No abstract

We report the ten-year results for three designs of stem in 240 total hip replacements, for which subsidence had been measured on plain radiographs at regular intervals. Accurate migration patterns could be determined by the method of Einzel-BildRoentgen-Analyse-femoral component analysis (EBRA-FCA) for 158 hips (66%).Of these, 108 stems (68%) remained stable throughout, and five (3%) started to migrate after a median of 54 months. Initial migration of at least 1 mm was seen in 45 stems (29%) during the first two years, but these then became stable. We revised 17 stems for aseptic loosening, and 12 for other reasons. Revision for aseptic loosening could be predicted by EBRA-FCA with a sensitivity of 69%, a specificity of 80%, and an accuracy of 79% by the use of a threshold of subsidence of 1.5 mm during the first two years. Similar observations over a five-year period allowed the long-term outcome to be predicted with an accuracy of 91%.We discuss the importance of four different patterns of subsidence and confirm that the early measurement of migration by a reasonably accurate method can help to predict long-term outcome. Such methods should be used to evaluate new and modified designs of prosthesis. J Bone Joint Surg [Br] 1999;81-B:273-80. Received 17 February 1998; Accepted after revision 12 May 1998 The prognostic value of early migration of an acetabular cup has been demonstrated by several authors, with loosening within two years predicted with sensitivities and specificities of over 80%.

We report a prospective, stratified study of 60 PCA-cups and 60 RM-polyethylene cups which have been followed for a median time of 90 months, with annual radiography.The radiological migration of cups was measured by the computer-assisted EBRA method. A number of threshold migration rates from 1 mm in the first year to 1 mm in five years have been assessed and related to clinically determined revision rates. A total of 28 cups showed a total migration of 1 mm or more within the first two years; 13 of these cups have required revision and been exchanged. The survival curves of cups which had previously shown early migration were considerably different from those without early migration. For cups with a migration of less than 1 mm within the first two years the mean survival at 96 months was 0.96 ± 0.02; for migrating cups, it was 0.63 ± 0.11 (log-rank test, p = 0.0001; chi-square value = 39.4).Early migration is a good predictor for late loosening of hip sockets.

In a systematic review, reports from national registers and clinical studies were identified and analysed with respect to revision rates after joint replacement, which were calculated as revisions per 100 observed component years. After primary hip replacement, a mean of 1.29 revisions per 100 observed component years was seen. The results after primary total knee replacement are 1.26 revisions per 100 observed component years, and 1.53 after medial unicompartmental replacement. After total ankle replacement a mean of 3.29 revisions per 100 observed component years was seen. The outcomes of total hip and knee replacement are almost identical. Revision rates of about 6% after five years and 12% after ten years are to be expected.

Malposition of the acetabular component is a risk factor for post-operative dislocation after total hip replacement (THR). We have investigated the influence of the orientation of the acetabular component on the probability of dislocation. Radiological anteversion and abduction of the component of 127 hips which dislocated post-operatively were measured by Einzel-Bild-Röentgen-Analysis and compared with those in a control group of 342 patients. In the control group, the mean value of anteversion was 15 degrees and of abduction 44 degrees. Patients with anterior dislocation after primary THR showed significant differences in the mean angle of anteversion (17 degrees), and abduction (48 degrees) as did patients with posterior dislocation (anteversion 11 degrees, abduction 42 degrees). After revision patients with posterior dislocation showed significant differences in anteversion (12 degrees) and abduction (40 degrees). Our results demonstrate the importance of accurate positioning of the acetabular component in order to reduce the frequency of subsequent dislocations. Radiological anteversion of 15 degrees and abduction of 45 degrees are the lowest at-risk values for dislocation.