Cementless Total Hip Arthroplasty Using a Modular Femoral Component in Patients with Femoral Head Osteonecrosis: Comparison of Metal-on-Metal and Ceramic-on-Ceramic Articulation

PURPOSE: The purpose of this study was to evaluate the clinical and radiological outcomes after total hip arthroplasty using the S-ROM modular system for osteonecrosis of the femoral head, and to compare the results between the groups using metal-on-metal articulation and ceramic-on-ceramic articulation. MATERIALS AND METHODS: Sixty-six patients (78 hips) with osteonecrosis of the femoral head were evaluated after primary total hip arthroplasty between January 2001 and December 2004, using an S-ROM proximal modular femoral stem. The average follow-up was 77 months (range, 60 to 122 months) and all patients were followed for more than five years. RESULTS: The average Harris hip score improved from 53 points to 88.5 points at the final follow-up. At the latest radiologic evaluation, sixty-seven stems had bony ingrowth stability, and 10 stems had stable fibrous ingrowth. However, one stem had diffuse extensive osteolysis and loosening, which was revised at 9 years. Postoperative complications included 4 cases of heterotrophic ossificiation, 1 case of linear fracture after insertion of the femoral stem, 1 case of dislocation, 2 cases of infection, and 1 case of extensive osteolysis and loosening. There were 3 cases of revision and Kaplan-Meier survivorship analysis with revision estimated at a 95.7% chance of survival for the femoral component during 122 months. CONCLUSION: Our study showed that total hip arthroplasty using the S-ROM modular system with metal-on-metal articulation or ceramic-on-ceramic articulation had favorable clinical and radiological mid- to long-term results.

Cementless Total Hip Arthroplasty for Osteonecrosis of the Femoral Head: A Follow-up Study for 10+ Years

PURPOSE: The aim of this study was to assess the outcome of cementless total hip arthroplasty (THA) in cases of osteonecrosis of the femoral head. MATERIALS AND METHODS: We studied long-term outcomes for 54 patients (72 hips). Mean duration of follow-up was 13.5 years. Clinical outcomes were evaluated by the Harris Hip Score. Radiographic evaluation from the preoperative and follow-up periods included assessment of the fixation of the femoral and acetabular components, polyethylene wear, osteolysis, and radiolucent line. RESULTS: The mean Harris Hip Score improved from a preoperative value of 51.9 points to 89.4 at final follow-up. Regarding the femoral components, there was radiographic evidence of stable bony ingrowth in 69 hips, stable fibrous ingrowth in 2 hips and unstable fixation in 1 hip. There was a radiolucent line of less than 1 mm in 7 hips, and femoral osteolysis in 27 hips. Regarding the acetabular components, there was radiographic evidence of stable fixation in 68 hips, unstable fixation in 4 hips, and osteolysis in 39 hips. There was a significant correlation between (i) failure of components and (ii) femoral osteolysis, acetabular osteolysis, polyethylene thickness, linear wear rate per year, or total linear wear. CONCLUSION: The findings of this study show favorable long term results, both clinical and radiographic, using cementless total hip replacement arthroplasties. However, the revision rates for the Harris-Galante acetabular components were high. Wear of the load? weight? bearing surface continues to limit the long-term success rate of THA, and improved design of the acetabular components should be considered.

Double-Chevron Subtrochanteric Osteotomy Combined with Total Hip Replacement Arthroplasty for Treatment of Neglected Highly Dislocated Hip in Adults / 대한정형외과학회잡지

PURPOSE: This study evaluated total hip replacement arthroplasty (THRA) combined with a double-chevron subtrochanteric osteotomy for the treatment of neglected highly dislocated hips in adults. MATERIALS AND METHODS: Six cases treated with THRA combined with a double-chevron subtrochanteric osteotomy under the diagnosis of a neglected highly dislocated hip (Crowe classification IV) from April 1997 to October 2001 were followed up for between 21 months and 75 months. Harris hip scores, leg length discrepancy pre and postoperatively, osteotomy site union and implant loosening were chekced. RESULTS: The average Harris hip score increased from 61 points preoperatively to 94 points postoperatively. The average leg length discrepancy was decreased from 6 cm preoperatively to 1.8 cm postoperatively. Bone union of the osteotomy site was obtained at 4 months after surgery. The radiographs showed no acetabular and femoral loosening sign at the latest follow up. CONCLUSION: According to the clinical and radiological assessments, THRA combined with doublechevron subtrochanteric osteotomy gave satisfactory results in adults with a neglected highly dislocated hip in adults on a midterm follow up.

