Results of Charnley Total Hip Arthroplasty at a Minimum of Thirty Years

Background Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade. Questions/purposes We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem.Methods We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13-81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20-25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed. Results Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%-90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%-96%). Undersized stems (canal fill index B 80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets. Conclusions Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening.

Section: Discussionsupporting

confidence: 73%

Long-term (20- to 25-year) Results of an Uncemented Tapered Titanium Femoral Component and Factors Affecting Survivorship

Streit¹,

Innmann²,

Merle³

et al. 2013

“…Details from this cohort have been published at regular intervals out to 35 years of followup [5,6,12,18,19,27]. The second cohort consisted of 357 hip arthroplasties in 320 patients performed between July 1976 and June 1978 and used modern second-generation cementing techniques [26].…”

Section: Methodsmentioning

confidence: 99%

What Can We Learn From 20-year Followup Studies of Hip Replacement?

Martin

Callaghan

Gao

et al. 2016

Self Cite

Background A patient who dies during the followup period of a study about total hip arthroplasty (THA) cannot subsequently undergo a revision. The presence of competing events (such as deaths, in a study on implant durability) violates an assumption of the commonly used Kaplan-Meier (KM) survivorship approach. In that setting, KM-based estimates of revision frequencies will be high relative to alternative approaches that account for competing events such as cumulative incidence methods. However, the degree to which this difference is clinically relevant, and the degree to which it affects different ages of patient cohorts, has been poorly characterized in orthopaedic clinical research. Questions/purposes The purpose of this study was to compare KM with cumulative incidence survivorship estimators to evaluate the degree to which the competing event of death influences the reporting of implant survivorship at long-term followup after THA in patients both younger than and older than 50 years of age. Methods We retrospectively reviewed 758 cemented THAs from a prospectively maintained single-surgeon registry, who were followed for a minimum of 20 years or until death. Revision rates were compared between those younger than or older than age 50 years using both KM and cumulative incidence methods. Patient survivorship was calculated using KM methods. A total of 21% (23 of 109) of the cohort who were younger than 50 years at the time of THA died during the 20-year followup period compared with 72% (467 of 649) who were older than 50 years at the time of surgery (p \ 0.001). Results In the cumulative incidence analysis, 19% of the younger than age 50 years cohort underwent a revision for aseptic causes within 20 years as compared with 5% in the older than age 50 years cohort (p \ 0.001). The KM method overestimated the risk of revision (23% versus 8.3%, p \ 0.001), which represents a 21% and 66% relative increase for the younger than/older than age 50 years groups, respectively. Conclusions The KM method overestimated the risk of revision compared with the cumulative incidence method, and the difference was particularly notable in the elderly cohort. Future long-term followup studies on elderly cohorts should report results using survivorship curves that take into account the competing risk of patient death. We

“…With the second-generation cementing technique, the survival rate seemed to improve at a minimum 15 years (88%) [12], but the comparison between these two cementing techniques from a minimum of 25-year followup study demonstrated no difference [11]. Focusing on the acetabular component, the revision rate of acetabular components was 7.3% and that of femoral components was 3.2% after a minimum followup of 30 years [3]. The failure rate of acetabular components has not been reduced by the use of contemporary cementing techniques [1,13].…”

Section: Discussionmentioning

confidence: 96%

“…To improve the longevity of cemented THA, fingerpacking cementing has been replaced by the so-called second-generation cementing technique (use of a distal cement plug and retrograde filling of the femoral canal with cement). In the finger-packing cementing technique, the revision rate of acetabular components was 7.3% at the average followup of 13.4 years and that of femoral components was 3.2% at the average followup of 15.2 years [3]. With the second-generation cementing technique, the survival rate seemed to improve at a minimum 15 years (88%) [12], but the comparison between these two cementing techniques from a minimum of 25-year followup study demonstrated no difference [11].…”

Section: Discussionmentioning

confidence: 99%

THA with Hydroxyapatite Granules at Cement-Bone Interface

Ohashi

Oonishi

Kim

2008

To augment cement-bone bonding, we interposed hydroxyapatite granules at the cement-bone interface (bioactive bone cement technique). Hydroxyapatite granules (2-3 g) were smeared on the bone surface of the acetabulum and femur just before cementing. We used porous hydroxyapatite granules 300 to 500 lm in diameter from 1986 to 1988 (first generation) and granules 100 to 300 lm in diameter from 1989 to 1991 (second generation). We followed 151 patients (222 hips) in the first generation and 170 patients (252 hips) in the second generation. The minimum followup was 15 years (mean, 17.3 years; range, 15-20 years). Radiolucent lines or spaces less than 1 mm were observed in four hips (1.8%) in the first generation and in 15 hips (6.2%) in the second generation. Osteolysis was observed in one hip (0.5%) in the first generation and six hips (1.6%) in the second generation. We observed loosening in two cups (0.8%) in the second generation. The long-term clinical results suggest the interface bioactive bone cement technique combined with our other techniques results in low incidences of radiolucent lines (spaces) and osteolysis, and may increase the longevity of cemented THA. The data suggest the larger hydroxyapatite granules performed better than smaller ones.