The Result of Revision Total Hip Arthroplasty in Patients with Metallosis Following a Catastrophic Failure of a Polyethylene Liner

BACKGROUND: Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. METHODS: Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. RESULTS: The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. CONCLUSIONS: The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.

Cementless Total Hip Arthroplasty Using the ABG I Hydroxyapatite-coated Prosthesis: Minimum 10 Year Follow-up / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) with an ABG I hip prosthesis after a minimum ten-year follow up. MATERIALS AND METHODS: From January 1996 to March 2001, 121 hips in 104 patients, whi were followed up for a minimum of ten-years, were enrolled in this study. The clinical and radiographic outcomes were evaluated and Kaplan-Meier survival analysis was performed. RESULTS: The mean Harris hip score at the last follow-up was 84 points. A radiolucent line around the cup, osteolysis, and cup loosening were observed in 5 hips(4.1%), 53 hips(43.8%), and 5 hips(4.1%), respectively. In the femoral side, osteolysis and stem loosening were observed in 11 hips(9.1%) and 2 hips(1.7%), respectively. The mean linear wear rate of the polyethylene liner was 0.23 mm/yr. Forty four revisions(36.3%) were performed. The outcomes were similar regardless of the cause of primary THA. The survival rate with the end point of revision due to cup loosening was 56.3%, and revision due to stem loosening was 98.1% after a 16 year follow-up. CONCLUSION: High polyethylene wear and the disappointing survival rate of the ABGI cup were observed after a minimum ten year follow-up. Therefore, close observation of patients who have received an ABG I prosthesis is necessary.

Periprosthetic Mass after Total Hip Replacement / 대한고관절학회지

PURPOSE: To analyze the characteristics and causes of periprosthetic huge mass which occur after treatment by total hip arthroplasty. MATERIALS AND METHODS: Of the patients who had undergone total hip arthroplasty from January 2000 to October 2007, we retrospectively evaluated the 10 patients who suffered huge soft tissue mass. Five of these patients had received metal-on-metal bearing (group 1) prostheses, and the other 5 had received metal-on-polyethylene bearings (group 2). We evaluated the size and location of the mass, the extent of osteolysis, and the hematologic and pathologic examination results. RESULTS: Roentgenographically, the location of the masses varied from the acetabular area to the distal femoral stem. The mean mass diameter of all 10 patients was 14.6 cm(7-21 cm)x6.2 cm(3-9 cm)x7.2 cm(4-12 cm). Osteolytic lesions were found in 3 group 1 patients and 3 patients in group 2. High counts of lymphocytes and eosinophils were present in group 1. High counts of macrophages were present in group 2. CONCLUSION: The occurrence of osteolysis and huge soft mass after total hip arthroplasty is thought to be related to foreign body reaction by polyethylene wear particles and metal hypersensitivity. Outside-in patterned cortical thinning was considered to be indicative of a long standing periprosthetic soft tissue mass effect.

Long-Term Results of Total Hip Arthroplasty with an Extensively Porous Coated Stem in Patients Younger than 45 Years Old

PURPOSE: This study analyzed the long-term results of cementless total hip arthroplasty using an extensively porous coated stem in patients younger than 45 years old. MATERIALS AND METHODS: The clinical and radiographic results of 45 hips from 38 patients who underwent cementless total hip replacement arthroplasty with an AML prosthesis were reviewed retrospectively. The average follow-up was 12 years (range, 10-15 years). RESULTS: The average Harris hip score at the time of final follow-up was 87.3 (range 77-94) points. Forty two hips (93.3%) showed excellent and good clinical results. Osteolysis occurred around the stem in 20 hips (44.4%) and around the cup in 26 hips (57.8%). Stress-mediated femoral resorption was observed in 33 hips (73.3%) at 10 years. There was no incidence of resorption progressing after 5 years postoperatively. There was no stem loosening. Five hips were revised for osteolysis, cup loosening and polyethylene wear. CONCLUSION: The long term results of total hip arthroplasty using an extensively porous coated stem were acceptable, and there was no case involving the progression of proximal bone resorption.

