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Background: Short stem cementless femoral components were developed to aid insertion through smaller incisions, preserve metaphyseal bone, and potentially decrease or limit the incidence of thigh pain. Despite some clinical success, the senior author (DDG) believed a higher percentage of his patients who had received a cementless short stem design were experiencing thigh pain, which, coupled with concerns about bone ingrowth fixation, motivated the review of this case series.Questions/purposes: (1) What is the proportion of patients treated with a short stem cementless THA femoral component that develop thigh pain and what are the hip scores of this population? (2) What are the radiographic results, specifically with respect to bone ingrowth fixation and stress shielding, of this design? (3) Are there particular patient or procedural factors that are associated with thigh pain with this short stem design?Methods: Two hundred sixty-one primary THAs were performed in 238 patients by one surgeon between November 2010 and August 2012. During this time period, all patients undergoing primary THA by this surgeon received the same cementless short titanium taper stem. Seven patients (eight hips) died and five patients (five hips) were lost to followup, leaving 226 patients (248 hips) with a mean followup of 3 years (range, 2-5 years). Patients rated their thigh pain during activity or rest at final followup on a 10-point visual analog scale. Harris hip scores (HHS) were obtained at every clinic appointment. Thigh pain was evaluated at the final followup or by contacting the patient by phone. Radiographs were evaluated for bone-implant fixation, bone remodeling, and osteolysis. An attempt was made to correlate thigh pain with patient demographics, implant specifications, or radiographic findings.Results: Seventy-six percent of hips (180 of 238) had no thigh pain, 16% of hips (37 of 238) had mild thigh pain, and 9% (21 of 238) had moderate or severe thigh pain. Preoperatively, mean HHS was 47 (SD, 16) and at last followup, mean HHS was 88 (SD, 13). There were two femoral revisions, one for severe thigh pain and the other for infection. All but two components demonstrated bone ingrowth fixation (99%). Femoral stress shielding was mild in 64% of hips (135 of 212), moderate in 0.5% (one of 212), and severe in no hips. There is an inverse linear relationship between age and severity of thigh pain (r = -0.196; p < 0.0024).Conclusions: Although reliable fixation was achieved and good HHS were attained, the frequency and severity of thigh pain with this short cementless stem were concerning. The surgeon has subsequently abandoned this short stem design and returned to a conventional length stem. Future study direction might investigate the biomechanical grounds for the thigh pain associated with this stem design.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

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 observed a high attrition rate as a result of patient deaths, and this emphasizes a need for future studies to enroll younger patients to ensure adequate study numbers at final followup.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

We report the updated results for a previously described cohort of patients who were less than fifty years old at the time of the index Charnley total hip arthroplasty with cement. The original cohort consisted of ninety-three consecutive hips in sixty-nine patients. The patients were followed for a minimum of thirty-five years after surgery or until death. At the latest follow-up evaluation, there were forty-one total hip replacements (44%) in thirty-two living patients. Thirty-four (37%) of the ninety-three total hip replacements in the original cohort had been revised or removed. Twenty acetabular (22%) and seven femoral (8%) components had been revised for aseptic loosening. Since the twenty-five-year follow-up, the average six-minute-walk distance decreased from 395 m to 171 m, and this decrease correlated with increasing comorbidity. This study demonstrates the durability of cemented total hip replacements in a young patient population. Although 63% (fifty-nine) of the ninety-three original hip replacements were functioning at the latest follow-up or at the time of death, a significant decrease in activity level was seen over time (p < 0.001). Of the forty-one original implants in the patients who were alive at the time of the thirty-five-year follow-up, only 46% (nineteen) were retained. [ABSTRACT FROM AUTHOR]

We report the updated results for a previously described cohort of patients who were less than fifty years old at the time of the index Charnley total hip arthroplasty with cement. The original cohort consisted of ninety-three consecutive hips in sixty-nine patients. The patients were followed for a minimum of thirty-five years after surgery or until death. At the latest follow-up evaluation, there were forty-one total hip replacements (44%) in thirty-two living patients. Thirty-four (37%) of the ninety-three total hip replacements in the original cohort had been revised or removed. Twenty acetabular (22%) and seven femoral (8%) components had been revised for aseptic loosening. Since the twenty-five-year follow-up, the average six-minute-walk distance decreased from 395 m to 171 m, and this decrease correlated with increasing comorbidity. This study demonstrates the durability of cemented total hip replacements in a young patient population. Although 63% (fifty-nine) of the ninety-three original hip replacements were functioning at the latest follow-up or at the time of death, a significant decrease in activity level was seen over time (p < 0.001). Of the forty-one original implants in the patients who were alive at the time of the thirty-five-year follow-up, only 46% (nineteen) were retained. [ABSTRACT FROM AUTHOR]

Full article available online at Healio.comOrthopedics. Search: 20131120-16 Tapered cementless femoral components have been used in total hip arthroplasty constructs for more than 20 years. In the past 5 to 10 years, these stems have gained popularity in the United States. The purpose of this study was to evaluate the results of the authors' initial experience using a contemporary tapered, proximally porous-coated, titanium femoral component at 4 to 6 years of follow-up. Eighty-eight patients underwent 100 total hip arthroplasties using the Summit stem (DePuy, Warsaw, Indiana) and a cementless acetabular component. Average age at the time of surgery was 61.6 years. Patients were prospectively followed for 4 to 6 years or until death. Patients were evaluated clinically using Harris Hip Scores and the need for revision. Radiographs were evaluated for femoral loosening and osteolysis. At final follow-up, no hips had been revised for femoral or acetabular loosening. Two hips required revision for dislocation and 1 for early femoral fracture. Bony ingrowth was seen in all but 2 femoral components. There was 1 instance of proximal femoral osteolysis and none distally on radiographs (cross-linked polyethylene was used in 73% of cases). There were 2 cases of severe stress shielding. One percent of cases had an early fracture (too tight) and 1% subsided without ingrowth (too loose). One patient reported significant thigh pain that did not limit activity. At final follow-up, the Summit femoral component demonstrated durable results at 4 to 6 years. Stability of the implant without femoral fracture is paramount. [ABSTRACT FROM AUTHOR]

