaction allografting for femoral revision hip arthroplasty: results in 87 cases after 3.6 years' follow-up.

Abstract: A total of 87 femoral exchange revision procedures were performed in 80 patients. Mean follow-up time was 3.6 years. Patients were followed prospectively. At follow-up, 5 patients had died, and 74 (93 %) completed follow-up. Results were evaluated on the basis of incidence of re-revisions and other complications, patient satisfaction, and preoperative and postoperative Harris hip score. Radiographic evaluation included preoperative femoral bone status evaluated according to Endo-Klinik and Mallory, incidence of subsidence, bone-graft incorporation, and signs of loosening. Three patients were re-revised, 2 patients suffered postoperative femoral fractures, 5 patients had hip dislocations, and 1 patient suffered deep infection. Of patients, 90% expressed satisfaction with the result. Harris hip score improved from 39 to 82 (P 5 mm. Of patients, 88% showed signs of graft incorporation, and only 1 patient showed signs of loosening. Intermediate follow-up evaluation of the exchange femoral revision technique showed good clinical and radiographic results. With a re-revision rate of 3.5% and incidence of >5 mm subsidence of 2.5%, we did not observe the problems of subsidence and femoral fractures that previous studies have described.

Revision surgery in pelvic discontinuity: an analysis of seven patients.

Abstract: The technical aspect and clinical outcome of seven patients with pelvic discontinuities in acetabular revision surgery after a mean followup of 96 months were analyzed. The surgical treatment consisted of three consecutive steps beginning with mechanical stabilization of the two acetabular columns, followed by bony acetabular reconstruction by filling the osteolytic defect with allograft chips covered with autologous bone to achieve a contained defect after healing of the autograft, and anchorage of the cup using an acetabular reinforcement ring (five with a hook, two without a hook). Complications included a partial ischial nerve lesion, one intraoperative femoral shaft fracture, and one recurrent dislocation. One patient had revision surgery 12 months after the first revision surgery because of aseptic loosening, and in one patient two prominent screws had to be removed. The clinical improvement according to the Harris hip score was 40.1 points on average (preoperative, 33 points; postoperative, 73.1 points). At the final followup all acetabular components were stable and the pelvic discontinuity had healed. Despite the technical feasibility of such revisions and the acceptable clinical results, the complication rate is high. Early diagnosis of acetabular loosening to minimize the osteolytic loss of bone stock is important.

Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. a nine to fifteen-year follow-up

Abstract: Aim: Proximal femoral allografts are a rare but valuable option in severe femoral bone loss in revision hip arthroplasty. However, there are no long-term follow-up reports on their use. The purpose of this study was to review the average 11-year results of massive proximal femoral allografts used for severe bone loss in revision hip arthroplasty. Method: Sixty-three total hip arthroplasties in 60 consecutive patients were revised with a proximal femoral allograft and a prosthesis. The mean length of the allograft was fifteen centimeters. All patients had undergone at least one previous total hip arthroplasty, with a mean of 3.8 operations. Each patient was assessed before operation and at follow-up with a modified Harris hip score and radiographs. Results: At a mean follow-up of 11 years (range: nine to 15 years), 45 patients (75%) were alive, 14 patients (23 %) were deceased and one patient was lost to follow- up. The average preoperative Harris hip score was 30 points; at the latest follow-up the average score of those with the original graft in situ was 71. The deceased and lost patients represented 15 allografts (24%) with an average of five years and seven months follow-up. There were five failures for infection, four of which were successfully revised. Three hips failed with aseptic loosening at average 10 years and three months, two have been successfully re-revised and the third is awaiting revision. Success was defined as a postoperative increase in the Harris hip score of greater than twenty points, a stable implant, and no need for further surgery related to the allograft at the time of review. The success rate for all patients was 78% at an average of nine years follow-up. The success rate of those living was 77% at an average of 11 years follow-up. Conclusion: At an average of 11-years following proximal femoral allografts the clinical and radiological results were encouraging.

The effect of partial or full weight bearing ambulation after cementless total hip arthroplasty.

