Long-term results of revision hip arthroplasty. Survival analysis with special reference to the femoral component

Abstract

We report a clinical and radiological survival analysis of 148 consecutive revisions of hip arthroplasties. All patients referred were offered revision if it was indicated and they were medically fit. About one-third (32%) had had at least one previous revision, and about one-third had an established deep infection. The revisions were performed in ultra-clean air with body-exhaust suits. The usual method of fixation was by contained and pressurised cement of standard viscosity, to which appropriate antibiotics had been added in infected cases. Some patients had cementless revision. Clinical failure meant that one or both of the implants had been removed; radiological failure was assessed from serial radiographs. The clinical survival at ten years was 95%. The Merle D'Aubigne and Postel rating for pain improved from a mean of 2.9 to 5.2; and in Charnley group A and B cases, walking ability improved from 2.3 to 4.3. In contrast to some reports we also found good radiological survival; this was 90.5% for cemented femoral stems. Isoelastic revision stems inserted without cement gave poor results.

Evidence for the validity of a patient-based instrument for assessment of outcome after revision hip replacement

“…1 This oversimplifies the matter by implying that patients who do not need a further revision have had a good outcome. 2 Information may be obtained directly from patients, whose judgements are often valid, reliable and free from clinical bias.…”

Towards Clinical Application of Mesenchymal Stromal Cells: Perspectives and Requirements for Orthopaedic Applications

“…The advantages and disadvantages of bone cement have been controversially discussed regarding different rates of implant failure in follow up examinations (Kavanagh, Ilstrup et al 1985;Izquierdo and Northmore-Ball 1994;Stromberg and Herberts 1996). Recent works suggest to proceed without use of bone cement if possible, and recommend other surgical techniques to implant a total hip endoprosthesis.…”

“…Bone cement is stiff and strong with a gradual increasing resorption area at its limits. Where bone cement is placed, immediate primary stability is provided, however, at the expense of bone regeneration that does not take place anymore (Izquierdo and Northmore-Ball 1994;Gruner and Heller 2009). Depending on the localization of the bone cement and the mechanical stress, this can gradually lead to a decreased stability.…”

“…Depending on the localization of the bone cement and the mechanical stress, this can gradually lead to a decreased stability. In case another revision operation is needed but great bone defects and osteolysis can impede or even inhibit surgical possibilities (Kavanagh, Ilstrup et al 1985;Izquierdo and Northmore-Ball 1994;Stromberg and Herberts 1996;Gruner and Heller 2009). Fresh autologous bone or allogenous acellular bone from a bone bank can support bone growth.…”

Clinical and radiological outcome of hydroxyapatite-coated femoral stem in revision hip arthroplasty

“…The results of revision hip arthroplasty are less satisfactory than after primary hip replacement, but revision operations improve the quality of life significantly [18]. A survivorship of 95% at 10 years has been reported, but especially with cemented revisions, high re-revision rates are reported, even with improved cementing techniques [11]. After aseptic loosening, the femur no longer has the trabecular structure that is needed for cement interdigitation.…”