Twenty-five-Year Survivorship of Two Thousand Consecutive Primary Charnley Total Hip Replacements

Berry, Daniel J.; Harmsen, William S.; Cabanela, Miguel E.; Morrey, B.F.

doi:10.2106/00004623-200202000-00002

Cited by 611 publications

(315 citation statements)

References 26 publications

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“…Our findings of indications for revision echo previous epidemiologic studies of revision total joint arthroplasties [7,8]; however, our findings for revision THAs differ from prior observational cohort studies [3,54] and international registry reports [33,43] that identified aseptic loosening, bearing surface wear, and osteolysis as primary causes of TKA failure. Likewise, our revision TKA findings differ from those of prior reports implicating aseptic etiologies, including polyethylene wear, prosthetic loosening, and instability as the primary mechanisms for failed TKA [16,36,37,41,51,52].…”

Section: Discussionsupporting

confidence: 64%

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Bozic

Kamath

Ong

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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398

235

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Background Revision THA and TKA are growing and important clinical and economic challenges. Healthcare systems tend to combine revision joint replacement procedures into a single service line, and differences between revision THA and revision TKA remain incompletely characterized. These differences carry implications for guiding care and resource allocation. We therefore evaluated epidemiologic trends associated with revision THAs and TKAs. Questions/purposes We sought to determine differences in (1) the number of patients undergoing revision TKA and THA and respective demographic trends; (2) differences in the indications for and types of revision TKA and THA; (3) differences in patient severity of illness scoring between THA and TKA; and (4) differences in resource utilization (including cost and length of stay [LOS]) between revision THA and TKA. Methods The Nationwide Inpatient Sample (NIS) was used to evaluate 235,857 revision THAs and 301,718 revision TKAs between October 1, 2005 and December 31, 2010. Patient characteristics, procedure information, and resource utilization were compared across revision THAs and TKAs. A revision burden (ratio of number of revisions to total number of revision and primary surgeries) was calculated for hip and knee procedures. Severity of illness scoring and cost calculations were derived from the NIS. As our study was principally descriptive, statistical analyses generally were not performed; however, owing to the large sample size available to us through this NIS analysis, even small observed differences presented are likely to be highly statistically significant.One or more of the authors (SMK, KO, EL) are employees of Exponent, Inc, Menlo Park, CA, USA, and Philadelphia, PA, USA. One of the authors certifies that he (DJB), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (TPV) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 10,001-USD 100,000 from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (HER) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from Zimmer, Inc (Warsaw, IN, USA Clin Orthop Relat Res (2015) 473:2131-2138 DOI 10.1007/s11999-014-4078-8 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results Revision TKAs increased by 39% (revision burden, 9.1%-9.6%) and THAs increased by 23% (revision burden, 15.4%-14.6%). Revision THAs were performed more often in older patients compared with revision TKAs. Periprosthetic joint infection (25%) and mechanical loosening (19%) were the most common reasons for revision TKA compared with dislocation (22%) and mechanical loosening (20%) for revision THA. Full (all-component) revision was more common i...

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Section: Discussionsupporting

confidence: 64%

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Bozic

Kamath

Ong

et al. 2015

Clinical Orthopaedics &Amp; Related Research

Self Cite

398

235

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“…Although weak, we did find some evidence of an increased risk of implant failure in women of 1.61 (95% CI, 0.98-2.66). A comparison with other publications, including those pertaining to THA, reveals mixed results with some showing improved implant survival for women [3,28] and others showing contrary findings [16,20,38]. These mixed results may be related to the high degree of association between gender and other factors such as height, weight, diagnosis, and implant size, which may have differed between this study and others.…”

Section: Discussionsupporting

(Expert classified)

Hip Resurfacing Arthroplasty: Risk Factors for Failure Over 25 Years

Yue

Cabanela

Duffy

et al. 2008

Clin Orthop Relat Res

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Many early metal-on-polyethylene hip resurfacing arthroplasty designs were abandoned after reports of high short-term and midterm failure rates. To investigate factors associated with failure, we retrospectively reviewed our experience with early-design hip resurfacing implants in 75 patients during a 25-year period (median followup, 7.9 years; range, 0.1-25.2 years). Implant failure was defined as revision for any reason. One of 75 patients was lost to followup. The estimated rate of implant survival was 73% at 5 years, 34% at 10 years, 27% at 15 years, 12% at 20 years, and 8% at 25 years. Of the many clinical and radiographic factors considered, only age, implant type, and gender were associated with implant survival independent of other variables considered. Hip resurfacing arthroplasty showed poor overall long-term survival in this series. Particular attention should be paid to the identified risk factors as long-term followup data become available for modern designs.

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“…In contrast to our findings, male sex had a moderate negative influence on long-term stem survival (relative risk 1.3) in their registry study. Berry et al analyzed risk factors for aseptic loosening in a large series of cemented Charnley THAs at a followup of 25 years [6]. They found that young age and male sex were independent risk factors for long-term aseptic stem loosening.…”

Section: Discussionmentioning

confidence: 99%

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

Streit¹,

Innmann²,

Merle³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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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.

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Twenty-five-Year Survivorship of Two Thousand Consecutive Primary Charnley Total Hip Replacements

Cited by 611 publications

References 26 publications

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Hip Resurfacing Arthroplasty: Risk Factors for Failure Over 25 Years

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

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