Abstract: The clinical and radiographic results of 46 patients who underwent 50 consecutive primary total hip arthroplasties using a fully porous-coated collared femoral component were determined at a minimum of 2 years' follow-up. Twenty-four patients (25 hips) who were allowed to bear full weight immediately postoperatively were compared with a historical control group of 24 patients (25 hips) who were instructed to bear < or =50 lb of weight for 6 weeks. The average Harris hip score for the partial weight bearing group was 95 compared with 97 for the full weight bearing group. All femoral components in both groups had radiographic evidence of bone ingrowth fixation at the final follow-up. When solid initial fixation is obtained intraoperatively and radiographically using a fully porous-coated (AML) femoral component, it seems that bone ingrowth fixation reliably occurs whether or not a partial or full weight-bearing postoperative protocol is followed.

Positive effects of anabolic steroids, vitamin D and calcium on muscle mass, bone mineral density and clinical function after a hip fracture. A randomised study of 63 women.

Abstract: A total of 63 women who had an operation for a fracture of the hip was randomly allocated to one year of treatment either with anabolic steroids, vitamin D and calcium (anabolic group) or with calcium only (control group). The thigh muscle volume was measured by quantitative CT. The bone mineral density of the hip, femur and tibia was assessed by quantitative CT and dual-energy x-ray absorptiometry and of the heel by quantitative ultrasound. Quantitative CT showed that the anabolic group did not lose muscle volume during the first 12 months whereas the control group did (p<0.01). There was less bone loss in the proximal tibia in the anabolic group than in the control group. The speed of gait and the Harris hip score were significantly better in the anabolic group after six and 12 months. Anabolic steroids, even in this moderate dose, given in combination with vitamin D and calcium had a beneficial effect on muscle volume, bone mineral density and clinical function in this group of elderly women.

Successful hip arthroplasty using cementless titanium implants in rheumatoid arthritis.

Abstract: Over a period of eight years, we implanted a total of 76 cementless hip prostheses in patients with rheumatoid arthritis. The clinical results of 47 patients (70 hips) increased from a mean Harris Hip Score of 33 to 85 after an average of 49 months (range 1-11 years). One threaded cup has had to be revised because of loosening, and one stem because of femoral fracture. At the latest follow-up, 88% of Hofer-Imhof threaded cups had complete bone ingrowth (Type 0); 10% had near-complete bone ingrowth with minimal radiolucency in one third of the bone contact area (Type 1), and 2% had radiolucency in two thirds of the bone contact area (Type 2). Hemispherical push-in cups showed significantly more radiolucency around the cup. For the stems (Uni, Zweymuller SL), 83% showed no radiolucency (Type 0); 17% had radiolucency only very proximally (Type 1). Minor remodelling (Type 1) occurred in 60% of the femoral shafts; 30% had moderate femoral density loss (Type 2), and 10% had severe bone loss and cortical thinning (Type 3). There was no correlation between marked shaft atrophy and clinical symptoms. With regard to radiolucency and remodelling, there was no significant difference between the two types of stem used. Cementless hip arthroplasty using titanium implants has an excellent outcome in the medium term.

Complications following the "T extensile" approach: a modified extensile approach for acetabular fracture surgery-report of forty-three patients.

Abstract: Objective: Analyze the prevalence and severity of surgical complications encountered with a modified extended iliofemoral approach, the "T extensile" approach, in the treatment of complex acetabular fractures Study Design: Prospective. Methods: During a sixteen-month study period, forty-three patients with complex acetabular fractures were treated via the T extensile approach. Perioperative antibiotics were used to prevent infection, and prophylaxis for heterotopic ossification was done with postoperative irradiation. Complications and clinical results were recorded. The patients were followed for an average of thirty months. Results: Acceptable reductions were obtained in forty patients. Poor reductions were obtained in three patients. There were no infections or iatrogenic nerve injuries. Brooker Grade 1 heterotopic ossification was seen in nineteen patients, eight had Grade 2, two had Grade 3, and no heterotopic ossification was seen in the other fourteen patients. No patient who received radiation developed heterotopic ossification beyond Brooker Grade 2. Seven patients went on to require total hip arthroplasty. The remaining thirty-six patients had an average Harris Hip Score of 86. Conclusions: Extensile exposures to the acetabulum can be safely carried out with limited morbidity, as long as appropriate steps are taken to limit predictable complications.

Long-term results of use of a collared matte-finished femoral component fixed with second-generation cementing techniques. A fifteen-year-median follow-up study.

