Contemporary alumina-on-alumina total hip arthroplasty performed in patients younger than forty years: a 5-year minimum follow-up study.
ABSTRACT Ceramic-on-ceramic bearing surfaces in total hip arthroplasties (THAs) are an attractive alternative coupling and may offer a promising option for young active patients. We evaluated the clinical results of 72 contemporary primary cementless alumina-on-alumina THAs performed in 61 patients younger than 40 years (mean age, 30 years), after a 5-year minimum follow-up. Most patients (97%) were able to return to their prearthritic activity levels, and none changed occupation because of a postoperative hip joint problem. No implant loosened radiographically and no stem or cup was revised. Ceramic wear was undetectable in 24 hips, where differentiation of the femoral head from the cup was possible on radiographs and no osteolysis was observed. One ceramic fracture following a major motor vehicle accident and a recurrent subluxation-associated ceramic liner edge fracture attributed to inadequate hip muscle tone occurred. We believe that this alternative articulation offers a promising option for young active patients. However, our findings also suggest that contemporary ceramic implant fracture is not a potential, but a real danger. Careful preoperative patient evaluation, proper indications for ceramic bearings, and meticulous surgical techniques are recommended to minimize the possibility of modern ceramic failure.
Article: Beneficial and limiting factors affecting return to work after total knee and hip arthroplasty: a systematic review.[show abstract] [hide abstract]
ABSTRACT: A large number of patients undergoing total knee (TKA) and hip (THA) arthroplasties are of working age at the time these procedures are performed. The objective of this study was to systematically review literature on the beneficial and limiting factors affecting return to work in patients undergoing TKA or THA. Pubmed and Embase were systematically searched to find studies that described factors that influence return to work (RTW) after surgery. The following inclusion criteria had to be met: (1) inclusion of patients with primary or revision TKA or THA; (2) description of return to work after surgery or employment status; and (3) description of a beneficial or restricting factor affecting return to work. Only three studies were found that fulfilled the three inclusion criteria. Three factors were discussed: (1) the mini-posterior approach compared to the two-incision approach; (2) patient movement restrictions after surgery compared to no restrictions; and (3) patient discharge based on guidelines compared to discharge without guidelines. This systematic review revealed that knowledge is sparse regarding beneficial or limiting factors affecting return to work after TKA or THA. Despite that, the results suggests that the two-incision approach is beneficial, patient movement restrictions are limiting, and patient discharge guidelines have no effect on the time patients take to RTW.Journal of Occupational Rehabilitation 09/2009; 19(4):375-81. · 2.80 Impact Factor