Background: There are two unusual remodeling patterns of the proximal femur around well-fixed Charnley total hip arthroplasties: cortical thinning leading to endosteal widening around the femoral component and hypertrophy of the distal femoral cortex. Previous studies have shown remodeling patterns are affected by stem design and occur early postoperatively. It is unclear if these changes are related to patient demographics or if they progress throughout the lifetime of the implant. Questions/purposes: We determined if patient demographic variables influence remodeling patterns after cemented Charnley total hip arthroplasty and if the observed remodeling changes persist long-term. Methods: We retrospectively reviewed the radiographs of 106 well-fixed Charnley femoral components. Using a novel digital edge detection program, we determined the femoral remodeling pattern and time-related changes in femoral dimensions. The minimum followup was 20 years (mean, 25.3 years; range, 19.5–37 years). Results: We found no association between remodeling type and age at surgery, sex, preoperative diagnosis, body mass index, or postoperative activity level. There was also no association between initial implant alignment and remodeling type. Cortical thickening in the distal hypertrophy group was an early phenomenon occurring primarily within the first 2 years, whereas cortical thinning begins later and is a more progressive process. Conclusions: These data show remodeling after cemented Charnley total hip arthroplasty is not related to patient demographic variables; however, distal cortical hypertrophy can be predicted in the early postoperative period. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Full article available online at Healio.com/Orthopedics. Search: 20121120-12 Rotating-platform, mobile-bearing total knee arthroplasty was initially developed using a posterior cruciate-sacrificing technique and design. Posterior cruciate-substituting and-retaining, rotating-platform total knee arthroplasty designs were developed later. The purpose of this study was to evaluate a minimum 4-year follow-up of total knee arthroplastyperformed with a posterior cruciate-retaining, rotating-platform design. The 4- to 6-year results of 123 patients undergoing 152 consecutive total knee arthroplasties using a posterior cruciate-retaining, rotating-platform design were evaluated. Patients were evaluated clinically for need for revision, and clinical outcome measures included the pain and functional components of the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index, the Short Form 36 Health Survey, and the University of California Los Angeles activity-level scores. Radiographs were evaluated for loosening, component positioning changes, femoral-tibial alignment, and osteolysis. One knee was lost to follow-up at an average of 5.2 years. No tibial or femoral components required revision. Three polyethylene liners were revised: 2 for infection and 1 for bearing spinout. Average range of motion was 120° (range, 70°-135°). Minor areas of osteolysis were noted around 4.5% of knees, and minimal incomplete radiolucencies were noted around 50% of components. The posterior cruciate-retaining, rotating-platform knee prosthesis demonstrated excellent survivorship at 4- to 6-year follow-up. [ABSTRACT FROM AUTHOR]

Unlabelled: The purpose of the present study was to analyze the longer-term results for a previously reported cohort of patients who were managed with cementless acetabular fixation at the time of revision arthroplasty. Sixty-one consecutive revision total hip arthroplasties were performed in fifty-five patients with use of a cementless acetabular component and screw-augmented fixation. This series was evaluated at minimum of twenty years. Twelve patients (fourteen hips) were living at twenty years. In this group of sixty-one arthroplasties, there were nineteen revisions in fourteen hips (22.9%) during the follow-up period, but no revisions were performed because of loosening of the acetabular component and no additional cups had loosened since the time of the last report at a minimum of ten years. Two components had previously been reported as loose and had migrated, but neither had been revised at the time of the latest follow-up. The minimum twenty-year follow-up of these cementless acetabular components demonstrated durable long-term fixation. The survival rate was 100% with revision of the shell because of aseptic loosening as the end point and 97.7% (95% confidence interval, ± 8.8%) with radiographic evidence of loosening as the end point. The authors continue to use cementless acetabular fixation with screw augmentation for most revision total hip arthroplasty procedures.Level Of Evidence: Therapeutic Level IV. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to analyze the longer-term results for a previously reported cohort of patients who were managed with cementless acetabular fixation at the time of revision arthroplasty. Sixty-one consecutive revision total hip arthroplasties were performed in fifty-five patients with use of a cementless acetabular component and screw-augmented fixation. This series was evaluated at minimum of twenty years. Twelve patients (fourteen hips) were living at twenty years. In this group of sixty-one arthroplasties, there were nineteen revisions in fourteen hips (22.9%) during the follow-up period, but no revisions were performed because of loosening of the acetabular component and no additional cups had loosened since the time of the last report ata minimum often years. Two components had previously been reported as loose and had migrated, but neither had been revised at the time of the latest follow-up. The minimum twenty-year follow-up of these cementless acetabular components demonstrated durable long-term fixation. The survival rate was 100% with revision of the shell because of aseptic loosening as the end point and 97.7% (95% confidence in-terval, ±8.8%) with radiographic evidence of loosening as the end point. The authors continue to use cementless acetabular fixation with screw augmentation for most revision total hip arthroplasty procedures. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to analyze the longer-term results for a previously reported cohort of patients with cementless acetabular fixation and to compare the results with those for historical controls with cement fixation and a comparable follow-up period. One hundred and twenty consecutive nonselected total hip arthroplasties were performed in 108 patients with use of a cementless acetabular component. This series was evaluated at a minimum of twenty years of follow-up and was compared with 330 consecutive hip arthroplasties that had been performed by the same surgeon with use of cemented acetabular components and had been followed for a comparable period of time. Thirty-nine patients (forty-two hips) in the cementless fixation group were living at twenty years of follow-up. In the group of 120 hips with cementless acetabular fixation, twenty-two hips (18.3%) were revised during the follow-up period, but only one hip (0.8%) was revised because of loosening of the acetabular component, with no additional cup loosening since the previous report at thirteen to fifteen years of follow-up. In the group with cemented acetabular fixation with comparable follow-up, thirty-two hips (10%) were revised overall and eighteen hips (6%) were revised because of acetabular loosening. An additional twenty-five hips (8%) had acetabular cups that were loose on radiographs but had not undergone revision. At a minimum of twenty years of follow-up, cementless acetabular components provided superior long-term fixation compared with cemented components but the overall rates of acetabular revision for mechanical reasons were comparable. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to analyze the longer-term results for a previously reported cohort of patients with cementless acetabular fixation and to compare the results with those for historical controls with cement fixation and a comparable follow-up period. One hundred and twenty consecutive nonselected total hip arthroplasties were performed in 108 patients with use of a cementless acetabular component. This series was evaluated at a minimum of twenty years of follow-up and was compared with 330 consecutive hip arthroplasties that had been performed by the same surgeon with use of cemented acetabular components and had been followed for a comparable period of time. Thirty-nine patients (forty-two hips) in the cementless fixation group were living at twenty years of follow-up. In the group of 120 hips with cementless acetabular fixation, twenty-two hips (18.3%) were revised during the follow-up period, but only one hip (0.8%) was revised because of loosening of the acetabular component, with no additional cup loosening since the previous report at thirteen to fifteen years of follow-up. In the group with cemented acetabular fixation with comparable follow-up, thirty-two hips (10%) were revised overall and eighteen hips (6%) were revised because of acetabular loosening. An additional twenty-five hips (8%) had acetabular cups that were loose on radiographs but had not undergone revision. At a minimum of twenty years of follow-up, cementless acetabular components provided superior long-term fixation compared with cemented components but the overall rates of acetabular revision for mechanical reasons were comparable. [ABSTRACT FROM AUTHOR]