Fracture of a Polyethylene Tibial Post in a Scorpio Posterior-Stabilized Knee Prosthesis

We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis.

Polyethylene Wear between Farming and Non-Farming Patients after Total Knee Arthroplasty

PURPOSE: We evaluated the polyethylene wear rate between patients from farming and non-farming communities to determine whether active life styles, knee scores, and occupations could affect outcomes. MATERIALS AND METHODS: 201 knee replacements were performed in 105 patients who were an average of 68.7 years old. 30 non-farming patients(59 cases) and 75 farming patients(142 cases) who had operation between 1989 and 1996 were reviewed retrospectively. Mean follow-up period was 12.1 years(range 10~16 years). The difference of clinical, radiographic, and functional results of total knee replacement were assessed by Knee Society scores and activity levels. RESULTS: The non-farming group had lesser activity levels(non-farming group 82.5, farming group 89.7), higher knee scores(non-farming group 88.4, farming group 81.1) and functional scores(non-farming group 87.9, farming group 80.4) than the farming group(p<0.05). Farming patients showed 33 cases(23%) of polyethylene wear and non-farming patients showed 7 cases(12%) which is statistically significant(p<0.001). CONCLUSION: Primary osteoarthritic patients from farming communities had higher activity levels and polyethylene wear rate with lower Knee Society scores which were expected to participate in more activities involving impact on knee joint. We assume that the increase rate of complication is due to the overuse of the prosthesis. Therefore, working condition and life style modification will be needed.

Polyethylene Wear and Osteolysis in Uncemented Acetabular Component / 대한정형외과학회잡지

PURPOSE: To investigate the influence of the linear wear rate of polyethylene, the osteolysis threshold of the linear wear rate, and the related factors on polyethylene wear in an uncemented metal-backed-cup of a primary total hip arthroplasty. MATERIALS AND METHODS: This study examined 87 hips from 75 patients (57 men and 18 women) who had undergone a primary total hip arthroplasty with a minimum follow-up of five years. The mean age was 47.3 years (range, 25-68 years). The mean follow up period was 90 months (range, 60-148 months). The most frequent diagnosis was avascular necrosis of the femoral head. 18 Harris-Galante I and 69 Harris-Galante II cups, were used on the acetabular side, and 66 Anatomic and 21 Harris-Galantestems were used on the femoral side. Radiographic polyethylene wear was estimated using the method reported by Livermore, and the above mentioned factors that influence polyethylene wear were investigated and analyzed statistically. RESULTS: The overall mean linear wear rate of polyethylene was 0.21 mm/year. The linear wear rate of 22 hips with osteolysis and 65 hips without osteolysis was 0.29 mm/year and 0.12 mm/year respectively, showing a significant difference (p=0.001). The patients with high activity had a significantly higher mean linear wear rate (0.28 mm/year) than that those patients with low activity (0.16 mm/year) (p=0.048). Patients younger than 40 year-old had a significantly higher mean linear wear rate (0.23 mm/year) than the patients older than 40 year-old (0.19 mm/year) (p=0.049). However, there were no correlations between the mean linear wear rate and gender, weight, diagnosis, the type of cup and the thickness of the polyethylene. CONCLUSION: The polyethylene wear rate in an uncemented metal-backed-cup was significantly affected by age and the activity of the patients, which strongly influenced the development of osteolysis. Therefore, in order to reduce the incidence of aseptic loosening due to osteolysis in young patients with high activity, a bearing surface with mean linear wear rate of 0.12 mm/year or less is recommended.

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.

Intrapelvic Pseudo-tumor Caused by Polyethylene wear Debris in Total Hip Arthroplasty: A Case Report / 대한정형외과학회잡지

After total hip arthroplasty, long-term complications such as loosening, wear, osteolytic lesion and granulomatous reaction by foreign bodies can occur. Granulomatous reaction is a chronic inflammatory reaction caused by polyethylene debris, which is rarely present as a mass. The case of a pseudotumor, which required surgical intervention because of pain and its large size with compression symptoms, has not been reported yet. This 70 year old male patient was admitted complaining of RLQ pain, a palpable mass and compressed adjacent organs, 2 years after a revision total hip arthroplasty performed in September 1999. During the operation, a well-encapsulated large mass was noted, which was near the lateral side of the iliopsoas muscle and compressed the femoral nerve from the posterolateral side. Here, we report a case of pseudotumor caused by polyethylene wear debris.

