Isolated Polyethylene Liner Exchange in a Revision Total Hip Arthroplasty

PURPOSE: To analyze the results of isolated exchange of polyethylene (PE) liners for treatment of wear and osteolysis around a well-fixed Harris-Galante (HG) cementless acetabular cup. MATERIALS AND METHODS: Thirty-three PE liner changes were performed without the removal of stably ingrown implants (33 hips of 32 patients). They were able to be followed for a mean period of 92 months. Clinically, the Harris hip score (HHS), pain evaluation, and complications were evaluated. Radiologically, the annual wear rate and the size of the osteolytic lesions were measured before the operation and the latest follow-up. The bone graft incorporation scale and the development of new osleolytic lesions were checked during the final follow-up. RESULTS: HHS improved to 89.3 at last follow-up. The size of the osteolysis was significantly reduced postoperatively. Bone graft incorporation scales were Grade I in 9 and Grade II in 14 cases. New osteolytic lesions have not developed at latest follow-up. As a complication, one case of dissociation of a liner and a periprosthetic fracture were noted. Annual wear rates during the same period were significantly reduced. There was no sign of alteration in stability of the PE liner. CONCLUSION: Exchange of a PE liner without removal of stable implants can be a good option for the treatment of wear and osteolysis around a stable cementless THA implant, even if the system has a weak locking mechanism, such as the HG cup. In these cases, under certain states with a higher risk of early failure in the locking mechanism, it would be better to select other revision procedures such as cup revision or cemented polyethylene liner fixation.

The analysis of Affecting Factors for the Dissociation of the Polyethylene Liner in Cementless Harris-Galante Acetabular Component

PURPOSE: This study was performed to evaluate the factors associated with dissociation of the polyethylene liner with using a Harris-Galante I or II acetabular component in a stably positioned acetabular cup. MATERIALS AND METHODS: Between January 1998 and February 2007, 32 cases underwent revision of the acetabular component due to osteolysis, wear of the polyethylene liner or locking mechanism failure around the acetabulum in spite of stable positioning. 5 cases were primarily operated on using the type I Harris-Galante Hip Prosthesis and 27 cases used the type II. We divided the 32 cases into the two groups: Group I (18 cases) was composed of cases with the existence of polyethylene liner (PE) dissociation and Group II (14 cases) had no dissociation. The analyzed factors were age, gender, body weight, the type and the size of the acetabular cup, the thickness of the polyethylene liner, the duration of the time interval from the primary surgery, the inclination and ante-version of the acetabular cup, the wear rate of the PE liner, the degree of the osteolysis around the acetabulum and the existence of failure of the locking mechanism in the acetabular component. Statistical analysis was performed using the Mann-Whitney test (SPSS 12.0). RESULTS: Statistical significance was noted only for the wear rate of the PE liner (Group I: 0.40+/-0.19 mm/year, Group II: 0.19+/-0.08 mm, p=0.002) and the existence of failure of the locking mechanism (Group I: 16 cases (88.9%), Group II: 6 cases (42.9%), p=0.006). CONCLUSION: According to this study, the dissociation of the PE liner was influenced by the wear rate of the PE liner and the existence of failure of the locking mechanism in the acetabular component. In order to prevent PE liner dissociation, improvement of the locking mechanism and the PE liner system are essential.

The Harris-Galante-II Acetabular Componentin Cementless Total Hip Arthroplasty : Average Ten-year Follow-up Results / 대한정형외과학회잡지

PURPOSE: To evaluate the average ten-year follow-up results of 98 total hip arthroplasties using Harris-Galante-II porous-coated acetabular components. MATERIALS AND METHODS: Ninety-eight hips were evaluated. The mean age of the patients was 45 years, and the mean follow-up was 121 months. The clinical and radiographic findings including the wear of the polyethylene liner were evaluated. The endurance of the acetabular component was analyzed using the Kaplan-Meier method. RESULTS: Retroacetabular osteolysis, dissociation of the PE liner and aseptic loosening of the acetabular component was observed in 25 hips (25.5%), 9 hips (9.2%), and 1 hip (1.0%), respectively. The average rate of liner wear was 0.16 mm/year. Twenty acetabular components (20.4%) were revised, and the survival probability of the acetabular components at 10 years was 87% (95% confidence limits, 83-90%). CONCLUSION: In this long-term follow-up study, the revision rate of Harris-Galante-II acetabular component was relatively high, and was associated with locking mechanism failure and retroacetabular osteolysis. However, the rarity of aseptic loosening suggests that excellent long-term fixation could be achieved with the surface treatment of a fiber-metal porous coating.

