Search

Background: The purpose of this study is to evaluate the outcome of revision total hip arthroplasty using an uncemented deep profile jumbo acetabular component in patients who had been followed for a minimum of 10 years postoperatively., Methods: Between 1997 and 2001, 61 revision total hip arthroplasties were performed in 58 patients, with use of the +5 Deep Profile acetabular shell. The outcome with regard to retention vs re-revision of the acetabular component was determined for every hip. At a mean of 13 years (range 10-16) postoperatively, 30 patients (32 hips) were living. The Harris hip score, radiographic results, complications, and Kaplan-Meier survivorship were evaluated., Results: In the entire cohort of 61 hips, 4 acetabular components have been re-revised. Two shells were re-revised for sepsis: 1 shell was re-revised for aseptic loosening and 1 for recurrent dislocation. In the 32 hips followed for a minimum of 10 years postoperatively, 2 cups have been re-revised: 1 for aseptic loosening and 1 for recurrent dislocation. One additional shell was loose by radiographic criteria. With failure defined as re-revision for any reason, implant survival (95% confidence interval) was 92.6% (81.0-97.2) at 16 years. With failure defined as re-revision for aseptic loosening, implant survival was 97.4% (82.8-99.6) at 16 years., Conclusion: Revision total hip arthroplasty with the +5 Deep Profile acetabular component was associated with a good rate of survival at 16 years., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Previously, we reported the mean 16-year results of primary uncemented total hip arthroplasty using a tapered femoral component in patients <50 years. The purpose of this study was to update our previous report using the Taperloc femoral component in young patients who had been followed for a minimum of 20 years postoperatively., Methods: Between 1983 and 1990, 108 consecutive uncemented total hip arthroplasties were performed in 91 patients of age <50 years, with use of the Taperloc femoral component. Every patient was followed for a minimum of 20 years after surgery or until death. At a mean of 25 (range, 20-29 years) postoperatively, 76 patients (91 hips) were living. The Harris Hip Score, radiographic results, complications, and Kaplan-Meier survivorship were evaluated., Results: In the entire cohort of 108 hips, 9 femoral components (8%) have been revised, none for aseptic loosening. Five well-fixed stems were removed during acetabular revision, 3 stems were revised for infection, and 1 stem was exchanged because of a peroneal nerve palsy. Distal femoral osteolysis was identified around 1 hip. With failure defined as stem removal for any reason, implant survival was 90% (CI = 82-95) at 29 years. With failure defined as stem removal for aseptic loosening, implant survival was 100% at 29 years., Conclusion: Primary total hip arthroplasty with the Taperloc femoral component in young patients was associated with a high rate of survival at 29 years., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Aims: To investigate the longevity of uncemented fixation of a femoral component in total hip arthroplasty (THA) in patients with Dorr type C proximal femoral morphology., Patients and Methods: A total of 350 consecutive uncemented THA in 320 patients were performed between 1983 and 1987, by a single surgeon using the Taperloc femoral component. The 63 patients (68 hips) with Dorr type C proximal femoral morphology were the focus of this review. The mean age of the patients was 69 years (24 to 88) and mean follow-up was 16.6 years (ten to 29). Survival analysis included eight patients (eight hips) who died without undergoing revision surgery prior to obtaining ten years follow-up. All 55 surviving patients (60 hips) were available for clinical assessment and radiographic review. As a comparator group, the survival and implant fixation in the remaining 282 THAs (257 patients) with Dorr type A and B morphology were evaluated. The mean age of these patients was 52 years (20 to 82)., Results: In the Dorr C patient group the mean Harris hip score improved from 51 points (21 to 69 points) pre-operatively to 89 (74 to 100) at final follow-up. No femoral component was loose by radiological criteria and osteolysis was only identified around two stems (3.3%). There was one revision (1.6%) of a well-fixed femoral component for sepsis at 11 years. The survival of the Taperloc femoral component at 20 years with revision for any reason as the endpoint was 98% (95% confidence interval; 87 to 99). A total of ten (3.5%) of the Dorr A and B patient group of 282 THAs required revision surgery. Only one (0.4%) for aseptic loosening. A total of two hips (1%) were loose by radiographic criteria and osteolysis occurred around 12 hips (4%)., Conclusion: This study demonstrates that excellent fixation can be achieved using the Taperloc stem in patients with Dorr type A and B, and Dorr type C bone., Take Home Message: The Taperloc stem demonstrated equivalent results in Dorr type A and B and Dorr type C bone. Cite this article: Bone Joint J 2016;98-B:595-600., (©2016 The British Editorial Society of Bone & Joint Surgery.)

