ABSTRACT
Seventy-six hips in 67 patients were evaluated an average of 119 months (range, 61-150 months) after total hip arthroplasty with porous coated Omnifit femoral and acetabular components. The patients were young (average age, 45 years), and most were male (67%). Two stems and one cup were revised for aseptic loosening, for aseptic revision rates of 2.6% on the femoral side and 1.3% on the acetabular side. Thigh pain was present in three cases, one of which was activity limiting. Twenty-five (35.7%) hips had evidence of osteolysis confined to proximal Gruen Zone 1 or 7 or to the acetabulum (22 proximal femoral, three both). There were no cases of intramedullary osteolysis in surviving stems. Thirteen (17.1%) hips have undergone reoperation for bone grafting of progressive proximal osteolysis without component revision, at an average 93 months after the total hip arthroplasty. At an average 40 months after reoperation, all stems remain well fixed, and there has been no recurrence of osteolysis of grafted femoral lesions. These results suggest that a circumferentially proximally porous coated femoral component in cementless total hip arthroplasty can provide stable fixation for as long as 12 years after implantation and caseal the canal from distal osteolysis. Serious concerns remain about the incidence of proximal femoral osteolysis.
Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Coated Materials, Biocompatible/therapeutic use , Femur Head Necrosis/surgery , Hip Prosthesis , Osteoarthritis, Hip/surgery , Adult , Aged , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Bone Cements , Bone Transplantation , Coated Materials, Biocompatible/adverse effects , Female , Femur Head Necrosis/diagnostic imaging , Follow-Up Studies , Hip Prosthesis/adverse effects , Humans , Male , Middle Aged , Osteoarthritis, Hip/diagnostic imaging , Osteolysis/etiology , Pain, Postoperative/etiology , Prosthesis Failure , Radiography , Reoperation/statistics & numerical data , Time Factors , Treatment OutcomeABSTRACT
Extended trochanteric osteotomies have been recommended to facilitate femoral component removal, femoral cement removal, and acetabular exposure in cases of difficult revision hip arthroplasty. Complications due to the osteotomy have been rare and no nonunions have been reported when this osteotomy has been used in conjunction with extensively porous-coated implants. It has been suggested that the osteotomy should also work well with impaction grafting revisions. This is a report of two cases of nonunion of extended trochanteric osteotomies in which the impaction grafting technique was used.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Femur/surgery , Osteotomy/adverse effects , Postoperative Complications/etiology , Aged , Arthroplasty, Replacement, Hip/adverse effects , Bone Cements , Hip Joint/diagnostic imaging , Humans , Male , Postoperative Complications/diagnostic imaging , Radiography , Reoperation/methods , Wound HealingABSTRACT
Total hip arthroplasty (THA) patients (186 primary, 92 revision) were surveyed regarding their satisfaction, their expectations regarding longevity, of the hip implant, and their perspective on the potential or actual need for revision surgery. The vast majority of patients were glad they had the original THA, would do it again if faced with a similar choice, and would recommend it to others. One-third of patients believed their current implants would last the rest of their life. The most common responses to either potential or actual failure were happiness it lasted as long as it did, accepting it as "one of those things," and disappointment. No primary THA patients and only 7% of revision of THA patients indicated that they would consider the primary THA a failure when revision surgery was indicated.