Bone Ingrowth into Harris-Galante Porous-coated Acetabular Cup Retrieved during Revision

Purpose: To investigate the extent of bone ingrowth into the porous-coated acetabular cups as well as the factors that correlated with bone ingrowth in total hip arthroplasty. Materials and Methods: Thirty six Harris-Galante porous-coated acetabular cups that were retrieved through revision surgery were examined in this study. Acetabular cups retrieved due to infection or severely destroyed cups (ed note: severe what?) were excluded. The extent of bone ingrowth into the acetabular cups was grossly measured, and its correlation with the variables including age, gender, weight, height, the duration of fixation, size, number of screws, inclination and anteversion was statistically analyzed. Results: The mean proportion of bone ingrowth was 52.9 21.9%(2~90%) and less than 30% in three cups(8.3%). The pattern and the location of bone ingrowth were not consistent. There was no correlation between the extent of bone ingrowth and age, gender, weight, height, the duration of fixation, cup size, number of screws, size, inclination and anteversion. Conclusion: Harris-Galante porous-coated acetabular cups showed satisfactory bone ingrowth regardless of the variables associated with the demographic or surgical conditions. Surface treatments with a fiber-metal porouscoating appears to be suitable for cementless acetabular cups in terms of the long term results.

Failure Mode of Polyethylene Liner in Total Hip Arthroplasty with Harris-Galante II Acetabular Cup / 대한정형외과학회잡지

PURPOSE: To assess the mode of a polyethylene liner failure in total hip replacement using a Harris-Galante II acetabular component. MATERIALS AND METHODS: A retrospective review was performed and 128 consecutive primary total hip arthroplasties were analyzed in 111 patients who had a second-generation Harris-Galante cup. All patients were followed up for a minimum of five years, with a mean follow up of 7.4 years (range, 5 to 12.9 years). A total of 26 cups (20.2%) were revised at the time of the latest follow up. The medical records, radiographs, surgical notes, and retrieved components were analyzed in order to determine the precise causes of the revision. RESULTS: Twenty-two cases (17.3%) were found to have experienced problems with the polyethylene liner. Three types of liner failure were identified; metallosis associated with polyethylene liner wear (14 cases), excessive wear without metallosis necessitating a revision (6 cases), and polyethylene liner dissociation without gross evidence of wear (2 cases). CONCLUSION: This study find that polyethylene liner failure is the main cause of the revision of this component. Early surgical intervention needs to be performed before fatal metal damage occurs in order to avoid metallosis, and severe bone stock damage in cases of excessive polyethylene wear.

Primary Total Hip Arthroplasties Using Harris-Galante Porous Coated Cementless Prosthesis: Mean 10-Year Follow-Up Results / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the intermediate to long-term results of primary total hip arthroplasties with a Harris-Galante prosthesis. MATERIALS AND METHODS: Among 97 consecutive total hip replacements with Harris-Galante prosthesis in 85 patients, 76 hips in 67 patients were evaluated clinically and roentgenographically. The mean follow-up was for 10.1 years (range 6.2-13 years). Clinical and radiographic evaluations including osteolysis, stability of prosthesis, and wear of polyethylene were performed. Statistical analysis was conducted to find the relevant factors influencing osteolysis. The survivorship of overall and each acetabular and femoral component was analyzed by Kaplan-Meier method. RESULTS: The Harris hip score averaged 44 points at preoperatively and improved to 89 points at the most recent follow-up. Pelvic osteol-ysis was found in 3 hips (4%) and femoral osteolysis was found in 32 (42%). The linear polyethylene wear rate was averaged 0.13 mm/year. Nine femoral components and two acetabular components were revised. There were 2 recurrent dislocations, 3 periprosthetic fractures and 4 infections. The probability of survival of the femoral and acetabular component at a mean 10 years was 81% (range 71- 93%) and 96% (range 91-100%) by the Kaplan-Meier method. CONCLUSION: The intermediate to long-term follow up of primary total hip arthroplasty with Harris-Galante prosthesis revealed a low failure rate of acetabular component and a relatively high failure rate of the femoral component which was usually related with loosening and osteolysis.