Background: Liner exchange and bone grafting are commonly performed for wear and osteolysis around well-fixed modular acetabular components that otherwise would require structural allografting and revision THA. However, liner exchange in the face of substantial lysis around TKA has been performed rarely with reports of failure rates of up to 25% at 3 year followup. Questions/purposes: We therefore evaluated the technique of liner exchange and bone grafting for cases of wear and extensive osteolysis around TKAs in which the components were well-fixed and well-aligned to determine (1) rerevision rates; (2) fate of the bone graft; (3) radiographic loosening rates; and (4) functional scores. Methods: We retrospectively reviewed 22 patients (25 knees) who underwent revision TKA with exchange of the modular polyethylene insert and bone grafting in cases with well-fixed components and large areas of osteolysis (up to 54 cm on a single projection) at the time of revision. The average area of osteolysis was 21 cm and 10 cm on the AP projection of the femur and tibia, respectively. On the lateral projection, the average area of osteolysis for the femur and tibia was 22 cm and 9.3 cm. Minimum clinical and radiographic followup was 22 and 22 months (average, 61 and 59; range, 22-142 and 22-130, respectively). Results: One of the 25 knees was revised for aseptic loosening or recurrence of osteolysis. On radiographs, 84.6% and 70% of femoral and tibial osteolytic lesions, respectively, showed evidence of complete or near complete graft incorporation. The remaining lesions showed evidence of partial graft incorporation with the exception of one tibial lesion, which was in the revised case. All other components were well fixed with no evidence of radiographic loosening. Conclusions: In this selected series of cases with extensive osteolysis around well-fixed and well-aligned TKAs, liner exchange and bone grafting provided durable midterm results with extensive graft incorporation. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

We previously evaluated 119 consecutive total knee arthroplasties performed by a single surgeon in eighty-six patients with use of the cemented LCS (low contact stress) mobile-bearing, rotating-platform system and an all-polyethylene patellar component. The average age of the patients at the time of surgery was seventy years. The patients were contacted as part of their routine follow-up and were asked to participate in this study. The purpose of the present study was to report the updated results at a minimum follow-up of twenty years. Twenty patients (twenty-six knees) were living, and one was lost to follow-up. Three knees required a reoperation (two for periprosthetic fractures and one for infection). No component was revised as a part of the reoperations. No knee required revision since the fifteen-year follow-up evaluation. Osteolysis was present in six knees compared with only three knees at the time of the fifteen-year follow-up. One knee had radiographic signs of femoral component loosening, which was associated with osteolysis. It occurred after the fifteen-year follow-up study. The average range of motion was from 1° of extension to 105° of flexion. The average clinical and functional Knee Society scores were 43 and 49 points, respectively, at the preoperative evaluation and 89 and 67 points at the time of the final follow-up. We concluded that the cemented LCS rotating-platform knee performed well, with durable clinical and radiographic results at a minimum follow-up of twenty years. However, the prevalence of osteolysis continues to increase with a longer duration of follow-up in these patients. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

