Minimum 10-Year Follow-Up of Total Hip Arthroplasty With a Collarless Triple-Tapered Polished Cemented Stem With Line-to-Line Implantation Using a Direct Anterior Approach.

BACKGROUND: The Trilliance stem (B. Braun-Aesculap, Tuttlingen, Germany), a novel collarless triple-tapered polished stem, was introduced in 2009. The aim of this study is to evaluate the long-term clinical and radiological results of the Trilliance stem with line-to-line implantation in primary total hip arthroplasty using a direct anterior approach. METHODS: A consecutive retrospective series of 130 patients (151 hips) who underwent total hip arthroplasty between February 2009 and August 2011 were evaluated for a minimum of 10 years. Of these, 87.4% had a diagnosis of secondary osteoarthritis based on developmental hip dysplasia. Clinical and radiological results, complications were evaluated and survival analysis was performed. RESULTS: The mean follow-up was 10.7 years (range, 10.0-12.1). Thirteen hips (13 patients, 6.8%) were lost to follow-up. Adequate cementation (Barrack grade A) was achieved in 136 hips (93.8%) 1 week post-operatively. Nearly all (144 hips, 99.3%) had been inserted within the range of 3°. No significant differences were identified between high- (≥30 procedures/year) and low- (<30 procedures/year) volume surgeons. The Kaplan-Meier survival analysis with revision of the femoral component for aseptic loosening, revision of the femoral component for any reason and revision of either component for any reason as the end points, cumulative survivorship was 100.0%, 97.6% (95% confidence interval (CI) 95.4-100.0) and 96.5% (95% CI 93.8-99.3) at 10 years, respectively. CONCLUSION: The Trilliance stem with line-to-line implantation using a direct anterior approach has an excellent clinical and radiological outcome at a minimum of 10 years' follow-up. LEVEL OF EVIDENCE: Level IV, Retrospective cohort study.

Natural history of noise and squeaking in cementless ceramic-on-ceramic total hip arthroplasty.

INTRODUCTION: Ceramic-on-ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris, and consequently the occurrence of osteolysis and aseptic loosening. The purpose of the present study was to determine the incidence and natural history of noise including squeaking after COC THA, and to clarify whether clinical outcomes and any demographic and implant-related factors are associated with noise from these ceramic bearings. METHODS: This was a retrospective observational study of 137 primary COC THAs between 2004 and 2009 at our institute. The Mean follow-up was for 10.5 years. All patients were followed up with an office visit to obtain information regarding noise, pain, and function. The correlations between the noise, and patient demographic, radiographic, and implant-related factors were evaluated. RESULTS: Noise developed in 30 hips (21.9%), specifically squeaking in 2 (1.5%) of the 137 hips during the follow-up period. Noise including squeaking was not associated with pain or functional outcomes. There was significant correlation between noise and cup anteversion, in that cup anteversion of patients with noise was smaller than that in those without noise. No significant correlation was found between noise and any other patient demographic including age, sex, height, body weight, or body mass index. Kaplan-Meier survivorship analysis with revision for any reason and an aseptic loosening of either component as the end point, revealed a cumulative survival rate at 10 years of 98.4% and 99.1% respectively. CONCLUSION: The long-term clinical and radiographic outcome of cementless COC THA is excellent, but we should be vigilant for noise from COC bearings.

The predictive value of synovial glucose level in septic arthritis.

The aim of this study was to investigate the ability of the joint fluid glucose level to detect septic arthritis. Thirty joints in 30 patients with suspected septic arthritis were evaluated. When glucose level was less than 40 mg/dl, we performed arthrotomy. Eleven patients had joint fluid glucose levels less than 40 mg/dl. All 11 (100%) had positive joint fluid cultures. Conversely, 19 patients had synovial glucose levels of at least 40 mg/dl. Six (31.6%) of these had positive joint fluid cultures. The remaining 13 were diagnosed with transient synovitis. Patients with joint fluid glucose levels less than 40 mg/dl should be suspected septic arthritis.

Spinopelvic Alignment and Low Back Pain after Total Hip Replacement Arthroplasty in Patients with Severe Hip Osteoarthritis.

STUDY DESIGN: Retrospective observational study. PURPOSE: We examined change in lumbrosacral spine alignment and low back pain (LBP) following total hip arthroplasty (THA) in patients with severe hip osteoarthritis (OA). OVERVIEW OF LITERATURE: Severe hip osteoarthritis has been reported to cause spine alignment abnormalities and low back pain, and it has been reported that low back pain is improved following THA. METHODS: Our target population included 30 patients (29 female, mean age 63.5 years) with hip OA who underwent direct anterior approach THA. There were 12 cases with bilateral hip disease and 18 cases with unilateral osteoarthritis. Visual analogue scale (VAS) scores for LBP and coxalgia, the Roland-Morris Disability Questionnaire (RDQ), and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and after surgery. Spinal alignment metrics were measured before and after surgery. RESULTS: VAS for LBP change from preoperative to final postoperative observation was significantly improved (p <0.05), as was VAS for hip pain (p<0.001). RDQ improved significantly (p<0.01). All five domains of JOABPEQ were significantly improved (p<0.05). In terms of coronal alignment, lumbar scoliosis change from preoperative to last observation was significantly reduced (p<0.05). There were no significant changes in the sagittal alignment metrics. In addition, there was a correlation between before and after RDQ difference and before and after lumbar scoliosis difference (p<0.05). VAS for LBP (p<0.05) as well as RDQ (p<0.05) were significantly improved only in unilateral OA. Lumbar scoliosis was significantly improved in cases of unilateral OA (p<0.05), but alignment did not improve in cases of bilateral OA (p=0.29). CONCLUSIONS: The present study demonstrates improvements in VAS for LBP, RDQ, and all domains of JOABPEQ. There were also significant reductions in lumbar scoliosis and an observed correlation of RDQ improvement with lumbar scoliosis improvement. We were able to observe improvements in lumbar scoliosis and low back pain only in cases of unilateral OA. It has been suggested that the mechanism of low back pain improvement following THA is related to compensatory lumbar scoliosis improvement.

Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position.

PURPOSE: The purpose of this study was to clarify the difference in implant alignment between the direct anterior approach (DAA) and the anterolateral approach in the supine position (ALS). METHODS: A retrospective comparative study consisted of 215 consecutive primary total hip arthroplasties using tapered polished and straight cemented-stems via two different minimally invasive approaches (DAA group in 106 hips and ALS group in 109 hips). RESULTS: The cup radiographic anteversion angle was significantly lower in the ALS group than in the DAA group (12.9° versus 16.9°, p = 0.001). The frequency of the safe zone tended to be more favourable in the ALS group than in the DAA group (95% versus 87%, p = 0.052). Stem alignment in the sagittal plane was significantly better in the ALS group than in the DAA group (84% versus 71%, p = 0.022). CONCLUSIONS: Both cup and stem alignments were better in the ALS group than the DAA group.