Abstract: Background: So-called second-generation cementing techniques in total hip arthroplasty have been shown to provide better survival of the femoral component than first-generation methods do; however, surface finish and other features of the component design also influence the durability of the reconstruction. The purpose of this study was to determine the results of primary total hip replacement with use of a collared femoral component with a matte-finished surface fixed with second-generation cementing techniques and followed for ten to twenty years. Methods: The study group consisted of 256 consecutive hips in 236 patients who had had a primary total hip arthroplasty with fixation of a Harris Design-2 femoral component with second-generation cementing techniques (use of an intramedullary plug and a cement gun). The mean age of the patients at the time of the operation was sixty-six years. One hundred and twelve patients were male, and 124 were female. Seven patients were lost to follow-up less than ten years after the operation. The median duration of follow-up of the living patients who had not had a revision was 15.4 years. Results: At the time of the most recent follow-up, nineteen femoral components (7%) had been revised because of aseptic loosening, five (2%) had been removed because of deep infection, and one (0.4%) had been revised because of recurrent dislocation. The mean Harris hip score for the surviving patients who had not had a revision improved from 51 points preoperatively to 91 points at the most recent evaluation. At fifteen years, the estimated survival rate of the femoral components was 92.2% with revision due to aseptic loosening as the end point and 90.1% with mechanical failure (radiographic loosening or revision due to aseptic loosening) as the end point. Patients who were younger than fifty years old at the time of the operation had a lower fifteen-year rate of survival of the femoral implant, in terms of both revision due to aseptic loosening (72.3% compared with 95.7%, p = 0.0001) and mechanical failure (72.3% compared with 93.1%, p = 0.005), than did patients who were fifty years or older. Conclusions: Fixation of this collared matte-finished femoral component with use of second-generation cementing techniques for primary total hip replacement provided satisfactory results at ten to twenty years in older patients but less satisfactory results in younger patients.

Revision cup arthroplasty using Burch-Schneider anti-protrusio cage.

Abstract: From 1986 until 1995 we used the Burch-Schneider anti-protrusio cage in 31 patients (33 hips) and followed the patients for 5 years. Five patients died within the 5-year follow-up. Clinical outcome listed an average Harris hip score of 71/70/66 points after 1, 2 and 5 years respectively. One patient had a revision due to late-onset haematogenous infection. We found cup migration in nine patients. Migration was self-limiting in three cases and in two there was no bony graft ingrowth. Screw breakage was seen in one case. All migrated cages showed a higher rotational centre than cages without migration.

Why a taper

Abstract: The purpose of this study was to substantiate the continued use of a cementless plasma-sprayed, proximal-to-distal dual-tapered-geometry femoral-component design on the basis of long-term clinical and radiographic evidence. This justification is particularly pertinent in cementless total hip arthroplasty, in which bone-stock preservation and prosthetic-host compatibility are essential. A series of 101 patients managed with 120 primary arthroplasties who had a minimum follow-up of ten years was retrospectively reviewed. A meta-analysis of published reports of cementless tapered femoral components with a minimum follow-up of five years then was performed to validate the results of this review. At a mean follow-up of 12.2 years, a mean 38-point improvement in the Harris hip score was observed. Thigh pain was mild or absent after 97.5% (117) of the 120 arthroplasties. Distal femoral osteolysis was observed after 1.7% (two). Three femoral components had been revised secondary to aseptic loosening, yielding a 97.5% survivorship. Tapered geometries are an important feature in cementless femoral-component design, and the use of this design typically results in minimal thigh pain, a low incidence of stress shielding, and a low incidence of distal osteolysis. Designs with porous coating remain durable and continue to produce positive osseous responses, as observed radiographically. The Harris hip score improvement, the low incidence of severe thigh pain, and the high survivorship, coupled with a low incidence of substantial stress shielding and distal osteolysis, suggest excellent long-term results with the use of this specific cementless tapered design, adding credence to the design rationale and justifying its continued use. These data were supported by the results of an evidence-based meta-analysis, indicating similar results among cementless tapered designs. Although early reports of cementless total hip arthroplasties revealed low rates of aseptic loosening and stable bone ingrowth 1-5, other concerns regarding cementless fixation arose, including a higher …

Hydroxyapatite coated stems in younger and older patients with hip arthritis.