We previously evaluated 119 consecutive total knee arthroplasties performed by a single surgeon in eighty-six patients with use of the cemented LCS (low contact stress) mobile-bearing, rotating-platform system and an all-polyethylene patellar component. The average age of the patients at the time of surgery was seventy years. The patients were contacted as part of their routine follow-up and were asked to participate in this study. The purpose of the present study was to report the updated results at a minimum follow-up of twenty years. Twenty patients (twenty-six knees) were living, and one was lost to follow-up. Three knees required a reoperation (two for periprosthetic fractures and one for infection). No component was revised as a part of the reoperations. No knee required revision since the fifteen-year follow-up evaluation. Osteolysis was present in six knees compared with only three knees at the time of the fifteen-year follow-up. One knee had radiographic signs of femoral component loosening, which was associated with osteolysis. It occurred after the fifteen-year follow-up study. The average range of motion was from 1° of extension to 105° of flexion. The average clinical and functional Knee Society scores were 43 and 49 points, respectively, at the preoperative evaluation and 89 and 67 points at the time of the final follow-up. We concluded that the cemented LCS rotating-platform knee performed well, with durable clinical and radiographic results at a minimum follow-up of twenty years. However, the prevalence of osteolysis continues to increase with a longer duration of follow-up in these patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to update the results, at a minimum of thirty-five years, in a single-surgeon series of primary Charnley total hip arthroplasties performed with cement. Twelve patients (fifteen hips) were alive, 249 patients (314 hips) had died, and one patient (one hip) had been lost to follow-up. Seven of the hips in the living patients had required at least one revision; 290 (88%) of the original group of total hip prostheses either continued to function or were in patients who had died. Since the time of a thirty-year study of this cohort, one hip that had previously been revised because of acetabular loosening required an additional revision because of acetabular loosening and two additional hips had evidence of radiographic loosening (of one acetabular and one femoral component). The survival rate with revision for any reason as the end point was 78%. This end result study should provide a benchmark for subsequent procedures and designs with the caveat that patient life expectancy will likely continue to increase and modern-design implants are being used in younger patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to update the results, at a minimum of thirty-five years, in a single-surgeon series of primary Charnley total hip arthroplasties performed with cement. Twelve patients (fifteen hips) were alive, 249 patients (314 hips) had died, and one patient (one hip) had been lost to follow-up. Seven of the hips in the living patients had required at least one revision; 290 (88%) of the original group of total hip prostheses either continued to function or were in patients who had died. Since the time of a thirty-year study of this cohort, one hip that had previously been revised because of acetabular loosening required an additional revision because of acetabular loosening and two additional hips had evidence of radiographic loosening (of one acetabular and one femoral component). The survival rate with revision for any reason as the end point was 78%. This end result study should provide a benchmark for subsequent procedures and designs with the caveat that patient life expectancy will likely continue to increase and modern-design implants are being used in younger patients. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Third-body wear can adversely affect the outcome of total hip arthroplasty by causing increased polyethylene wear, osteolysis, and component loosening. We hypothesized that there would be greater generation and migration of metal debris to the bearing surfaces in hips in which cobalt-chromium cables were used to reattach the osteotomized greater trochanter when compared with hips in which stainless steel wires were used. Methods: Between June 1981 and December 1983, 196 consecutive total hip arthroplasties were performed with use of an Iowa stem and a titanium-backed cemented acetabular component, with cobalt-chromium cable trochanteric re-attachment. After nineteen to twenty years of follow-up, the patients were evaluated with regard to the depth of head penetration into the polyethylene (as a surrogate for wear), osteolysis, loosening, and the need for revision. The results were compared with those for a series of 304 total hip arthroplasties that were performed by the same surgeon from January 1984 to December 1985 with use of the same components and the same surgical technique, but with stainless steel wire trochanteric reattachment. The two groups had a comparable nineteen to twenty-year follow-up. All living patients (fifty-nine hips in the cable group and ninety-two hips in the wire group) had minimum ten-year follow-up radiographs. Results: The polyethylene wear rate was 0.101 mm/yr for the cable group and 0.082 mm/yr for the wire group (p = 0.039). For the living patients, the rate of revision of the acetabular component because of aseptic loosening was 37.3% (twenty-two hips) for the cable group and 20.7% (nineteen hips) for the wire group (p = 0.025). The rate of acetabular osteolysis was 44% (twenty-six hips) for the cable group and 26% (twenty-four hips) for the wire group (p = 0.022). Kaplan- Meier analysis with revision of the acetabular component because of aseptic loosening as the end point demonstrated survival rates of 73.7% ± 9% and 83% ± 7% for the cable and wire groups, respectively, at twenty years (p = 0.03). Conclusions: Because cable trochanteric attachment led to significantly greater polyethylene wear, osteolysis, acetabular loosening, and acetabular revision, presumably due to third-body metallic debris generation in this cemented total hip replacement construct, surgeons should be aware of the deleterious effects of third-body debris and avoid the use of potential debris generators in the total hip arthroplasty construct. If cable is used and fretting is recognized, especially with intra-articular migration of metallic material or nonunion of the greater trochanter, consideration should be given to cable removal. [ABSTRACT FROM AUTHOR]

Background: In the mid- to late 1970s, on the basis of laboratory and finite element data, many surgeons in the United States began using collared matte-finish femoral components and metal-backed acetabular components in their total hip arthroplasties. The purpose of this study was to evaluate the long-term results of the use of one such construct in arthroplasties performed by a single surgeon in a consecutive nonselected patient cohort.Methods: Between January 1984 and December 1985, 273 patients underwent a total of 304 consecutive nonselected total hip arthroplasties with cement and use of the Iowa femoral component (which is collared, has a proximal cobra shape, and has a matte finish) and a metal-backed TiBac acetabular component performed by a single surgeon. At nineteen to twenty years postoperatively, only two patients (two hips) were lost to follow-up. For clinical evaluation, we attempted to interview all living patients and the families of the patients who had died to verify the status of the hip prosthesis or any revisions. Radiographic evaluation consisted of analysis for loosening and osteolysis as well as wear of the acetabular component.Results: At the time of the nineteen to twenty-year follow-up, the rate of revision of the arthroplasty for any reason was 10.5% (thirty-two hips) for all patients and 25% (twenty-three hips) for living patients. The rate of revision due to aseptic femoral loosening was 2.6% (eight hips). There was radiographic evidence of loosening of the femoral component in fifteen hips (4.9%), including those that were revised, and femoral osteolysis was seen distal to the trochanters in twenty-two hips (7.2%). The rate of revision due to aseptic loosening of the acetabular component was 7.9% (twenty-four hips), and there was radiographic evidence of acetabular loosening in forty-two hips (13.8%), including those that were revised.Conclusions: This study demonstrates the durability of a cemented matte-finish collared femoral component at twenty years postoperatively, with a rate of revision due to aseptic loosening of 2.6%. The metal-backed acetabular component also performed well in many patients, with a 7.9% rate of revision due to aseptic loosening. However, in the living patients, the rate of loosening of the acetabular component, including cases revised because of aseptic loosening, was 30.4%. [ABSTRACT FROM AUTHOR]

Background: In the mid- to late 1970s, on the basis of laboratory and finite element data, many surgeons in the United States began using collared matte-finish femoral components and metal-backed acetabular components in their total hip arthroplasties. The purpose of this study was to evaluate the long-term results of the use of one such construct in arthroplasties performed by a single surgeon in a consecutive nonselected patient cohort. Methods: Between January 1984 and December 1985, 273 patients underwent a total of 304 consecutive nonselected total hip arthroplasties with cement and use of the Iowa femoral component (which is collared, has a proximal cobra shape, and has a matte finish) and a metal-backed TiBac acetabular component performed by a single surgeon. At nineteen to twenty years postoperatively, only two patients (two hips) were lost to follow-up. For clinical evaluation, we attempted to interview all living patients and the families of the patients who had died to verify the status of the hip prosthesis or any revisions. Radiographic evaluation consisted of analysis for loosening and osteolysis as well as wear of the acetabular component. Results: At the time of the nineteen to twenty-year follow-up, the rate of revision of the arthroplasty for any reason was 10.5% (thirty-two hips) for all patients and 25% (twenty-three hips) for living patients. The rate of revision due to aseptic femoral loosening was 2.6% (eight hips). There was radiographic evidence of loosening of the femoral component in fifteen hips (4.9%), including those that were revised, and femoral osteolysis was seen distal .to the trochanters in twenty-two hips (7.2%). The rate of revision due to aseptic loosening of the acetabular component was 7.9% (twenty-four hips), and there was radiographic evidence of acetabular loosening in forty-two hips (13.8%), including those that were revised. Conclusions: This study demonstrates the durability of a cemented matte-finish collared femoral component at twenty years postoperatively, with a rate of revision due to aseptic loosening of 2.6%. The metal-backed acetabular component also performed well in many patients, with a 7.9% rate of revision due to aseptic loosening. However, in the living patients, the rate of loosening of the acetabular component, including cases revised because of aseptic loosening, was 30.4%. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Third-body effects are a major cause of the substantial variability of wear in total hip replacements. One potential mechanism by which third-body debris can access wear-critical central regions of closely conforming metal-on-polyethylene bearing couples is by fluid convection during incidents of subluxation accompanying neck-on-liner impingement. To provide evidence for this premise, we determined the association of severity of liner rim indentation damage (indicative of impingement frequency/vigor) and the presence of embedded third-body debris in 194 implants retrieved at revision. Rim damage was graded using the five-point Hospital for Special Surgery scale. Particle embedment was assessed both manually and by means of an image analysis computer program that detected the composition, size, and location of each particle. Sixty-eight percent of the cups showed rim indentation damage. We found an association between severity of rim damage and presence of embedded debris. There was substantial nonuniformity of the spatial distribution of the embedded debris, with the predominance of embedded debris at intermediate latitudes. These findings support the premise of convection of debris-laden joint fluid during lever-out subluxation as a mechanism for wear-consequential third-body particles to gain access to highly loaded regions of the bearing surface, thus potentiating increased wear. [ABSTRACT FROM AUTHOR]