The purpose of this study was to evaluate the efficacy of an uncemented tapered femoral component in obese patients at a mean follow-up of 23 years. We retrospectively reviewed 119 consecutive uncemented total hip arthroplasties in 105 obese patients using a tapered femoral component between 1983 and 1987. The mean body mass index of these patients was 34 (range 30-47). Complete clinical and radiographic follow-up was obtained on the 55 hips in 47 patients who survived a minimum of 18 years (range 18-27 years). Three femoral components (6%) have been revised, none for aseptic loosening. One was loose by radiographic criteria. These results demonstrate that an uncemented tapered stem can provide excellent fixation in obese patients out to 27 years., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The purpose of the present study was to evaluate the outcome of primary uncemented total hip arthroplasty in patients younger than 50 years using the Taperloc (Biomet, Warsaw, Ind) femoral component. We evaluated 94 hips in 79 patients at a mean follow-up of 16 years (range, 11-18.5 years). The average age of the patients at the time of surgery was 36 years (range, 20-49 years). Three femoral components had been revised, none for aseptic loosening. Complete clinical and radiographic follow-up was obtained on the 91 hips that had not undergone femoral component revision. The mean Harris hip score increased from 54 points (range, 20-72) before surgery to 93 points (range, 68-100) at the time of this review. Radiographically, 89 stems (98%) were determined to have fixation by bone ingrowth, 2 (2%) demonstrated stable fibrous ingrowth, and no femoral component was loose. Distal femoral osteolysis was identified in 1 hip (1%). These findings indicate that excellent clinical and radiographic results can be achieved in young patients with the Taperloc femoral component at a mean follow-up of 16 years., (Copyright © 2011 Elsevier Inc. All rights reserved.)

We reviewed 123 second-generation uncemented total hip replacements performed on 115 patients by a single surgeon between 1993 and 1994. The acetabular component used in all cases was a fully porous-coated threaded hemispheric titanium shell (T-Tap ST) with a calcium ion stearate-free, isostatically compression-moulded polyethylene liner. The titanium femoral component used was a Taperloc with a reduced distal stem. No patient was lost to follow-up. Complete clinical and radiological follow-up was obtained for all 123 hips at a mean of 14 years (12 to 16). One femoral component was revised after a fracture, and three acetabular components for aseptic loosening. No additional femoral or acetabular components were judged loose by radiological criteria. Mild proximal femoral osteolysis was identified in two hips and minor acetabular osteolysis was present in four. The mean rate of penetration of the femoral head was 0.036 mm/year (0.000 to 0.227). These findings suggest that refinements in component design may be associated with excellent long-term fixation in cementless primary total hip replacement.