A Study of Autotransfusion in THRA: Comparison Between Autotransfusion and Homologous Transfusion / 대한정형외과학회잡지

It is well known that autotransfusion can reduce or eliminate the use of homologous transfusion and can overcome the side effects of homologous transfusion. Also, many studies have been reported that autotransfusion showed better postoperative courses than homologous transfusion. We have reported the concept and benefit of autotransfusion in spinal surgery. So we would also compare the autotransfusion and homologous transfusion in total hip replacement arthroplasty, and would find out the effect of autotransfusion. From March 1993 to February 1995, autotransfusion group(38 hips) and homologous transfusion group(30 hips) were compared and eight patients(8 hips) who required homologous blood among autotransfusion group were excluded in comparison. The results were as follows: 1. Total transfusion amounts were 1013±174cc in autotransfusion group and 1088±601cc in homologous transfusion group. There were no statistically significed difference between both groups. 2. Total amounts and duration of postoperative drainage were significantly less in autotransfusion group, especially in the cases of postoperative autotransfusion with Orth-evac. 3. There was no difference of preoperative hemoglobin level in both groups, but the level was recovered more promptly in autotransfusion group. 4. In autotransfusion group, 3 hips(10%) showed fever and chilling sensation. Among them, 2 hips were transfused postoperatively with Orth-evac. In homologous transfusion group, 8 hips(27%) experienced one or more than one of transfusion side effects. 5. Homologous blood was also required in eight patients of autotransfusion group. Four patients of them were hypertensive and one was revision case. In conclusion, we think we can expect better postoperative recovery and also reduce or eliminate homologous transfusion with autotransfusion. But, hematologically and physiologically, further study will be necessary.

A Clinical Study of Deep Infection after Cementless Total Hip Arthroplasty / 대한정형외과학회잡지

Deep infection following total hip replacement arthroplasties remains one of the most serious complications in orthopaedic surgery. Between Jan. 1986 to Dec. 1991, 1130 cementless total hip arthroplasties were performed at Wilson rehabilitation hospital. Among them, fourteen patients (incidence :1.2%) developed deep wound infection, and they were retrospectively reviewed including clinical features, laboratory datas and their managements. The infection was noted in ten patients within three months, in one patient between three to twelve months and in three patients after twelve months from cementless total hip replacement arthroplasties. All of them were suffered from hip pain, six patients were manifested with generalized fever, and twelve patients with draining fistulas. Thirteen patients showed elevated ESR. Major infecting organism was Staphylococcus in ten patients. They were initially treated with meticulous debridement, ingress and eress tube irrigation, and antibiotics, but four patients had to be operated Girdlestone arthroplasties due to recurrence of infection and loosening of the prosthesis. Eight patients got quiescency from infection for at least five months from the last drainage operation. But two patients still have draining fistulas inspite of bony ingrowth achieved to the prosthesis.

In Vitro Biomechanical Evaluation of Proper Position of Acetabular Cup and Femoral Stem for T.H.R.A.: by Using Mueller Apparatus / 대한정형외과학회잡지

The Primary objectives of total hip replacement arthroplasty are not only to relieve pain, but to improve motion and function. The range of motion following total hip replacement arthroplasty depends on several factors, especially the position of acetabular cup and femoral stem. Also the oriental need more flexion and abduction in hip motion for squarting position as compared with the European who have different living activity. We studied in vitro biomechanical evaluation of proper position of acetabular cup and femoral stem for T.H.R.A. The following results were obtained: l. Effect of component orientation on R.O.M. 2. Acceptable position of prosthesis was as follows: Acetabular cup: inclination 40–50 degree, anteversion 20–30 degree, Femoral stem: anteversion 0–10 degree. 3. The sum of ideal anteversion of the two components was 30–35 degree 4. Oriental sitting position was performed normally in the ideal position of the prosthesis 5. Acetabular cup is likely insert in the position as far as post sup rim of acetabulum mightbe feasible to be full recovered.