The hemispherical porous acetabular component fixed by press-fit technique and additional screws

Seventy consecutive primary total hip arthroplasties in which a Harris-Galante porous-coated acetabular component had been used from October, 1986 to December, 1989 were reviewed for 5 to 9 years follow-up. We performed the retrospective, clinical and radiological analysis of the hemispheric, porous-coated, cementless acetabular component using press-fit and screw fixation. No component had detectable migration or any other position change. No acetabular fractures and no screw problems were noted. Initial peripheral gaps were observed in 11 cases (16%). Twelve cases had a postoperative polar gap less than 0.5 mm which were stabilized at 2 years postoperatively. Radiolucent line was present in at least one zone in 53% of cases and occurred most frequently in zones 1 and 3. No continuous radiolucent line greater than 2 mm was seen in any zone and radiolucent lines were stabilized 2-3 years postoperatively. Twelve hips (17.1%) had osteolysis of the acetabulum. No acetabular component was revised because of aseptic loosening. Revision arthroplasties were performed in 9 hips during follow-up. We concluded that the hemispheric porous-coated, acetabular components using press-fit and screw fixation had good results with a 5 to 9-year follow-up.

Analysis of Femoral cortical Indices in Cementless Femoral Stem / 대한정형외과학회잡지

Preperative radiologic indices, such as cortical index of Engh, morphological cortical index of Sportono and Romagnoli, canal flare index of Noble, and their relationship to the postoperative canal filling, femoral stem fitness, stability and clinical result at last follow up were analyzed in 111 hips of 96 patients treated with bipolar or total hip arthroplasty at the Department of Chthopedic Surgery, Korea University Hospital, between January 1985 and May 1993. The results obtained were as follows: 1. The cortical index had no correlations with age, metaphyseal filling and clinical result but isthmic filling was proportional to the cortical index. In femoral stem fitness and stability, most cases of press fit and optimal stability were obtained in group 3 and 4 that have thick cortex. 2. The morphological cortical index had no correlation with age, canal filling and clinical results. But it was proportional to the postoperative femoral stem fitness and stability. 3. The canal flare index had no correlation with age. The metaphyseal filling was increased in the stove piped canal group(less than 3.0 canal flare index), but isthmic filling was increased in normal canal group(3.0-4.7 canal flare index). The most cases of press fit and optimal stability were obtained in normal canal group. More satisfactory clinical results were obtained in nomal canal group. Above results suggest that straight type of cementless femoral component could get better press fit fixation, postoperative stability and more satisfactory clinical results in the cases of cortical index larger than 2.0, mophological cortical index larger than 2.7 and canal flare index larger than 4.0 but metaphyseal filling is unsatisfactor.

Comparative Study between Uncemented Proximal Filling Stem and Distal Filling Stem: A retrospective matched-pair study / 대한정형외과학회잡지

The authors performed a retrospective matched-pair study for 54 uncemented total hip arthroplasties which were performed in management of avascular necrosis of femoral head from July, 1989 to May, 1991 to investigate what kind of stem is better between Anatomic stem as a proximal filling stem and Harris-Galante stem as a distal filling stem. The results were as followings: 1. Clinical results of Anatomic group were slightly better than those of Harris-Galante group in terms of incidence of thigh pain, groin or buttock pain and final functional score of hip. 2. Incidence of radiolucency around femoral stem in Harris-Galante group was higher than that in Anatomic group, especially in zone I, V of anteroposterior view and in zone IV of lateral view, which were statistically significant(p < 0.05). 3. The incidence of vertical subsidence of femoral stem in Harris-Galante group was significantly higher than that in Anatomic group(p < 0.05) and the average distance of subsidence was 3.2mm. 4. The incidence of endosteal osteolysis and bone resorption in Harris-Galante group was higher than that in Anatomic group. 5. In overall view, clinical and radiographic results of Anatomic group were better than those of Harris-Galante group.