The goal of this study was to evaluate the outcome at a mean follow-up of 24.5 years (range, 22-26 years) of a consecutive series of 138 patients (145 hips) treated with total hip arthroplasty (THA) with the use of the Taperloc femoral component (Biomet, Warsaw, Indiana). This was an FDA-approved prospective study. All surgeries were performed by a single surgeon. Each of the 138 patients (145 hips) was followed annually until death, femoral component revision, or a minimum of 22 years. Complete clinical and radiographic follow-up was obtained on 95% of living patients at 5 years, and 100% at 10, 15, 20, and 24.5 years. Of the original series of 145 hips, only 1 femoral component (0.7%) had undergone revision for aseptic loosening, and 1 was loose by radiographic criteria (0.7%). Femoral osteolysis was identified in 8 hips (5.5%). A subset of 63 THAs in 56 patients was followed for a mean of 24.5 years. In this group, no femoral component required revision for aseptic loosening, and 1 was loose by radiographic criteria. Femoral osteolysis was present in 4 hips. Survivorship analysis of the femoral component with revision for aseptic loosening as the endpoint was 99% (95% confidence interval, 0.97-100) at 26 years. This stem demonstrates excellent fixation at a follow-up of 24.5 years with no apparent deterioration of the results with time., (Copyright 2010, SLACK Incorporated.)

Background: Excellent intermediate-term results with use of tapered femoral components in primary total hip arthroplasty have been reported. The purpose of this study was to update our previous report and to evaluate the outcome of total hip arthroplasty with use of the porous Taperloc femoral component in patients who had been followed for a minimum of eighteen years postoperatively., Methods: One hundred and forty-five consecutive uncemented total hip arthroplasties in 138 patients were performed between 1983 and 1985, by a single surgeon, with use of the Taperloc femoral component. The outcome of every femoral component with regard to stem fixation, retention, or revision was determined for all 145 total hip replacements. At a mean of twenty years (range, eighteen to 22.6 years) postoperatively, fifty-eight patients (sixty-five hips) were living. In fifty living patients (fifty-seven hips), the femoral component had not undergone revision surgery. Evaluation of the living patients included clinical and radiographic analysis and recording of complications., Results: Of the eighty patients (eighty hips) who had died, five hips had undergone revision of the femoral component. Only one stem had been revised for aseptic loosening, and no femoral component had been definitely loose by radiographic criteria. In the remaining sixty-five hips in the fifty-eight living patients, eight femoral components were revised. No femoral component underwent revision for aseptic loosening. Definite radiographic evidence of femoral component loosening occurred in one hip. In the fifty living patients (fifty-seven hips) who had not undergone femoral component revision, there was a significant improvement in the mean Harris hip score from 49.3 points preoperatively to 85.4 points at the time of latest follow-up (p = 0.001). Survivorship analysis of all 145 hips, with revision for any reason as the end point, estimated that the survival rate for the femoral component was 87% (95% confidence interval, 79% to 93%) at twenty-two years., Conclusions: Primary total hip arthroplasty with the Taperloc femoral component is associated with a low rate of aseptic loosening at a mean follow-up of twenty years.

One hundred eight uncemented total hip arthroplasties were performed in 91 patients who were 50 years of age or younger using the Taperloc femoral component. The average age of the patients at time of surgery was 37 years (range, 20-50 years). The mean followup was 10.2 years (range, 8-13 years). No patient was lost to followup. Seven patients (eight hips) died before obtaining the minimum time of 8 years for inclusion in this study. All seven died with their femoral components in place. Of the remaining 100 total hip arthroplasties, no femoral component required revision for aseptic loosening. One femoral component was revised to correct a leg length discrepancy, and one well-fixed femoral component was revised for sepsis. In the 98 total hip arthroplasties that had not undergone femoral component revision, complete radiographic and clinical followup was obtained. Radiographically, 96 (98%) femoral components were determined to have fixation by bone ingrowth, two (2%) femoral components showed stable fibrous ingrowth, and no femoral component was unstable. Femoral cortical osteolysis occurred in seven (7%) hips; major lysis was present in only one (1%). Clinically, 91 (93%) total hip arthroplasties were rated good or excellent; six (6%) were rated fair, and one (1%) was rated poor. Thirty-nine patients with 47 total hip arthroplasties (48%) were engaged in moderate to strenuous manual labor. These results indicate that excellent fixation and minimal lysis can be achieved with an uncemented femoral component in young and active patients at 10 years.

