Charnley low-friction arthroplasty in teenage patients: the ultimate challenge.
ABSTRACT Increasing follow-up identifies the outcome in younger patients who have undergone total hip replacement (THR) and reveals the true potential for survival of the prosthesis. We identified 28 patients (39 THRs) who had undergone cemented Charnley low friction arthroplasty between 1969 and 2001. Their mean age at operation was 17.9 years (12 to 19) and the maximum follow-up was 34 years. Two patients (4 THRs) were lost to follow-up, 13 (16 THRs) were revised at a mean period of 19.1 years (8 to 34) and 13 (19 THRs) continue to attend regular follow-up at a mean of 12.6 years (2.3 to 29). In this surviving group one acetabular component was radiologically loose and all femoral components were secure. In all the patients the diameter of the femoral head was 22.225 mm with Charnley femoral components used in 29 hips and C-stem femoral components in ten. In young patients who require THR the acetabular bone stock is generally a limiting factor for the size of the component. Excellent long-term results can be obtained with a cemented polyethylene acetabular component and a femoral head of small diameter.
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ABSTRACT: THA is a concern in juvenile idiopathic arthritis (JIA) owing to patients' youth, poor bone stock, and small physical size. We asked whether (1) uncemented alumina-on-alumina THAs have good clinical and radiographic results at midterm followup in young patients with inflammatory arthritis and end-stage hip disease secondary to JIA, and (2) the anatomic center of rotation of the hip could be reconstructed in patients with acetabular protrusion. We also assessed the rate of surgical complications. We retrospectively reviewed 31 alumina-on-alumina THAs in 21 patients with a mean age of 30.9 years (range, 14-48 years). Minimum followup until the time of revision of any component or the latest evaluation was 16 months. For nonrevised cases, the minimum followup was 60 months (range, 60-108 months). Acetabular protrusion was mild in 17 hips (Group 1) and moderate-severe in 14 (Group 2). Bone autograft was used to reconstruct the acetabulum in Group 2. Acetabular reconstruction was evaluated according to Ranawat et al. One cup was revised owing to aseptic loosening at 16 months; the remaining hips showed good clinical and radiographic results. The mean postoperative horizontal distance and the distance between the center of the head of the prosthesis and the true center of the femoral head improved in Group 2. There were no complications related to alumina. Although THA is a technically demanding procedure in patients with JIA, uncemented alumina-on-alumina THA provides pain relief and improves quality of life. In patients with acetabular protrusion, bone grafts enable anatomic cup positioning. Continued followup will be required to determine whether the alumina-on-alumina bearings in patients with JIA result in less osteolysis and loosening. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 08/2011; 470(5):1421-30. · 2.79 Impact Factor
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ABSTRACT: Although Charnley-Kerboull metal-on-polyethylene 22.2mm cemented total hip arthroplasty (THA) is considered to be the gold standard in France, results with this prosthesis are conflicting, in particular in relation to Scandinavian registers. The goal of this retrospective study was to confirm the validity of this prosthesis at a minimum of 10years follow-up. Survival of this type of THA would fulfill NICE conditions (survival at 10years of at least 90%). One hundred and five primary THA were performed in 93 patients (30 men and 63 women) mean age 72.6years old (60-86) between January 1998 and March 2001. After a mean follow-up of 10.6years (10-13years), 21patients (23 THA) were lost to follow-up and 32 (35 THA) had died leaving 40 patients (47 THA) for clinical analysis (Merle d'Aubigné and Oxford scores) and X-ray assessment. Survival was calculated with revision for any cause and radiological loosening with or without revision as end-points. The mean Oxford score at the final follow-up was 22/60 (13-45), the PMA score was 14.2 (11-17). Eight patients underwent revision surgery after a mean 7.5years (2-11) (1 early dislocation and 7 acetabular cup loosenings). Survival at 10years was 89.4% (CI95%: 78-95) for all causes of revision and 78% (CI95%: 61-91) for loosening with (n=7) or without (n=3) revision. No cases of septic or femoral loosening were observed. Twelve of the 47 revised hip replacements (25.5%) presented wear≥2mm. Although functional results were acceptable for this elderly population, survival did not reach the NICE value and was lower than results in the literature for this type of implant. Cup loosening and wear were the main causes of revision. retrospective.Orthopaedics & Traumatology Surgery & Research 04/2014; · 1.06 Impact Factor
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ABSTRACT: BACKGROUND: The number of total hip arthroplasties in patients under 30 years is increasing over the years. Almost all of them will face at least one or more future revisions in their life. Therefore, the implant used should have a high survival rate, and needs to be easily revisable resulting in a low re-revision rate. Several studies have evaluated the outcome of total hip arthroplasties in patients under 30 years. However, only a few reported on the follow-up outcome of 10 years or more. In addition, none of these reports published data of the subsequent revisions of these implants within their original report. METHODS: We studied historically prospective collected data of 48 consecutive patients (69 hips) younger than 30 years, treated with a cemented primary total hip prosthesis between 1988 and 2004. Since the last evaluation of this cohort, two patients were lost to follow-up. For all hip revisions in this cohort, again cemented implants were used, mostly in combination with bone impaction grafting. Kaplan-Meier survival curves at 10- and 15 years for the primary total hip arthroplasties and revisions were determined. RESULTS: The mean age at time of primary surgery was 25 years (range, 16 to 29 years). Mean follow-up of the primary hips was 11.5 years (range, 7 to 23 years). During follow-up 13 revisions were performed; in 3 cases a two-stage total revision was performed for septic loosening and 9 cups were revised for aseptic loosening. There were no aseptic stem revisions. The 10 and 15-year survival rates with endpoint revision for aseptic loosening of the primary total hip were 90% (95% CI: 79 to 96) and 82% (95% CI: 65 to 92) respectively. None of our 13 subsequent revisions needed a re-revision within 10 years after re-implantation. CONCLUSIONS: Cemented total hip implants in patients under 30 years have an encouraging outcome at 10 and 15 years after surgery in these young patients. The 13 revised hips, treated with bone grafting and the third generation cement technique, were performing well with no re-revisions within ten years after surgery.BMC Musculoskeletal Disorders 01/2013; 14(1):37. · 1.88 Impact Factor