Ultrasound for diagnosis of infection in revision total hip arthroplasty.

Eighty consecutive patients (85 hips; 43 women; median age, 74 years [range, 33-90 years]) underwent a revision total hip arthroplasty. Preoperatively and guided by ultrasound, biopsy specimens of the joint pseudocapsule were taken, and joint fluid was aspirated for culture. Capsule morphology was investigated with light microscopy. When septic loosening was defined as 2 intraoperative cultures yielding the same microorganism, the prevalence was 12%. Sensitivity of the capsule biopsy cultures was 67%; specificity, 68%; positive predictive value, 22%; and negative predictive value, 94%. Joint fluid was often sparse and always falsely sterile. One specimen from a hip with septic loosening showed histologic changes (> or =3 foci, each with > or =3 plasma cells/high-power field) consistent with chronic infection. The remaining 8 septic loosenings eluded histologic detection, yielding 11% sensitivity. All aseptic loosenings were classified correctly (specificity 100%). Positive and negative predictive values were 100% and 89%. Ultrasound-guided aspiration and capsule biopsy with cultures and histology does not seem to be sufficiently accurate in the preoperative diagnosis of infected total hip arthroplasty.

Revision total hip arthroplasty using third-generation cementing technique.

A total of 83 consecutive first-revision total hip arthroplasties were performed in 83 patients using pressurized vacuum-mixed cement, a third-generation cementing technique. At a median follow-up of 3.6 years (range, 1.5-6.3 years), the overall failure rates (radiographic loosening, re-revision, or both) were 39% for the femoral components and 30% for the acetabular components. With definite radiographic loosening as an endpoint, the cement-bone interface achieved was the only significant factor to predict stem durability, with an adjusted odds ratio of 1.8 (95% confidence interval, 1.1-3.0). On the acetabular side, bone stock was the only significant factor, with an adjusted odds ratio of 5.3 (95% confidence interval, 4.0-27.7). In this retrospective cohort study, femoral cement pressurization per se did not appear to improve the results over those of other studies using second-generation techniques.

Charnley total hip arthroplasty. A ten- to 14-year follow-up study.

The long-term results of 325 consecutive Charnley total hip arthroplasties (THAs) were assessed at an average of 62 and 140 months (five-year and ten-year follow-up examinations) postoperatively. Cases developing deep infection during the first five years were not included. Pain, walking ability, and mobility were rated as advocated by Charnley. The results were then graded as excellent, good, fair (clinically successful), and failure. At the five-year follow-up evaluation, 77 hips were excluded; 92% (228/248) of the results were successful. At the ten-year follow-up examination, interest was focused on the 228 hips graded as successful after five years. Sixty-six were excluded, one that had not been included at the five-year evaluation was traced, and 92% (150/163) were again clinically successful. The failure rate owing to mechanical causes during the first five years and between the five-year and ten-year follow-up examinations was 6.9% and 6.7%, respectively. The clinical results were considered highly satisfactory because only 50% of the hips judged successful at the ten-year examination had roentgenographically intact components. There is good reason to have great confidence in the Charnley THA.

Ten-year results of the Charnley hip in arthrosis.

After exclusion of 15 infected cases, 165 consecutive primary Charnley hip replacements for arthrosis were examined 5 and 10-13 years postoperatively. The failure rates during the first 5 years and between the 5- and 10-year follow-ups were 6 and 5 percent, respectively. Failures were more common in men. Among the hips followed for at least 10 years, 43 and 50 percent of the stems were radiographically loose at the 5- and 10-year follow-ups, respectively; the corresponding figures for the socket were 8 and 12 percent. No hips with radiographically intact components at 5 years were clinical failures at the 10-year follow-up.

Long-term results of bilateral Charnley total hip arthroplasty.

The results of 58 bilateral Charnley total hip arthroplasties in 29 patients operated on were assessed at an average of 62 and 145 months after operation (5-year and 10-year follow-up evaluations). At the 5-year follow-up evaluation, 96% of the available hips were graded as clinically successful. At 10 years, 94% of the successes at 5 years were again thus graded. All clinical failures (4) were caused by fracture of the stem.

Correlation between radiologic and clinical findings in Charnley total hip replacement. A 10-year follow-up study.

The main purpose of this study was to evaluate the relationship between the radiologic findings in clinically successful Charnley total hip replacements (THR) at an average of five years postoperatively ('5-year follow-up') and the clinical result 10 to 14 years after operation ('10-year follow-up'). The study included 150 arthroplasties graded as clinically successful at the 5-year follow-up despite radiologic loosening of the femoral component in 41 per cent and of the acetabular component in 7 per cent. The incidence of clinical failure between the two follow-ups was 7 per cent (10 hips). Only 2 per cent (3/125) of THRs with intact components or a loose stem with migration not exceeding 4 mm became failures. Clinical failures resulted in 28 per cent (7/25) of THRs with more extensive loosening of the stem or with a loose socket. At the 10-year follow-up 47 per cent of the femoral and 13 per cent of the acetabular components were loose. Progression of loosening of the femoral stem occurred in 63 per cent and of the socket in 73 per cent between the two follow-ups. The incidence of loosening of the stem showed a significant correlation both with the extent of cementation distal to the tip and with the orientation of the prosthesis in the sagittal plane.