Background: Recent studies have suggested that cemented femoral components with a polished surface may provide superior long-term fixation when compared with femoral components with a roughened surface. The purpose of this study was to evaluate the results of total hip arthroplasty with a cemented femoral component with a polished surface finish and compare them with the results of total hip arthroplasty performed with a similar design of cemented femoral component with a rougher surface finish.Methods: We retrospectively reviewed a consecutive group of 132 patients (149 hips) in whom primary total hip arthroplasty had been performed by one surgeon using a cemented collared femoral component with a polished (0.1-microm Ra) surface finish and a cementless acetabular component. Ninety-eight patients (115 hips) were followed for a minimum of ten years. We compared the survivorship of this prosthesis with that of a femoral component of similar design but with rougher surfaces (matte or grit-blasted).Results: No polished stems were revised because of aseptic loosening or demonstrated radiographic evidence of loosening; however, eight hips (5.4%) with a polished stem demonstrated osteolysis distal to the greater or lesser tro-chanter. In contrast, six stems (2.0%) with a matte surface finish of 0.8-microm Ra were revised because of aseptic loosening, and an additional five stems were seen to be loose radiographically. Eleven stems (9.2%) with a grit-blasted surface finish of 2.1-microm Ra were revised because of aseptic loosening, and an additional four stems were seen to be loose radiographically. The difference in the prevalence of revision due to aseptic loosening between the group with the 0.1-microm Ra surface and the group with the 2.1-microm Ra surface was significant (p = 0.001), as was the difference between the prevalence of revision due to aseptic loosening between the group with the 0.8-microm Ra surface and the group with the 2.1-microm Ra surface (p = 0.001). No cups were revised because of aseptic loosening, and one hip had radiographic signs of acetabular loosening.Conclusions: This study demonstrated excellent durability of a prosthesis consisting of a cemented, collared, polished femoral component and a cementless acetabular component. While no hips were revised because of aseptic loosening, distal femoral osteolysis was observed in eight hips (5.4%), a higher prevalence than has been reported by others after similar durations of follow-up of tapered, collarless, polished femoral components. [ABSTRACT FROM AUTHOR]

Background: Recent studies have suggested that cemented femoral components with a polished surface may pro- vide superior long-term fixation when compared with femoral components with a roughened surface. The purpose of this study was to evaluate the results of total hip arthroplasty with a cemented femoral component with a polished surface finish and compare them with the results of total hip arthroplasty performed with a similar design of cemented femoral component with a rougher surface finish. Methods: We retrospectively reviewed a consecutive group of 132 patients (149 hips) in whom primary total hip arthroplasty had been performed by one surgeon using a cemented collared femoral component with a polished (0.1-µm Ra) surface finish and a cementless acetabular component. Ninety-eight patients (115 hips) were followed for a minimum of ten years. We compared the survivorship of this prosthesis with that of a femoral component of similar design but with rougher surfaces (matte or grit-blasted). Results: No polished stems were revised because of aseptic loosening or demonstrated radiographic evidence of loosening; however, eight hips (5.4%) with a polished stem demonstrated osteolysis distal to the greater or lesser trochanter. In contrast, six stems (2.0%) with a matte surface finish of 0.8-µm Ra were revised because of aseptic loosening, and an additional five stems were seen to be loose radiographically. Eleven stems (9.2%) with a grit-blasted surface finish of 2.1-µm Ra were revised because of aseptic loosening, and an additional four stems were seen to be loose radiographically. The difference in the prevalence of revision due to aseptic loosening between the group with the 0.1-µm Ra surface and the group with the 2.1-µm Ra surface was significant (p = 0.001), as was the difference between the prevalence of revision due to aseptic loosening between the group with the 0.8-µm Ra surface and the group with the 2.1-µm Ra surface (p = 0.001). No cups were revised because of aseptic loosening, and one hip had radiographic signs of acetabular loosening. Conclusions: This study demonstrated excellent durability of a prosthesis consisting of a cemented, collared, polished femoral component and a cementless acetabular component. While no hips were revised because of aseptic loosening, distal femoral osteolysis was observed in eight hips (5.4%), a higher prevalence than has been reported by others after similar durations of follow-up of tapered, collarless, polished femoral components. [ABSTRACT FROM AUTHOR]