Abstract: A primary aim of research in total hip arthroplasty is to extend longevity through improved fixation and decreased wear and osteolysis. Age range of patients receiving hip implants is ever increasing as technology improves and average life span increases. The current report focuses on minimum 10-year results of a proximally hydroxyapatite-coated stem in patients with degenerative joint disease, comparing those 45 years and older (n = 229 hips) with younger patients (n = 41 hips). Clinically, the average Harris hip score is 91 points and 88 points in the older and younger groups, respectively. Mechanical failure rates for the stem are 0.4% and 2.4%, with one stem revision for aseptic loosening and no radiographically loose stems in each age group. Proximal femoral osteolysis is seen more often in younger patients (48% versus 38%), and younger patients (six hip arthroplasties) had reoperation for wear or osteolysis. Therefore, this stem has performed well at a 10-year minimum followup. However, polyethylene wear and osteolysis have led the authors to begin a United States Food and Drug Administration study of an alumina ceramic-on-alumina ceramic bearing surface in conjunction with the same stem. At 2 years minimum followup, there have been no complications related to the ceramic bearing surfaces, no cortical erosions, and no stem revisions for aseptic loosening.

The thrust plate prosthesis in patients with aseptic osteonecrosis of the femoral head.

Abstract: Background. The thrust plate prosthesis (TPP) is an implant with a metaphyseal fixation at the proximal femur that transmits the load forces of the hip onto the femoral neck. The osseous incorporation of the TPP and the adaptation of the bone to this force transmission depend on the bone quality, which is reduced to minor vitality and stability in patients with osteonecrosis of the femoral head. Depending on the etiology of the femoral head necrosis, the TPP might lead to early failures. Methods. In a prospective study, 63 patients with 72 cementless TPP due to femoral head osteonecrosis were examined. A clinical and radiological evaluation was performed preoperatively, 3 and 6 months postoperatively, and every year thereafter. The average follow-up period was 4.8±1.3 years with a minimum of 3 years. The pathogenesis of femoral head necrosis included alcoholism (n=19), subsequent to renal transplantation (n=11), during cortisone therapy of other dyscrasia (n=9), preceding a polychemotherapy (n=4), diabetes (n=3), sickle cell anemia (n=1), and idiopathic osteonecrosis (n=25). Results. The Harris Hip Score increased continuously from 50.0 points beyond 79.8 points after 3 months to 86.8 points within the 1st year, and subsequently remained stable at this level. Revision was necessary in six cases (8.3%). Of these, three had an aseptic loosening of the implant: 2 cases with renal transplantation and 1 of alcoholism with an extension of the necrotic area to the seating of the TPP. The other three patients showed septic implant loosenings: 2 cases with renal transplantation and 1 of alcoholism. Radiolucent lines were found in 9 cases (12.5%), mostly in zones 1 and 2 underneath the TPP. Of these, 1 with an idiopathic osteonecrosis was assessed to be radiologically loosened. The overall failure rate was 9.7%, with a proportion of 36.4% in patients with renal transplantation. Excluding this specific patient group, the failure rate was 4.9%. Conclusions. Femoral head necrosis following renal transplantation and extension of the necrotic area into the femoral neck are contraindications for TPP. Excluding these patients, the TPP shows comparable mid-term results to cementless stemmed prostheses and supplies advantages especially for younger patients, because of its metaphyseal, bone-preserving fixation. However, evaluation of the clinical impact of the TPP in comparison with other cementless femoral stem systems requires long-term examinations in the future.

Kurz- bis mittelfristige klinische und radiologische Ergebnisse mit der dreifachen Beckenosteotomie nach Tönnis im Jugend- und Erwachsenenalter

Abstract: AIM We report our clinical and radiological results after triple pelvic osteotomy according to Tonnis and accompanying femoral osteotomies in selected cases. METHOD 48 patients were evaluated in a retrospective study with an average follow-up to 2 years and 9 months. RESULTS In 68 % of our patients excellent to good results in the Harris Hip Score were achieved. We could significantly decrease pain awareness. The CE angle improved significantly from 10.6 degrees to 32.2 degrees and the acetabular angle of the weight-bearing zone according to Bombelli from 20.8 degrees to 3.8 degrees at the last follow-up. The VCA angle according to Lequesne and de Seze improved from 18.6 degrees to 33.5 degrees. Non-union of the ischial or the pubic bone developed in 7 cases as a relevant complication. CONCLUSION On the basis of our results and the literature, the triple pelvic osteotomy according to Tonnis can be recommended for the treatment of acetabular dysplasia in adolescents and adults.

Five-year follow-up with a ceramic sandwich cup in total hip replacement.

