ABSTRACT
We report the minimum five-year follow-up of 352 primary total hip replacements using the uncemented hydroxyapatite-coated ANCA-Fit femoral component with a modular neck and head. The series comprised 319 patients (212 men, 107 women) with a mean age at operation of 64.4 years (28 to 97). The principal diagnosis was osteoarthritis. A total of 18 patients (21 hips) died before their follow-up at five years, nine patients (11 hips) were lost to follow-up, and four (four hips) declined further follow-up. Patient-reported outcomes have been recorded for 288 patients (316 hips). Their mean Oxford Hip Score improved significantly from 41 points (16 to 57) pre-operatively to 20 points (12 to 44) at five-year follow-up. Radiological assessment showed good bony stability in 98% of implants. There were two cases of aseptic loosening of the femoral component. There were no clinical or radiological complications related to modularity. In our series we did not see the high rate of intra-operative fracture previously reported for this implant. This medium-term follow-up study demonstrates that the clinical outcome of the ANCA-Fit femoral component is, to date, comparable with that of other metaphyseal loading femoral components.
Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Coated Materials, Biocompatible/therapeutic use , Durapatite/therapeutic use , Hip Joint/surgery , Hip Prosthesis/standards , Range of Motion, Articular/physiology , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Follow-Up Studies , Hip Joint/diagnostic imaging , Humans , Male , Middle Aged , Prosthesis Design , Radiography , Reoperation , Survival Analysis , Treatment OutcomeABSTRACT
We report the outcome of total hip replacement in 29 failed metal-on-metal resurfacing hip replacements in which the primary surgery was performed between August 1995 and February 2005. The mean length of follow-up was five years (1.7 to 11.7). Of the 29 hip resurfacings, 19 acetabular components and all the femoral components were revised (28 uncemented stems and one cemented stem). There were no deaths and none of the patients was lost to follow-up. None of the hips underwent any further revision. The results of the revision resurfacing group were compared with those of a control group of age-matched patients. In the latter group there were 236 primary total hip replacements and 523 resurfacings performed during the same period by the same surgeons. The outcome of the revision resurfacing group was comparable with that of the stemmed primary hip replacement group but was less good than that of the primary hip resurfacing group. Long-term follow-up is advocated to monitor the outcome of these cases.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Hip Prosthesis , Adult , Aged , Female , Follow-Up Studies , Hip Joint/diagnostic imaging , Humans , Male , Metals , Middle Aged , Prosthesis Design , Radiography , Reoperation/methods , Surface Properties , Treatment Outcome , Young AdultABSTRACT
We report the clinical and radiological outcome at ten years of 104 primary total hip replacements (100 patients) using the Metasul metal-on-metal bearing. Of these, 52 had a cemented Stuehmer-Weber polyethylene acetabular component with a Metasul bearing and 52 had an uncemented Allofit acetabular component with a Metasul liner. A total of 15 patients (16 hips) died before their follow-up at ten years and three were lost to follow-up. The study group therefore comprised 82 patients (85 hips). The mean Oxford score at ten years was 20.7 (12 to 42). Six of 85 hips required revision surgery. One was performed because of infection, one for aseptic loosening of the acetabular component and four because of unexplained pain. Histological examination showed an aseptic lymphocytic vasculitis associated lesion-type tissue response in two of these. Continued follow-up is advocated in order to monitor the long-term performance of the Metasul bearing and tissue responses to metal debris.
Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip/methods , Hip Joint/surgery , Hip Prosthesis/standards , Acetabulum/diagnostic imaging , Acetabulum/physiopathology , Adult , Aged , Aged, 80 and over , Equipment Failure Analysis , Female , Follow-Up Studies , Hip Joint/diagnostic imaging , Hip Joint/physiopathology , Humans , Male , Middle Aged , Polyethylenes , Prosthesis Failure , Radiography , Reoperation/statistics & numerical data , Time Factors , Treatment OutcomeABSTRACT
Macular amyloidosis is the commonest form of primary localized cutaneous amyloidosis; its etiology remains unclear. Various incriminating factors include genetics, sunlight, and friction. Seventy-five patients with a clinical diagnosis of macular amyloidosis (confirmed by at least two observers) were enrolled in the study. A detailed history was elicited in relation to the etiological factors and followed by cutaneous examination. Skin biopsy was performed in 44 patients. Amyloid deposits were demonstrated in 21 (48%) of the biopsies. The female to male ratio was over 3:1. Patients with skin type V had a more delayed onset than those with skin types III and IV. Two patients gave histories of regularly subjecting their skin to friction. There was no correlation between the sites affected and the sites subjected to friction, hair style of the patient, or the use of cosmetics. Family history was present in 7 (9.3%) patients. A majority, 44 (58.7%) of the patients, had involvement of both sun-exposed and sun-protected sites. To conclude, there was no direct correlation between macular amyloidosis and atopy, sunlight, or friction to the skin in our patients. Multiple factors may play a collective role in the genesis of macular amyloidosis to variable degrees. These include racial, familial, and environmental factors, atopy, sunlight, friction, and female gender.