Unlabelled: The current study was performed to determine the status, at a minimum of twenty-five years, of a prospective, single-surgeon series of patients treated with primary Charnley total hip arthroplasty with a contemporary femoral cementing technique that included use of a distal cement plug and a retrograde cement-delivery system. Since our review at a minimum of twenty years postoperatively, two primary total hip prostheses were revised (one because of acetabular loosening, and one because of femoral loosening). Of the original cohort of 357 hips (320 patients), ten (2.8%) had revision of the femoral stem because of aseptic loosening. Forty-nine patients (fifty-two hips, 14.6%) who had been in the initial study group were still living at the time of the present review. Five hips (10%) in living patients had required a femoral revision because of aseptic loosening. Including those that were revised, eight femoral components (17%) in living patients were seen to be loose radiographically. Although this study demonstrates the remarkable durability of the femoral fixation obtained with the polished flatback Charnley prosthesis and the contemporary cementing technique, there was some deterioration of the results with time. These results provide a standard for comparison with cementless fixation after hips treated with that technique have been followed for a similar duration.Level Of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The current study was performed to determine the status, at a minimum of twenty-five years, of a prospective, single-surgeon series of patients treated with primary Charnley total hip arthroplasty with a contemporary femoral cementing technique that included use of a distal cement plug and a retrograde cement-delivery system. Since our review at a minimum of twenty years postoperatively, two primary total hip prostheses were revised (one because of acetabular loosening, and one because of femoral loosening). Of the original cohort of 357 hips (320 patients), ten (2.8%) had revision of the femoral stem because of aseptic loosening. Forty-nine patients (fifty-two hips, 14.6%) who had been in the initial study group were still living at the time of the present review. Five hips (10%) in living patients had required a femoral revision because of aseptic loosening. Including those that were revised, eight femoral components (17%) in living patients were seen to be loose radiographically. Although this study demonstrates the remarkable durability of the femoral fixation obtained with the polished flatback Charnley prosthesis and the contemporary cementing technique, there was some deterioration of the results with time. These results provide a standard for comparison with cementless fixation after hips treated with that technique have been followed for a similar duration. [ABSTRACT FROM AUTHOR]

We previously evaluated 119 consecutive total knee arthroplasties that were performed in eighty-six patients with use of the cemented LCS (low contact stress) rotating-platform system with an all-polyethylene patellar component. The average age of the patients at the time of surgery was seventy years (range, thirty-seven to eighty-eight years). The purpose of this study was to report the updated results at a minimum follow-up of fifteen years. Thirty-seven patients (fifty-three knees) were living, and no patient was lost to follow-up. No knee was revised because of loosening, osteolysis, or wear. Three knees required a reoperation (two for periprosthetic fractures and one for infection). No component was revised as a part of the reoperations. Osteolysis was present in three knees. No knee had radiographic signs of component loosening, and there were no dislocated bearings. The average range of motion was from 1 degrees of extension to 105 degrees of flexion. The average clinical and functional Knee Society scores were 43 and 49, respectively, at the preoperative evaluation and 85 and 58 at the time of the final follow-up. We concluded that the cemented LCS rotating-platform knee performed well, with durable clinical and radiographic results at a minimum follow-up of fifteen years. [ABSTRACT FROM AUTHOR]

Abstract: We previously evaluated 119 consecutive total knee arthroplasties that were performed in eighty-six patients with use of the cemented LCS (low contact stress) rotating-platform system with an all-polyethylene patellar component. The average age of the patients at the time of surgery was seventy years (range, thirty-seven to eighty-eight years). The purpose of this study was to report the updated results at a minimum follow-up of fifteen years. Thirty-seven patients (fifty-three knees) were living, and no patient was lost to follow-up. No knee was revised because of loosening, osteolysis, or wear. Three knees required a reoperation (two for periprosthetic fractures and one for infection). No component was revised as a part of the reoperations. Osteolysis was present in three knees. No knee had radiographic signs of component loosening, and there were no dislocated bearings. The average range of motion was from 1 ° of extension to 105 ° of flexion. The average clinical and functional Knee Society scores were 43 and 49, respectively, at the preoperative evaluation and 85 and 58 at the time of the final follow-up. We concluded that the cemented LCS rotating-platform knee performed well, with durable clinical and radiographic results at a minimum follow-up of fifteen years. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the types and prevalence of complications associated with bilateral total knee replacement performed four to seven days apart during a single hospitalization and to compare them with those associated with bilateral knee replacement performed sequentially under the same anesthetic session or staged unilateral replacements performed during separate hospitalizations.Methods: Using a computerized database and medical records, we retrospectively evaluated 332 consecutive patients who underwent bilateral total knee replacement performed by two surgeons. A total of 241 patients underwent staggered bilateral knee replacement with the procedures performed four to seven days apart during one hospitalization, twenty-six underwent sequential bilateral total knee replacement, and sixty-five underwent staged bilateral knee replacement performed during two separate hospitalizations. The data on major complications, including death, return to operating room, myocardial infarction, and pulmonary embolism, and on minor complications, including atrial fibrillation, deep-vein thrombosis, and urinary tract infection, were evaluated.Results: Patients undergoing sequential bilateral total knee replacement and staged bilateral knee replacement had an overall rate of complications that was 2.5 times higher than that of the staggered group. Major complications were rare in all groups, but they occurred most often in the staged bilateral replacement group. The overall rate of complications for the patients who had staggered bilateral knee replacement (13%) was significantly less (p = 0.0009) than that for the patients who had sequential bilateral knee replacement (35%) or staged bilateral knee replacement (31%). The length of inpatient stay for those with staggered total knee arthroplasty was four days longer than that for the sequential arthroplasty group (p = 0.0001).Conclusions: Staggered bilateral total knee replacement, with the procedures performed four to seven days apart in a single hospitalization, is a safe and practical method for performing bilateral total knee replacement. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the types and prevalence of complications associated with bilateral total knee replacement performed four to seven days apart during a single hospitalization and to compare them with those associated with bilateral knee replacement performed sequentially under the same anesthetic session or staged unilateral replacements performed during separate hospitalizations. Methods: Using a computerized database and medical records, we retrospectively evaluated 332 consecutive patients who underwent bilateral total knee replacement performed by two surgeons. A total of 241 patients underwent staggered bilateral knee replacement with the procedures performed four to seven days apart during one hospitalization, twenty-six underwent sequential bilateral total knee replacement, and sixty-five underwent staged bilateral knee replacement performed during two separate hospitalizations. The data on major complications, including death, return to operating room, myocardial infarction, and pulmonary embolism, and on minor complications, including atrial fibrillation, deep-vein thrombosis, and urinary tract infection, were evaluated. Results: Patients undergoing sequential bilateral total knee replacement and staged bilateral knee replacement had an overall rate of complications that was 2.5 times higher than that of the staggered group. Major complications were rare in all groups, but they occurred most often in the staged bilateral replacement group. The overall rate of complications for the patients who had staggered bilateral knee replacement (13%) was significantly less (p = 0.0009) than that for the patients who had sequential bilateral knee replacement (35%) or staged bilateral knee replacement (31%). The length of inpatient stay for those with staggered total knee arthroplasty was four days longer than that for the sequential arthroplasty group (p = 0.0001). Conclusions: Staggered bilateral total knee replacement, with the procedures performed four to seven days apart in a single hospitalization, is a safe and practical method for performing bilateral total knee replacement. [ABSTRACT FROM AUTHOR]

