Total Hip Arthroplasty for the Treatment of Ankylosed Hips

Total hip arthroplasty after previous arthrodesis has been associated with increased complications and decreased survivorship of the prosthesis. We evaluated pain, function, and the factors influencing survivorship of total hip arthroplasties after previous arthrodesis between 1985 and 2000 and compared these results with those obtained in prior years with the same procedure and in the same institution. We retrospectively reviewed 30 patients who had previous spontaneous or surgical arthrodesis. The minimum followup was 2 years (mean, 10.4 years; range 2-20.5 years). Seven failures were identified (23%). The overall survival free of failure was 86% at 5 years and 75% at 10 years. At last followup, 27 of the 30 patients (91%) had no or slight pain, 26 (87%) had a limp, and 18 (61%) needed a gait aid. Surgical arthrodesis, age younger than 50 years at the time of arthroplasty, and length of arthrodesis less than 30 years independently predicted failure. Conversion of arthrodesis to hip arthroplasty reliably decreases pain and improves function, but many patients will limp and require a gait aid. Our outcomes were similar to those after revision rather than after primary hip arthroplasty.

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hip Arthroplasty after Previous Arthrodesis

Peterson

Nemanich²,

Altenburg³

et al. 2009

“…At the authors' institution, a modified Charnley-type low-friction THA, using a 22.25-mm metal head articulating with a cemented allpolyethylene socket, has been used since 1972 [14]. Our previous results have been consistent with those reported by other groups, even in high-demand patient populations [9,13]. We found, along with others, that the main reason for revision was socket loosening related to high polyethylene wear and periprosthetic osteolysis [23].…”

Section: Introductionsupporting

confidence: 85%

Do Oxidized Zirconium Femoral Heads Reduce Polyethylene Wear in Cemented THAs? A Blinded Randomized Clinical Trial

Zaoui

Hage

Langlois

et al. 2015

Self Cite

Background Charnley low-friction torque total hip arthroplasty (THA) remains the gold standard in THA. The main cause for failure is wear of the socket. Highly crosslinked polyethylene (HXLPE) has been associated with reduced wear rates. Also, oxidized zirconium has shown in vitro reduced wear rates. However, to our knowledge, there are no data comparing oxidized zirconium femoral heads with metal heads against HXLPE or ultrahigh-molecular-weight polyethylene (UHMWPE) when 22.25-mm bearings were used, which was the same size that performed so well in Charnley-type THAs. Questions/purposes We hypothesized that after a minimal 4-year followup (1) use of HXLPE would result in lower radiographic wear than UHMWPE when articulating with a stainless steel head or with an oxidized zirconium head; (2) use of oxidized zirconium would result in lower radiographic wear than stainless steel when articulating with UHMWPE and HXLPE; and (3) there would be no difference in terms of Merle d'Aubigné scores between the bearing couple combinations. Methods One hundred patients were randomized to receive cemented THA with either oxidized zirconium or a stainless steel femoral head. UHMWPE was used in the first 50 patients, whereas HXLPE was used in the next 50 patients. There were 25 patients in each of the four bearing couple combinations. All other parameters were identical in both groups. Complete followup was available in 86 of these patients. Femoral head penetration was measured using a validated computer-assisted method dedicated to all-polyethylene sockets. Clinical results were compared between the groups using the Merle d'Aubigné score. Results In the UHMWPE series, the median steady-state penetration rate from 1 year onward was 0.03 mm/year (range, 0.003-0.25 mm/year) in the oxidized zirconium group versus 0.11 mm/year (range, 0.03-0.29 mm/year) in the metal group (difference of medians 0.08, p\0.001). In the HXLPE series, the median steady-state penetration rate from 1 year onward was 0.02 mm/year (range, À0.32 to 0.07 mm/year) in the oxidized zirconium group versus 0.05 mm/year (range, À0.39 to 0.11 mm/year) in the metal group (difference of medians 0.03, p \ 0.001). The Merle d'Aubigné scores were no different between the groups with a median of 18 in each of the groups (range, 16-18). Conclusions This study demonstrated femoral head penetration was reduced by oxidized zirconium when compared with metal on both UHMWPE and HXLPE. However, apart the metal-UHMWE group, all other groups had a steady-state penetration rate well below the osteolysis threshold with a low difference between groups that

“…The survival rate of this stem was greater than 90% at 20 years using radiographic loosening as the end point [10,16,18,27]. Later, this polished stem became available with a satin and matte surface finish.…”

Section: Introductionmentioning

confidence: 99%

Minimum 10-year Survival of Kerboull Cemented Stems According to Surface Finish

Hamadouche

Baqué²,

Lefèvre³

et al. 2008

Self Cite

The optimal surface finish for a cemented THA stem is still debated. We hypothesized surface finish would influence survival of Kerboull cemented hip arthroplasties and a matte finish would have lower survival. We reviewed survival of 433 total hip arthroplasties in 395 patients: 284 consecutive patients (310 hips) were enrolled in a prospective, randomized study of polished (165 hips) or matte finish stems (145 hips) and compared to a historical series of satin stems (123 hips) in 111 patients. The satin and matte finish implants had similar geometry but the polished was quadrangular rather than oval. Finish roughnesses were: polished (radius, 0.04 lm), satin (radius, 0.9 lm), and matte (radius, 1.7 lm). The mean age of the patients at the time of the index arthroplasty was 63.6 years. The survival rate at 13 years, using radiographic loosening as the end point, was 97.3% ± 2.6% for polished stems, 97.1% ± 2.1% for satin stems, and 78.9% ± 5.8% for matte stems. The data suggest survival of Kerboull stems was higher with a polished or satin surface finish than with a matte finish.