Evaluation of Clinical and Radiographic Results of Cemented Total Hip Arthroplasty in 477 Patients^[*]

Abstract

Objective The purpose of the present study was to evaluate retrospectively the clinical and radiographic results of total hip arthroplasty (THA) performed with the Exeter technique and using the Exeter prosthesis.

Methods Between March 2000 and December 2006, 504 THAs were performed in 477 patients, with several etiological diagnoses. A total of 260 surgeries were performed on the right side, 244 on the left side, and 27 were performed bilaterally. The mean age of the patients was 58.9 (17.7–86.8) years old, with a median of 69.0 years old. The preoperative planning was performed with appropriate templates. All of the surgeries were performed through the posterolateral approach with the patient placed on lateral decubitus. The clinical evaluation was performed according to the Harris hip score (HHS). In the radiographic evaluation, the bone cement interface in the three zones of DeLee and Charnley on the acetabular side and in the seven zones of Gruen on the femoral side were studied. Subsidence of the femoral component, presence of diaphyseal hyperthrophy, and heterotopic ossification were also observed.

Results The mean follow-up of 441 surgeries (87.5%) was of 7.2 (1.0-16.6) years, with a median of 7.1 years. The incidence of complications was: dislocation, 3.2%; infection, 2.2%; peripheral nerve disorders 2.0%; thromboembolism 2.7%, acetabular cup loosing 2.0%; diaphyseal hypertrophy, 1.26%; distal migration of the femoral component between 2,0 mm and 2.9 mm, 0.5%; 1 case of aseptic loosing of the femoral component and 9 (1.8%) of the acetabular component. The mean HHS was mean 92.3 (50–100) points.

Conclusion Cemented THA, with the methodology applied, proved to be an effective treatment for this group of patients. The results were satisfactory with acceptable complication rates.

Keywords

arthroplasty, replacement, hip - hip prosthesis - bone cement - hip osteoarthritis - hip joint

^* Work performed at the Orthopedics Clinic of Hospital Governador Israel Pinheiro, IPSEMG, Belo Horizonte, MG, Brazil.

• Referências

• 1 Jasty M, Maloney WJ, Bragdon CR, Haire T, Harris WH. Histomorphological studies of the long-term skeletal responses to well fixed cemented femoral components. J Bone Joint Surg Am 1990; 72 (08) 1220-1229
• 2 Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007; 370 (9597): 1508-1519
• 3 Willert HG, Buchhorn GH. Intefaces in Total Hip Arthroplasty. In: Learmonth ID. Interfaces in total hip arthroplasty. Great Britain: Springer-Verlag; 2000: 33-43
• 4 Charnley J. Biomechanics. In: Charnley J. Low friction arthroplasty of the hip. Berlin: Springer-Verlag; 1979: 332-344
• 5 Lee C. The time-dependente properties of polymethylmethacrylate bone cement: the interaction of shape of femoral stems, suface finish and bone cement. In: Learmonth ID. Interfaces in total hip arthroplasty. Berlin: Springer-Verlag; 2000: 11-9
• 6 Gonçalves H, Honda E, Ono N. Análise da incorporação do enxerto ósseo acetabular. Rev Bras Ortop 2003; 38 (04) 149-160
• 7 Rosenberg WW, Schreurs BW, de Waal Malefijt MC, Veth RP, Slooff TJ. Impacted morsellized bone grafting and cemented primary total hip arthroplasty for acetabular protrusion in patients with rheumatoid arthritis: an 8- to 18-year follow-up study of 36 hips. Acta Orthop Scand 2000; 71 (02) 143-146
• 8 Alencar P, Klassen R, Dau L, Benato ML. Uso de enxerto autólogo de cabeça femural em artroplastia total de quadril primária. Rev Bras Ortop 1999; 34 (9/10): 499-504
• 9 Bolder SB, Melenhorst J, Gardeniers JW, Slooff TJ, Veth RP, Schreurs BW. Cemented total hip arthroplasty with impacted morcellized bone-grafts to restore acetabular bone defects in congenital hip dysplasia. J Arthroplasty 2001; 16 (08) (Suppl. 01) 164-169
• 10 Welten ML, Schreurs BW, Buma P, Verdonschot N, Slooff TJ. Acetabular reconstruction with impacted morcellized cancellous bone autograft and cemented primary total hip arthroplasty: a 10- to 17-year follow-up study. J Arthroplasty 2000; 15 (07) 819-824
• 11 Schreurs BW, van Tienen TG, Buma P, Verdonschot N, Gardeniers JW, Slooff TJ. Favorable results of acetabular reconstruction with impacted morsellized bone grafts in patients younger than 50 years: a 10- to 18-year follow-up study of 34 cemented total hip arthroplasties. Acta Orthop Scand 2001; 72 (02) 120-126
• 12 Engesaeter LB, Furnes O, Havelin LI, Lie Sa, Volset SE. Survival of Total Hip Arthroplasties after DDH in the Norwegian Arthroplasty Register 1987–2004. Hip Int 2007; Suppl 5: 119-119
• 13 Kwon YM, Morshed S, Malchau H. Cemented or cementless stem fixation in THA: what is the current evidence?. Orthopedics 2006; 29 (09) 793-794
• 14 Brooker AF, Bowerman JW, Robinson RA, Riley Jr LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973; 55 (08) 1629-1632
• 15 NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003. Am J Infect Control 2003; 31 (08) 481-498
• 16 DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976; (121) 20-32
• 17 Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 1979; (141) 17-27
• 18 Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51 (04) 737-755
• 19 Della Valle AG, Padgett DE, Salvati EA. Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg 2005; 13 (07) 455-462
• 20 Crites BM, Berend ME, Ritter MA. Technical considerations of cemented acetabular components: a 30-year evaluation. Clin Orthop Relat Res 2000; (381) 114-119
• 21 Warth LC, Callaghan JJ, Liu SS, Klaassen AL, Goetz DD, Johnston RC. Thirty-five-year results after Charnley total hip arthroplasty in patients less than fifty years old. A concise follow-up of previous reports. J Bone Joint Surg Am 2014; 96 (21) 1814-1819
• 22 Schmalzried TP. The infected hip: telltale signs and treatment options. J Arthroplasty 2006; 21 (04) (Suppl. 01) 97-100
• 23 DeHart MM, Riley Jr LH. Nerve injuries in total hip arthroplasty. J Am Acad Orthop Surg 1999; 7 (02) 101-111
• 24 Ranawat CS, Peters LE, Umlas ME. Fixation of the acetabular component. The case for cement. Clin Orthop Relat Res 1997; (344) 207-215
• 25 Fowler JL, Gie GA, Lee AJ, Ling RS. Experience with the Exeter total hip replacement since 1970. Orthop Clin North Am 1988; 19 (03) 477-489