We followed 138 patients (145 hips) who had had uncemented total hip arthroplasty using the Taperloc femoral component for a mean of ten years (8 to 12.5). No patient was lost to follow-up; 31 (31 hips) died before the minimum time of eight years for inclusion in the study, and 30 of these still had their femoral component in place. One well-fixed prosthesis had been exchanged at the time of acetabular revision. Of the remaining 114 hips, one femoral component required revision for aseptic loosening and one for sepsis. Three other well-fixed femoral components were removed during acetabular revision. Complete clinical and radiological follow-up was obtained in the 109 hips which had not had revision. Clinically, 94 (87%) were rated good or excellent, eight (7%) fair and seven (6%) poor. The average Harris hip score increased from 48 before operation to 88 at the time of the last follow-up. Radiologically, 103 hips (94%) had fixation by bone ingrowth, three (3%) showed stable fibrous ingrowth and three (3%) were unstable. Osteolysis of the fomoral cortex was seen in seven hips (6%), with major lysis in only one. At a mean follow-up of ten years, the results of the Taperloc femoral component are comparable with those of modern techniques of cementing in primary total hip arthroplasty.

Patients who have major loss of bone in the region of the medial aspect of the femoral neck, shortening of the limb, or a high center of the hip joint constitute a special challenge for surgeons performing revision total hip replacements. The use of a so-called calcar-replacement femoral component is one approach to these problems. Of forty-eight hips (forty-four patients) that had been treated consecutively with a total revision arthroplasty with insertion of a calcar-replacement femoral component with cement, thirty-eight hips (thirty-five patients) were followed for a mean of 10.8 years (range, 5.8 to 16.6 years). Ten of the forty-eight hips did not qualify for this study, including nine hips in eight patients who had died before the minimum five-year duration of follow-up and one hip in a patient who had refused follow-up. Of the thirty-eight hips that were followed, seven (18 per cent) had had a repeat revision because of aseptic loosening of the femoral component, one (3 per cent) had been revised again because of lysis around a well fixed femoral component, and an additional four (11 per cent) had a component that was loose according to radiographic criteria. Thus, twenty-six (68 per cent) of the thirty-eight index femoral components were rigidly fixed according to radiographic criteria, and thirty (79 per cent) were still in place. The clinical results were very good for the thirty hips that had not been revised. The mean Harris hip-rating for these patients increased from 50 points preoperatively to 84 points at the most recent follow-up evaluation.

The objective of this study was to investigate retrieved ultra high molecular weight polyethylene (UHMWPE) liners from Total HIp Arthroplasty (THA) revisions. The amount of in vivo wear on compression molded v. ram extruded and machined acetabular liners was the focus of comparison between 43 surgically retrieved samples. The principal experimental methods were scanning electron microscope (SEM) observations and a fluid displacement method to quantify volumetric wear. SEM observations revealed similar wear mechanisms between the compression molded and ram extruded and machined UHMWPE retrieved liners. More third body wear corresponded with more volumetric in vivo wear. This study found that the ram extruded and machined UHMWPE liners had a significantly larger average wear rate than the compression molded UHMWPE liners. In order to determine whether the observed difference in wear rates can be attributed to the different types of UHMWPE processing, a more controlled experiment would have to be performed.

An improved technique is presented for placement of a combined polyethylene and polymethylmethacrylate (PMMA) plug in the femoral medullary canal prior to cementing the femoral component during total hip arthroplasty. PMMA plugs provide excellent occlusion of the canal, but when used alone they often become excessively long. This can make revision surgery, if it becomes necessary, more difficult. By first inserting a polyethylene plug distally in the femoral canal, followed by a bolus of PMMA, the surgeon can limit the length of the cement portion of the plug in the femoral canal while retaining the advantages of a PMMA plug.