We previously reported the results at a mean of five years following the use of a tripolar constrained acetabular component to treat recurrently dislocating total hip prostheses. In this study, we report the results after longer follow-up, with emphasis on the prevalence of implant loosening, osteolysis, and later recurrent instability. Fifty-five patients treated with a total of fifty-six constrained acetabular components because of recurrent dislocations of a total hip prosthesis (average, six dislocations; range, two to twenty dislocations) were followed for an average of 10.2 years (range, 7.0 to 13.2 years) or until death. Four (7%) of the fifty-six hips had a subsequent dislocation or failure of the device. Three femoral components (5%) and two acetabular components (4%) were revised because of aseptic loosening. One hip was revised because of osteolysis. We concluded that this constrained acetabular component provides durable protection against additional dislocations without substantial deleterious effects on component fixation. We use this device to treat recurrent dislocation when other modalities are unlikely to be effective. [ABSTRACT FROM AUTHOR]

Background: Constrained acetabular components have been used to treat hips with recurrent instability following total hip arthroplasty and hips that demonstrate instability during revision surgery. In such hips, when a secure cementless acetabular shell is present, the surgeon can cement a constrained liner into the existing shell. The purpose of this study was to evaluate the clinical and radiographic outcome of this technique with use of a tripolar constrained liner that was cemented into a well-fixed cementless acetabular shell. Methods: Between 1988 and 2000, constrained liners were cemented into thirty-one well-fixed cementless acetabular shells at three centers. The average age of the patients at the time of the index surgery was 72.1 years, and the indications for the procedure were recurrent hip instability in sixteen hips and intraoperative instability in fifteen hips. The patients were evaluated with respect to the clinical outcome and radiographic evidence of shell loosening and osteolysis. Results: At an average duration of follow-up of 3.9 years, twenty-nine liners (94%) were securely fixed in the cement- less shells and two constrained liners had failed. One liner failed because it separated from the cement, and one failed because of fracture of the capturing mechanism. Both hips were successfully revised with another cemented tripolar constrained liner. No acetabular component demonstrated radiographic evidence of progressive loosening or osteolysis. Conclusions: A constrained tripolar liner cemented into a secure, well-positioned cementless acetabular shell provides stability and durability at short-term follow-up. Careful attention to the preparation of the liner, the sizing of the component, and the cementing technique are likely to reduce the failure of this construct, which can be used for difficult cases of total hip instability. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). [ABSTRACT FROM AUTHOR]

The purpose of the current study was to update the results of a prospective, single-surgeon series of primary Charnley total hip arthroplasties performed with cement. This investigation is one of the first studies in which hips treated with total hip arthroplasty with cement were followed for a minimum of thirty years. Twenty-seven patients (thirty-four [10.3%] of the hips in the initial study group) were alive at a minimum of thirty years postoperatively. These patients served as the focus of the present study. Revision because of aseptic loosening of the acetabular component was performed in 7.3% (twenty-three) of the hips from the original study group (excluding those revised because of infection or dislocation) and 26% (eight) of the hips in the living cohort. Revision because of aseptic loosening of the femoral component was performed in 3.2% (ten) of the hips from the original study group (excluding those revised because of infection or dislocation) and 10% (three) of the hips in the living patients. Since the twenty-five-year review, three hips were revised (one because of acetabular loosening, one because of femoral loosening, and one because of instability). This end-result study demonstrated the remarkable durability of cemented Charnley total hip replacements over a span of three decades, with 88% of the original prostheses intact at the time of the final follow-up or at the patient's death. Level of Evidence: Therapeutic study, &dLevel IVline; (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

We report the updated results for a previously evaluated cohort of patients who were less than fifty years old when they underwent Charnley total hip arthroplasty with cement. The original cohort consisted of ninety-three total hip arthroplasties performed in sixty-nine patients. The patients were followed for a minimum of twenty-five years after surgery or until death. The present report describes the findings of the radiographic and functional follow-up, which was performed for forty-two of the forty-three living patients. At the time of the latest follow-up, twenty-nine (31%) of the ninety-three total hip replacements had been revised or removed. Eighteen acetabular and five femoral components were revised secondary to aseptic loosening. The combined prevalence of radiographic failure or revision because of aseptic loosening was 13% for the femoral components and 34% for the acetabular components. Comorbid medical conditions significantly hindered results on each functional sub-scale (p < 0.05). This study demonstrates the durability of cemented total hip replacements in a young patient population. Sixty-nine percent of the original hip replacements were functioning well at the latest follow-up examination or at the time of death, and only 5% required more than one revision arthroplasty. Level of Evidence:Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

