Early Results of Total Cementless Hip Joint Arthroplasty with a Conical Screw Cup.

BACKGROUND: With the development of hip arthroplasty, there are increasingly more indications for effective use of this surgical method. Endoprostheses are now being more and more commonly used in difficult cases of secondary coxarthrosis and in increasingly younger patients. The aim of this study is to present the early results of hip joint arthroplasty with the Zweymüller conical screw cup. MATERIALS AND METHODS: The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the Zweymüller conical screw cup. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 94.3% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the Zwey-müller conical screw cup affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening over time, indicating a need of regular long-term follow-up.

Early Results of Cementless Hip Joint Arthroplasty with the Straight Zweymller Stem.

BACKGROUND: Total cementless hip joint arthroplasty is a method commonly used in the treatment of advanced hip osteoarthritis. The aim of this paper is to present the early results of hip joint arthroplasty with the straight Zweymller stem. MATERIALS AND METHODS: The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the straight Zweymller stem. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years). RESULTS: Pre-operative Merle dAubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 95.1% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the straight Zweymller stem affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, indicating a need of regular long-term follow-up.

Analysis of the Results of Hip Arthroplasty with the Use of Khanuja Group 6 stems.

BACKGROUND: Total cementless hip joint arthroplasty is universally recognized as a method of treatment of ad-vanced hip osteoarthritis. Multifaceted research by a wide group of implant specialists has led to the development of special implants that fulfill their purpose even in the most severe deformities of the hip joint. The aim of the study is to present and analyse the results of hip joint arthroplasty with the Antega anatomical stem. MATERIALS AND METHODS: The study enrolled 533 patients (342 women and 191 men) who underwent a total of 595 hip joint arthroplasties with the Antega anatomical stem. The mean age of the patients at surgery was 56.2 years (range: 20-87 years). The mean follow-up period was 7.3 years (range: 5-15.5 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) were poor in all patients. Mean post-operative improvement was 6.1 points. The outcomes were classified as excellent in 419 cases (70.4%), good in 102 cases (17.1%), satisfactory in 39 (6.6%) and poor in 34 cases. Poor results were usually associated with loosening of one of the prosthetic components. Heterotopic ossification was noted in 37 cases (6.2%). According to the Kaplan-Meier estimator, 10 years' survival probability was 89.9% for the whole implant and 96.1% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 10 years) indicate that the Antega anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Modification of the Antega stem implantation technique significantly reduces the risk of so-called unexplained thigh pain, which sometimes occurs following hip replacement surgery. 4. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

Future of total hip arthroplasty with the Metha short stem in modern surgeries.

The aim of the study was to analyse the results of uncemented total hip replacement, using the Metha (metaphyseal) stem. A total of 158 patients (70 females and 88 males) were qualified to the study and submitted to total hip arthroplasty (183 procedures altogether), using the Metha stem. The mean age of the patients on the day of surgery was 51.7 years (the range from 17 to 69 years). The mean follow up period was 9.2 years (the range from 5 to 13.5 years). Preoperative assessments gave poor scores, according to the Merle d'Aubigne and Postel classification, modified by Charnley. The average improvement after surgery, according to the used scale, was 6.9 points. A very good outcome was recorded in 154 cases (84.2%), a good outcome was achieved in 20 cases (10.9%) and a poor outcome was confirmed in 9 cases, while no satisfactory case was observed. Poor outcomes were associated with implant loosening. Extraskeletal ossification was noted in 10 cases (5.5%). According to the Kaplan-Meier estimator, the 10-year survival was 93.2% and 97.3% for the whole implant and the stem alone, respectively. 1. Our follow-up period of more than 9 years on the average, indicates that Metha stems produce excellent clinical and functional results in operated young patients with advanced degenerative changes of the hip joint. 2. Assuming a proper qualification for the procedure, the absence of complications and a correct surgical technique, which is slightly more difficult, when compared to standard stem implantation, the risk of aseptic loosening is fairly negligible.

Early Results of Total Cementless Hip Joint Arthroplasty with the Anatomical Stem.

BACKGROUND: The aim of this study is to present the early results of hip joint arthroplasty with the EXCEPTION anatomical stem (BIOMET). MATERIALS AND METHODS: The study enrolled 173 patients (110 women and 63 men) who underwent a total of 190 hip joint arthroplasties with the EXCEPTION anatomical stem. The mean age of the patients at surgery was 58.2 years (range: 28-82 years). The mean follow-up period was 7.3 years (range: 5-10.1 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 131 cases, good in 39, satisfactory in 13 and poor in 7 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 14 cases (7.4%). According to the Kaplan-Meier estimator, 5 years' survival probability was 96.31% for the whole implant and 99.47% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the EXCEPTION anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the relatively short duration of follow-up, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

An assessment of the return to professional activity of patients aged ≤30 years after hip replacement surgery.