Abstract: The results of the first 56 consecutive total hip replacements using a new cementless, sandwich (alumina-polyethylene-titanium) acetabular component are reported. From March 1994 to March 1995 we operated on 39 female and 17 male patients; their mean age was 62.8 years (range 32-85 years). The Harris Hip Score was used for clinical evaluation. X-rays were examined according to the DeLee and Charnley method. At an average follow up of 62.4 months, 51 patients had complete clinical and radiographic data. For them, we recorded a good clinical result (average HHS 90.6), and we could detect no acetabular radiolucencies on X-rays. At the 5-year follow-up the results of this ceramic acetabular cup are quite encouraging. As a matter of fact, although the clinical results are very similar to those reported by other authors with conventional ceramic-polyethylene coupling prosthesis, the absence of periacetabular radiolucency and socket migration could mean less debris formation, less acetabular wear and, consequently, a longer life of the implant.

Cementless total hip arthroplasty with a close proximal fit and short tapered distal stem (third-generation) prosthesis.

Abstract: This study presents the results of a prospective, consecutive series of 50 patients (60 hips) who were observed for a minimum of 6 years after they had a primary total hip arthroplasty with a cementless Duraloc 100 series cup (DePuy, Warsaw, IN) with a close proximal fit and short tapered distal stem prosthesis (IPS hip; DePuy, Leeds, UK). There were 37 men and 13 women; the mean age was 46.6 years (range, 26 to 70 years). The mean follow-up was 6.3 years (range, 6 to 7 years). The mean preoperative Harris hip score was 42 points, which improved to 96 points at the final follow-up examination. The prevalence of transitory thigh pain was 2%. All hips had a satisfactory fit of the femoral stem in coronal (average, 88%) and sagittal (average, 94%) planes. There was no aseptic loosening or revision of the components. The wear rate per year was 0.23 mm. Four hips (7%) had osteolysis in the calcar femorale <1 cm in diameter. Although there was no aseptic loosening of the components, a low incidence of osteolysis, and a low incidence of thigh pain, a high rate of polyethylene liner wear in these young patients is a problem.

The uncemented Bi-Contact total hip arthroplasty

Abstract: We reviewed a consecutive series of 153 uncemented Bi-Contact (Aesculap, Tuttlingen, Germany) total hip arthroplasties (THAs) in 138 patients who had been followed for at least 5 years (mean, 6.8 years; range, 5–9 years). The Bi-contact uncemented THA consists of a straight femoral stem made of titanium alloy. The proximal portion of the stem is titanium plasma-sprayed. The cup is press-fit with or without hydroxyapatite coating with a facility for anchoring screws with a snap-fit polyethylene liner. The mean age of the patients was 70.8 years (range, 41–94 years). The mean preoperative Harris hip score of 41 (range, 20–80) improved postoperatively to a mean of 92 (range, 56–96). Three acetabular cups were revised for aseptic loosening, and 1 cup was revised for recurrent dislocation. To date, none of the stems have been revised for aseptic loosening. Radiographic evaluation of the remaining 149 hips revealed that the acetabular cup was stable in 146 hips and possibly unstable in the remaining 3 cases with nonprogressive osteolysis behind the cup. None of the stems showed any evidence of instability. Using the recommendation of revision as the endpoint, the cumulative survival for the prosthesis was 97.3% at a mean follow-up of 6.8 years (95% confidence interval, 95.9–99.4) , with stem survival of 100%. In the medium-term, these results are comparable to cemented primary THA and justify the continued use of this prosthesis. Copyright 2002, Elsevier Science (USA). All rights reserved.

Mid-term results and migration behaviour of a ti-alloy cemented stem.

Abstract: Between 1991 and 1994, 147 patients (154 hips) underwent a primary cemented total hip replacement using the Ultima ti-alloy, collarless, double-tapered stem and a UHMWPE cup. The average age at operation was 66.4 years. Ninety-one patients (97 hips) were available for review with an average follow-up of 76 months. The Harris hip score had improved from pre-operative average of 43.1 (12.5–65.0) to the latest score of 88.9 (67.5–100). There were 11 revisions in total, eight of which were for aseptic stem loosening. The results of Kaplan-Meier survival analysis, based on stem revision for aseptic loosening as an end-point, was 92% at 8 years. Early stem migration analysis at 2 years was possible in 114 cases using digitised radiographs analysed by the EBRA method. Sixty-three stems had not migrated and 35 migrated less than 2 mm with only one of these ending in failure. Sixteen stems showed early migration of more than 2 mm and five of these failed. Early stem migration is predictive of stem failure. Osteolytic lesions occurred in 12 femurs and four of these stems failed.