We report the updated results for a previously evaluated cohort of patients who were less than fifty years old when they underwent Charnley total hip arthroplasty with cement. The original cohort consisted of ninety-three total hip arthroplasties performed in sixty-nine patients. The patients were followed for a minimum of twenty-five years after surgery or until death. The present report describes the findings of the radiographic and functional follow-up, which was performed for forty-two of the forty-three living patients. At the time of the latest follow-up, twenty-nine (31%) of the ninety-three total hip replacements had been revised or removed. Eighteen acetabular and five femoral components were revised secondary to aseptic loosening. The combined prevalence of radiographic failure or revision because of aseptic loosening was 13% for the femoral components and 34% for the acetabular components. Comorbid medical conditions significantly hindered results on each functional subscale (p < 0.05). This study demonstrates the durability of cemented total hip replacements in a young patient population. Sixty-nine percent of the original hip replacements were functioning well at the latest follow-up examination or at the time of death, and only 5% required more than one revision arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Most intermediate and long-term studies of cemented posterior-cruciate-substituting total knee prostheses were performed with nonmodular tibial components. The purpose of this study was to evaluate the intermediate-term results of posterior-cruciate-substituting total knee arthroplasties in which a cemented modular tibial component had been used, with a particular focus on evaluating the prevalence of radiographic osteolysis. Methods: Between 1992 and 1995, 176 consecutive primary total knee arthroplasties with use of the Insall-Burstein II system were performed in 134 patients at our institution. A modular metal-backed tibial component was inserted in 145 knees, and an all-polyethylene tibial component of the same design was inserted in thirty-one. Standard-terminology questionnaires were completed or Knee Society and The Hospital for Special Surgery scores were determined preoperatively and at the time of final follow-up, at an average of 6.4 years (range, 5.0 to 7.9 years). Initial postoperative radiographs were compared with those made at the time of final follow-up to assess component position, wear, radiolucent lines, and osteolysis. Results: Ninety-two patients (128 knees) treated with the modular tibial component were alive at the time of final follow-up. No patient was lost to follow-up. Radiographs were available for 105 knees (82%). Three knees had been revised because of instability or infection; none had been revised because of loosening or osteolysis. The mean Knee Society clinical and functional scores were 85 points (range, 41 to 100 points) and 79 points (range, 30 to 100 points), respectively, at the time of final follow-up. According to The Hospital for Special Surgery score, 94% of the knees had a good or excellent result. Knee flexion averaged 113° (range, 90° to 130°) at the time of final follow-up. Osteolysis was present in seventeen (16%) of the knees with radiographic follow-up. Osteolysis did not develop in any... [ABSTRACT FROM AUTHOR]

Determines whether the cementing technique of using a distal cement plug and retrograde filling of the femoral canal with cement versus hand-packed technique provided better long-term fixation. Calculation of the prevalence of revision of the original prosthesis; Complications; Patient satisfaction; Radiographic results.

Background: Although cementless acetabular components are routinely used in revision hip surgery, few investigators have evaluated the retention and efficacy of these components in the long term. In the current study, the clinical and radiographic outcomes of a series of arthroplasties performed by one surgeon with a cementless acetabular component were assessed at a minimum of ten years. Methods: From 1986 through 1988, sixty-one consecutive revision total hip arthroplasties were performed in fiftyfive patients because of aseptic failure of one or both components of a prosthesis in which both components had been cemented. Twenty-eight patients (thirty-two hips) were alive at a mean of 12.9 years (range, 11.5 to 14.3 years) after the operation. In all of the patients, the acetabular component was revised to a porous-coated Harris-Galante component inserted without cement, and the femoral component was revised to an Iowa component affixed with contemporary cementing techniques. The hips were evaluated clinically and radiographically at a minimum of ten years subsequent to the index revision. No hips were lost to follow-up. Results: None of the acetabular components required revision because of aseptic loosening. Two hips (3%) demonstrated radiographic evidence of aseptic loosening of the acetabular component. The polyethylene liner was exchanged during the follow-up period in eight hips. Conclusion: After a minimum of ten years of follow-up, cementless acetabular fixation in revision hip arthroplasty had produced durable results that were markedly better than those reported for acetabular fixation with cement. [ABSTRACT FROM AUTHOR]

Background: Although the LCS (low contact stress) rotating-platform mobile-bearing knee replacement has been used extensively, there have been few intermediate or long-term clinical and radiographic follow-up studies evaluating the device. The purpose of this study was to report the nine to twelve-year results of a consecutive series of patients who had a primary total knee replacement performed with this device. Methods: Between November 1985 and November 1988, the senior author (R. C. J.) performed 119 consecutive total knee arthroplasties in eighty-six patients with LCS rotating-platform femoral and tibial components and a Townley all-polyethylene dome patellar component. All components were fixed with cement. The average age of the patients at the time of the operation was seventy years (range, thirty-seven to eightyeight years). Fifty-two patients (seventy-six knees) were female, and thirty-four patients (forty-three knees) were male. The patients were evaluated with clinical knee ratings and radiographic analysis nine to twelve years following the knee replacement. Results: At the time of the nine to twelve-year follow-up, sixty-four patients (eighty-six knees) were alive, eighteen patients (twenty-eight knees) had died, and four patients (five knees) had been lost to followup. Of the 114 knees in the eighty-two patients for whom the final outcome was known, none required a reoperation and none had a dislocation of the mobilebearing prosthesis. For the forty-five patients (sixty-six knees) who returned for final clinical and radiographic follow-up examinations at nine to twelve years, the average clinical and functional Knee Society ratings were 30 points (range, 2 to 70 points) and 44 points (range, 0 to 80 points) preoperatively and 90 points (range, 63 to 102 points) and 75 points (range, 30 to 100 points) at the final follow-up evaluation. The average Hospital for Special Surgery knee rating was 57 points (range, 28 to 80 points) preoperatively and 84... [ABSTRACT FROM AUTHOR]

Background: This report presents the results of the senior author's initial twenty-five-year experience with the use of Charnley total hip arthroplasty with cement. The purpose of this paper was to evaluate the longterm results of total hip arthroplasty. Methods: Between July 1970 and April 1972, the senior author (R. C. J.) performed 330 Charnley total hip replacements with cement using a hand-packing cement technique in 262 patients. Fifty-one patients (sixty-two hips) who were alive at least twenty-five years postoperatively were evaluated from a clinical standpoint with use of a standard-terminology questionnaire. The average age of this group at the time of surgery was fifty-six years (range, thirty-five to seventy-one years) compared with sixty-five years (range, twenty-one to eighty-nine years) for the entire group. All patients were evaluated for radiographic changes at the time of their most recent follow-up. Of the fifty-one patients (sixty-two hips) who were alive at least twenty-five years postoperatively, thirty-one (thirty-six hips) had a follow-up radiograph made at a minimum of twentyfive years after the surgery. The average duration of radiographic follow-up for the fifty-one patients was 22.7 years (range, two to twenty-seven years). Results: Of the sixty-two hips in the fifty-one patients who were alive at least twenty-five years postoperatively, fourteen (23 percent) had been revised. Three (5 percent) had the revision because of loosening with infection; eleven (18 percent), because of aseptic loosening; and none, because of dislocation. The prevalence of revision due to aseptic loosening of the acetabular component in all 316 hips (excluding those that were lost to follow-up or that were revised for infection or dislocation) was 6 percent (eighteen hips), whereas the prevalence in the fifty-nine hips (excluding the three revised for infection) in the patients who were alive at least twenty-five years after the arthroplasty was 15 percent... [ABSTRACT FROM AUTHOR]