Measurement Methods for Acetabular Cup Wear in Total Hip Replacement Arthroplasty: Accuracy versus ease of use / 대한정형외과학회잡지

PURPOSE: To compare the accuracy of four wear measurement methods using 17 retrieved polyethylene liners previously used in revision hip arthroplasty. MATERIAL AND METHOD: Direct measurement was done using a point contact micrometer. Three manual measurement methods and Devane's three dimensional computerized method were compared. RESULT: Dorr's method underestimated wear by 26.2% with a mean error of 0.39 mm. Livermore's method estimated wear to within 22.4%, with a mean error of 0.21 mm, Devane's method estimated wear to within 12.1%, with a mean error of 0.14 mm. The new method (with correction factor adjustment by the Dorr method) estimated wear to within 13.4%, with a mean error of 0.17 mm. CONCLUSION: The new method can more accurately estimate average acetabular cup wear.

Wear rate of polyethylene in hybrid Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: Articles reporting on the wear rate of polyethylene cup in hybrid THA are rare. So, we now report the results of wear rate of polyethylene in cementless Harris-Galante acetabular components and cemented Harris precoat femoral stem. MATERIALS AND METHODS: The cementless Harris-Galante acetabular components and cemented Harris precoat femoral stem of one-hundred hips in 71 patients were followed up for 2.5 ~ 7.5 years (mean 4.7 year) . The clinical results were evaluated by Harris hip score (HHS) and wear rates were measured using Livermore technique. RESULTS: The most recent follow-up of HHS was improved from 52 to 91 in average. The mean linear wear rate in cemetless acetabular component was 0.17 0.06mm/yr (range 0.05 ~ 0.35) . Two femoral components were revised for aseptic loosening and one acetabular component revised for aseptic loosening. Wear rate in the revision group was higher than mean wear rate. In chronological change of wear rate according to final follow up period, there was decreasing tendency for mean wear rate with time. There was no correlation found between mean wear rate and body weight. There was a decreasing tendency on mean wear rate with acetabular cup shell size and increasing tendency with level of activity. CONCLUSION: We concluded that cemented femoral stem was the reason for the trend in lower wear rate of polyethylene cup than which had been previously reported in cementless THA, but further follow-up studies will be needed to confirm that.

Effect Of the Polyethylene Wear On Osteolysis in Cementless Primary Total Hip Arthroplasty: Minimum 5 Years' Follow - Up Study / 대한정형외과학회잡지

We measured poiyethylene wear radiographically in 85 cementless primary total hip arthroplasties by the modified technique of Livermore et al. All the patients were followed up for at least five years (mean, 6.31 years; range, 5 years-8 years 2 months). The mean extent of linear wear was 0.88mm (range, 0.0083-3.2839mm), and the mean rate of linear wear was 0.14mm/year(range, 0.00-0.47mm /year). The mean volumetric wear was 539.42mm (range, 5.11 2022.09mm), and the mean rate of volumetric wear was 87.69mm/year(range, 0.65-290.12mm/year). The polyethylene wear was correlated inversely with the patients age only, but was not influenced by weight or gender of the patients, Harris hip score, thickness of the polyethylene, the abduction angle of acetahular cup, or the duration of in situ implantation. Osteolysis developed in the femur of 34 hips(40%) and in the acetabulum of 11 hips(12.9%). Radiographic loosening was found in one case in the femur and none in the acetabul pm. The extent of polyethylene wear was significantly correlated with frequencies and sizes of the osteolytic lesion and was not directly associated with radiographic loosening of the prostheses. Calcar resorption was observed in 39 hips(45.9%) and was not associated with polyethylene wear. These results indicated that polyethylene wear of primary total hip arthroplasty should be considered one of major causes of osteolysis and has no direct relationship with prosthesis loosening. To reduce the extent of polyethylene wear, the material characteristics of polyethylene should be improved or new, durable, articulating materials should be researched.