OBJECTIVES: The study evaluated the professional activity of patients after a total cementless hip replacement surgery performed at the age of ≤30 years. MATERIAL AND METHODS: The study group comprised 87 patients, with 95 total cementless hip replacements. The mean age was 25.7 years. The youngest patient was 17 years old, and the oldest 30 years old. The mean length of observation was 20.1 years, ranging 5-33 years. All patients underwent clinical and radiological evaluations before the surgery, and again in the third, sixth and twelfth months after the surgery. Further follow-up visits were performed every year. The tests were scored according to the Merle d'Aubigné and Postel (MAP) classification, as recommended by the Polish Society of Orthopaedics and Traumatology. Postoperative radiographs were used to assess the position of the endoprosthesis, and the degree of implant healing in the bone tissue. The data was subjected to statistical analysis. RESULTS: Of the surveyed group, 67 patients were professionally active before the surgery: 34 were white-collar workers, 29 manual workers, and 4 students or school pupils. The remaining 20 had not worked for many years, and were receiving sickness or disability benefits. An excellent result, according to the Kellgren-Lawrence classification, was noted in 22 cases, a good result in 42 cases, and a satisfactory result in 6 cases. In 25 cases, a poor result was observed. All of the patients professionally active before the surgery returned to work following the procedure. A further analysis found that 15 previously-unemployed patients commenced employment following the procedure. The mean length of the sick leave was 196.2 days, and rehabilitation payments were granted in 5 cases. CONCLUSIONS: Total cementless hip replacement is a valuable method of treating osteoarthritis in young patients. All of the patients who worked before the surgery returned to work in the same position and on the same employment conditions. Most of the previously-unemployed patients commenced employment following the procedure. Int J Occup Med Environ Health. 2021;34(6):747-54.

The return to professional activity patients treated surgically due to advanced gonarthrosis.

OBJECTIVES: The goal of this work is to analyze the issue of return to professional activity by working-age patients who have been treated surgically with total knee arthroplasty (TKA) due to gonarthrosis. MATERIAL AND METHODS: Overall, 88 working-age patients were examined, with a total of 91 TKA procedures performed due to advanced gonarthrosis. The average age of the patients was 54.2 years for women and 58.1 years for men. A modified Knee Society Score scale was used to compile the results of the clinical trial. The Kellgren-Lawrence classification was used to assess preoperative radiographs. Postoperative radiographs evaluated the position of the endoprosthesis of both the femoral and tibial components in the anteriorposterior and lateral upright projections. The obtained results were subjected to statistical analysis. RESULTS: In the preoperative assessment, both the clinical and radiological results obtained were unfavorable in all cases. Throughout the observation period of approximately over 3.8 years, a very good result was noted in 65 cases (71.4%), a good result in 20 cases (22%), and a satisfactory result in 6 cases. There were no bad results. The average improvement on the Visual Analogue Scale was 6.5 pts. The radiological assessment did not reveal any radiological symptoms of the aseptic loosening of the endoprosthesis, simultaneously concluding that each time the endoprosthesis components were properly seated. Only 53 (58.3%) of the examined patients were professionally active before the surgery. After completing the treatment, 46 (50.5%) of all patients returned to work, in favor of intellectual workers. The average duration of sick leave was 136.2 days, and rehabilitation allowance was granted in 19 cases. CONCLUSIONS: Firstly, in working-age patients, TKA is a valuable method for surgical treatment of advanced gonarthrosis of varying etiology. Secondly, most of the patients who worked before the surgery returned to performing work in the position held and on the same full-time equivalent basis. Int J Occup Med Environ Health. 2021;34(5):617-28.

Outcomes of Cementless Total Hip Arthroplasty with Anatomical AURA II Stem.

BACKGROUND: The aim of the paper is to describe the outcomes of hip arthroplasty with the anatomical AURA II stem (BIOMET). MATERIAL AND METHODS: The study enrolled 189 patients (105 women and 84 men) who underwent a total of 213 hip arthroplasty procedures with the anatomical AURA II stem. Mean age of the patients at surgery was 61.7 years (range: 21 to 76 years) and mean follow-up period was 131.9 months (11 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement in the scores was 6.8 points. Excellent results were obtained in 123 cases, good in 22, fair in 24 and poor in 44 cases. The poor results were always associated with acetabular cup loosening. A total of 13 (6.1%), patients developed heterotopic ossification. According to the Kaplan-Meier estimator, 10 years' survival probability was 76.19% for the whole endoprosthesis and 100% for the stem alone. CONCLUSIONS: 1. Our follow-up data from a mean of 11 years show that the use of the anatomical AURA II stem results in a considerable reduction in hip pain and produces good and lasting clinical outcomes. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal.

Analysis of Outcomes of Total Cementless Hip Joint Arthroplasty in the Treatment of Advanced Hip Osteoarthritis Following Childhood Perthes' Disease.

BACKGROUND: The aim of this study is to analyse the outcomes of total cementless hip joint arthroplasty in the treatment of advanced hip osteoarthritis following Perthes' disease in childhood. MATERIAL AND METHODS: The study enrolled 56 patients (15 women and 41 men) who underwent a total of 61 hip joint arthroplasties for coxarthrosis following Perthes' disease. The mean age of the patients at surgery was 46.7 years (range 21-67 years). The mean follow-up period was 13.7 years. RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 25 cases, good in 16, satisfactory in 16 and poor in 9 cases. Poor results were always related to loosening of the acetabular cup. Heterotopic ossification was noted in 7 cases. According to the Kaplan-Meier estimator, 10 years' survival probability was 85.24% for the whole implant and 100% for the stem. CONCLUSIONS: 1. Total cementless hip joint arthroplasty is an effective method in the treatment of advanced hip osteoarthritis following Perthes' disease in childhood. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the patients' young age, there may be more cases of loosening over time, requiring regular long-term follow-up.

Fracture of the Femoral Stem as a Rare Complication of Total Hip Arthroplasty. Cases Report.

The aim of this paper is to present the femoral stem fracture as a rare complication of total hip arthroplasty and describe further management in such cases. We present 5 cases of stem fracture in the Mittelmeier prosthe-sis which occurred from 8 to 29 years after the primary procedure. In three cases, the primary hip arthroplasty was performed due to dysplastic coxarthrosis. The remaining two patients had idiopathic and post-traumatic coxarthrosis. The four female patients underwent revision hip arthroplasty with stem replacement. One patient refused surgical treatment and has been followed up at the outpatient clinic. Annual clinical and radiological examination is an approved method for detecting late complications Hip arthroplasty should be performed at specialised centres where relevant prostheses and instruments are used. A transfemoral approach and the use of revision stems anchored in the femoral shaft is a method of choice for revision procedures performed due to stem fractures.

Return to Work after Surgical Treatment of Coxarthrosis by Total Cementless Hip Arthroplasty.

BACKGROUND: Total hip arthroplasty is currently commonly used in surgical treatment of advanced hip osteoarthritis of various aetiologies. Studies show that the number of these procedures has been growing every year, which is associated with global population ageing. The aim of the study was to assess return to work in patients after surgical treatment by arthroplasty due to hip osteoarthritis. MATERIAL AND METHODS: The study assessed 114 patients of productive age who underwent surgery due to advanced hip osteoarthritis. The mean age was 49.9 years in women and 52.2 years in men. All patients included in this retrospective study underwent clinical and radiographic assessment prior to arthroplasty and at the last out-patient follow-up visit. The patients' occupational status and the time of return to work after surgery were also assessed. The results of this clinical study were analysed according to the Merle d'Aubigne-Postel classification (modified by Charnley). Preoperative radiographs were assessed according to the Kellgren-Lawrence classification. The radiographs served to assess the position of the endoprosthesis, including both the acetabular component and the stem. The results were statistically analysed. RESULTS: Pre-operative assessment classified all cases as poor both clinically and radiographically. The post-operative outcomes were excellent in 71 cases (61.7%), good in 37 cases (32.2%) and fair in 7 cases. No case was classified as poor. The mean improvement was 6.6 points and reached the level of statistical significance. Radiographic evaluation did not reveal evidence of aseptic implant loosening and confirmed a normal seat of endoprosthetic components within the Lewinnek safe zone in each case. Only 75 (65.8%) of the study participants worked before the procedure. After the treatment was completed, 67 (58.8%) study patients took up employment. The mean duration of sick leave was 138.6 days and 21 patients were receiving rehabilitation benefits. CONCLUSIONS: 1. Total hip arthroplasty is a valuable method of surgical treatment of advanced coxarthrosis of various aetiologies in patients of productive age. 2. Most patients who worked before the surgery return to work in the same position and work time. 3. Only dysplastic coxarthro-ses have an unfavourable prognosis with respect to starting or resuming work after surgery.

Results of Total Cementless Hip Joint Arthroplasty with Taperloc Stem.

BACKGROUND: The aim of this paper is to present the results of hip joint arthroplasty with the use of the Taperloc stem. MATERIAL AND METHODS: The study group consisted of 117 patients (75 women and 42 men) who underwent 121 hip joint arthroplasties with Taperloc stems. Mean age of the patients at surgery was 53.8 years (range: 2475 years). Mean follow-up period was 159.5 months. RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.6 points. Excellent results were obtained in 86 cases, good in 19, fair in 9 and poor in 7 cases. Poor results were always associated with implant component loosening: 5 cases of acetabular cup loosening, 1 case of a loosened stem and 1 septic loosening of the entire endoprosthesis. In six cases (4.9%), patients developed heterotopic ossification. According to the Kaplan-Meier estimator, 10 years' survival probability was 94.21% for the whole endoprosthesis and 98.34% for the stem alone. CONCLUSIONS: 1. Our follow-up data covering a mean period of over 13 years showed that the use of the Ta-perloc stem substantially reduces hip pain and results in a good lasting clinical outcome. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal.