Charnley Low-friction Arthroplasty Research Articles

THR Using a 3D Printed Custom Made Acetabulum Component: A Case Report

Introduction: THR is one of the commonly performed adult arthroplasties in the world. Over the past 6 decades, Charnley low friction arthroplasty has evolved in design and concept. One among those recent advances is the use of 3D printing technology in arthroplasties. Purpose of this article is to discuss and share the details of a hip arthroplasty case where a customized 3D printed acetabulum component was used. Case: A 3 year postop case of acetabulum fracture fixation presented with arthritis of hip. CT revealed a periacetabular massive bone loss. After considering all options, decision was made to use a 3D printed acetabulum shell. Discussion: Complex THRs with special instrumentation and augmented implants are frequently seen in revision surgeries and post acetabulum fracture cases. Based on the size and pattern of the defect, IlioIschial cages, Triflange cups, Trabecular metal augments, CupCage constructs, Jumbo cups are some common options at a surgeons disposal while tackling an acetabulum bone loss challenge. A 3D manufactured component can be of aid when the defect is too large. It gives the advantage of being anatomically contoured. It also allows a porous structure for bone ingrowth. Conclusion: Life size models of the pelvis and the component gives an explicit simulation of the surgery, including the component placement and trajectory of the screws. This effective preoperative planning can improve the surgical precision and reduce the complications. Literature on the survival rates and long term complications of such 3d printed acetabulum shells is limited. Studies on the long term outcomes with usage of these implants would be insightful Keywords: 3D Printing, Complex THR, Customised acetabular shell

Classifications in Brief: The Hartofilakidis Classification of Developmental Dysplasia of the Hip

Classifications in Brief: The Hartofilakidis Classification of Developmental Dysplasia of the Hip

A proximal referencing system for the Charnley low friction arthroplasty.

Dislocation is a serious complication of total hip arthroplasty occurring in up to 9% of cases. Recurrent dislocation accounts for 4% of revisions in the Swedish Hip Arthroplasty Study. Soft tissue balancing is one of the factors, independent of the surgical approach used, that is involved in producing a stable total hip replacement. We describe a proximal referencing system for use with the Charnley low friction arthrosplasty (LFA), which optimises this factor. The dislocation rate, using this method, is 0.3% (in 333 cases performed by a single surgeon over a 5 year period). This system should prove valuable to orthopaedic surgeons in training, ensuring they achieve correct soft tissue balance in total hip arthroplasty. (Hip International 2002; 12: 303-7).

Early femoral loosening of the titanium 3M capital cemented hip: A lesson relearned.

A 4-year follow-up study is presented comparing 3M Capital cemented hip replacements with Charnley low friction arthroplasty controls. The mean radiological follow-up in the Capital and Charnley groups was 47 months (25 to 61) and 47 months (23 to 66) respectively. All cases were performed by the same surgical team over the same period (April 1991-October 1993). The operative technique including femoral preparation and cementing technique was identical in each group. Charnley broaches were used for femoral preparation in both groups and Charnley cups were used in all cases. In all of the 3m Capital cases cobalt-chrome femoral heads were used. There was no case selection for either group. Six of the 21 Capital femoral components were deemed to be loose on radiological criteria. None of the Charnley hips was loose. This represents an unacceptably high incidence of radiological femoral stem loosening in the Capital hip replacement. A previous uncontrolled study has attributed early failures to deficient femoral preparation and/or cementing technique. We suggest that early femoral stem loosening in the Capital hip occurs despite satisfactory operative technique in contrast with the results using the Charnley total hip replacement. (Hip International 2002; 1: 17-22).

Obituary: A Remembrance of Nas S. Eftekhar (1935-2016).

Obituary: A Remembrance of Nas S. Eftekhar (1935-2016).

Low friction arthroplasty and dual mobility cup: a new gold standard.

Low friction arthroplasty (LFA) introduced by Sir John Charnley was the gold standard for many years. Dislocation and infection are the first causes for early revision. Late failures are polyethylene (PE) wear and loosening. Due to dislocation risk we slowly switched to the use of LFA with dual mobility cups (DMC). The purposes of this study are (1) to assess whether our changes have improved outcomes and (2) what is the new gold standard? We selected from an observational registry of 1,091 cases of hybrid Charnley total hip arthroplasty (THA). The acetabular component was either DMC in 455 cases or fixed cup (FC) in 636 cases. Three dislocations (0.6%) occurred in the DMC group (none revised). In the FC group 54 dislocated (8.49%) and 20 were recurrent and underwent revision (revision rate 3.14%). In the DMC group, five acetabular and three femoral revisions were performed (revision rate for loosening 1.7%). In the FC group 19 cases underwent acetabular revision, and five cases had femoral component revised (revision rate for loosening 3.7%). Charnley's LFA has proven over 50years of excellent survivorship. To decrease dislocation risk, one suggested increasing femoral head diameter. Gilles Bousquet proposed another way, namely, the DMC concept. Dislocation is no longer a critical issue with DMC as demonstrated in our series and main series. DMC in primary THA is still a subject of debate. Mid-term results do not demonstrate a higher rate of wear than LFA. What is the current gold standard? LFA was and is our current gold standard in association with a DMC.

Do temperature variations at the bearing surface during gait affect polyethylene wear in Charnley low-friction arthroplasty of the hip? Simulator study comparing UHMWPE and highly cross-linked polyethylene

IntroductionThere are significant individual variations in the polyethylene (PE) wear of Charnley total hip arthroplasty (THA) in published studies. This could be in part related to variations in hip joint kinematics with abnormal heating at the metal/PE interface. The objectives of our hip simulator experiment were: (1) to measure PE wear as a function of hip kinematics and temperature variations at the interface; (2) to compare ultra-high molecular weight polyethylene (UHMWPE) to latest generation highly cross-linked PE (XLPE). HypothesisOur hypothesis was that PE wear is correlated with temperature increases at the interface and thereby hip joint kinematics. Material and methodsA simulator study was performed with four UHMWPE cups (Initiale™, Amplitude, Valence, France) and two XLPE cups (X3, Stryker, Kalamazoo, Michigan, USA) subjected to 5 million cycles each. The temperature at the femoral head/cup interface was measured every 500 cycles and implant dimensions were measured every 1 million cycles. ResultsThe average temperature was 42°C for 1Hz and 50°C for 1.5Hz, no matter the type of PE tested. There was a large difference between UHMWPE and XLPE in their roughness, but no temperature variations or wear effects. Femoral head penetration after the first 1 million cycles was 0.18mm for the XLPE and 0.075mm UHMWPE on average. Between 1 and 5 million cycles, the penetration was less than 0.1mm per million cycles, with XLPE being similar to UHMPWE. DiscussionOur study found a significant temperature increase at the bearing interface as a function of frequency. But there was no correlation between temperature variations and PE degradation. However, shear stresses were under-estimated because our simulator could not reproduce abduction and adduction movements. Our hypothesis was not confirmed because PE deformation was not correlated to temperature variations. XLPE was not better than UHMWPE in the particular conditions of this study. Simulator studies are limited because of the lack of standards on cycling and the simulator bath. Level of evidenceIII–prospective case-control study in vitro.

Over twenty-five-year results after Charnley low-friction arthroplasty in patients less than fifty years old

Over twenty-five-year results after Charnley low-friction arthroplasty in patients less than fifty years old

The Outcome of 241 Charnley Total Hip Arthroplasties Performed by One Surgeon 30 to 40 Years Ago

We present the outcome of 241 consecutive low friction arthroplasties (LFAs) performed by one surgeon (GH) 30 to 40years ago. The overall survival rate at 30years with revision for any reason or removal of the components as the end point was 53% (43.2–62.8%) when 40 hips remained in the study. Cox regression analysis for the possible risk factors of age, gender and diagnosis revealed higher risk of the overall failure in younger patients, and higher risk of failure due to loosening in younger patients and in those with congenital hip disease. Our follow-up study at 30 to 40years following Charnley LFA can be used as a benchmark for comparison with the newer methods of total hip arthroplasty.

Long term outcomes of Charnley THA in patients under the age of 50: an editorial comment on recently published article by Warth et al.

Fifty three years have passed from 1962 when Sir John Charnley developed the procedure of total hip arthroplasty (THA) in UK (1). Since then the principles of total joint replacement remain very similar to those advocated by Charnley. Moreover, the Charnley low friction arthroplasty represents the most classical cemented arthroplasty that has been used and currently used in several orthopaedic centers with minor changes regarding the initial procedure and implant design and the only implant where long term outcomes exceeding 30 years have been reported. The published literature is dominated by a large amount of studies reporting on outcomes of Charnley THA (2-5). The vast majority of these studies report on outcomes not exceeding follow-up periods longer than 30 years and usually involve a wide range of ages among the included patients. Although THA was initially developed to treat end-stage arthritic conditions in older patients, the need for the procedure in younger, more active patients is increasing. However, despite the improvements in the design of the implants and the surgical techniques THA in younger patients has not showed comparable outcomes to those performed in older patients, rising from the increased biomechanical demand of patients under 50 due to the higher activity levels (2,6).

Innovation or regulation – differing needs in different areas

The history of orthopaedic surgery is one of innovators – a star-studded cast stretching from Thomas with his splint through to Charnley with his hip and beyond. Like all histories, the history of orthopaedics is written by the victors. Think of the Judet family, and the acetabular views and decortication technique come to mind, not the poor-outcome acrylic hips. However the truth is that for every Charnley Low Friction Arthroplasty, there were many more ‘Delbet Rubber Femurs’, ‘Hey-Groves Ivory Hips’ and ‘Ring Metal-on-Metal’ hips. Innovation in the time of our forefathers was embraced and the truth is that it was acceptable to experiment on patients. This is of course no longer true. Established technologies such as hip replacement are now ‘designed’ with iterative changes hoping for ever improved results. It is easy to see why …

Perioperative Skin Preparation

Liaison: Anthony T Tokarski BS Leaders: David Blaha MD (US), Michael A. Mont MD (US), Parag Sancheti MS, DNB, MCh (International) Delegates: Lyssette Cardona MD, MPH, MHA, AAHIVS, FIDSA, Gilberto Lara Cotacio MD, Mark Froimson MD, Bhaveen Kapadia MD, James Kuderna MD, PhD, Juan Carlos Lopez MD, Wadih Y Matar MD, MSc, FRCSC, Joseph McCarthy MD, Rhidian Morgan-Jones MB BCh, FRCS, Michael Patzakis MD, Ran Schwarzkopf MD, Gholam Hossain Shahcheraghi MD, Xifu Shang MD, Petri Virolainen MD, PhD, Montri D. Wongworawat MD, Adolph Yates Jr, MD

Charnley low-friction arthroplasty in patients 35 years of age or younger

We evaluated the outcome of 41 consecutive Charnley low-friction arthroplasties (LFAs) performed by a single surgeon in 28 patients aged ≤ 35 years at operation between 23 and 36 years previously. There were 20 women and eight men with a mean age of 32 years (23 to 35) at surgery. Two patients (three hips) were lost to follow-up at 12 and 17 years post-operatively, respectively, and one patient (one hip) died at 13 years post-operatively. These patients were excluded from the final evaluation. The survival rate of the acetabular components was 92.7% (95% confidence interval (CI) 88.7 to 96.7) at ten years, 67.1% (95% CI 59.75 to 74.45) at 20 years and 53.2% (95% CI 45.3 to 61.1) at 25 years. For the femoral component the survival was 95.1% (95% CI 91.8 to 98.5) at ten years, 77.1% (95% CI 73.9 to 80.3) at 20 years and 68.2% (95% CI 60.7 to 75.8) at 25 years. The results indicate that the Charnley LFA remains a reasonable choice in the treatment of young patients and can serve for comparison with newer techniques and implants.Cite this article: Bone Joint J 2013;95-B:1052–6.

Medium-term result of Elite Plus hip arthroplasty: the second modular evolution of the original Charnley low-friction arthroplasty

BackgroundThe Elite Plus total hip arthroplasty (THA) system was introduced as the second modular evolution of the original Charnley low-friction arthroplasty. However, the results of the Elite Plus THA are currently considered to be inconsistent. The aim of this study was to clarify the medium-term results and the factors affecting the results of Elite Plus THA. MethodsThe results of 97 Elite Plus THAs in 87 patients at 5 years or more postoperatively were reviewed. The patients’ mean age was 65 years, and follow-up averaged 8.0 years. The Elite Plus stem was used in all hips, and three designs of socket, Hylamer Ogee in 40 hips, Wroblewski Offset Bore in 38, and Charnley Ogee in 19, were implanted. The survival rates with loosening and revision as endpoints were analyzed. To clarify the risk factors affecting the survival rates, Charnley’s functional classification, Bombelli’s classification, Crowe’s classification, structural bone grafting of the acetabulum, cup design, stem position, and grading of the cement mantle were evaluated. ResultsThe stem survival rate with aseptic loosening as the endpoint was 96 %, and the rate with revision was 100 %. The cup survival rate with aseptic loosening as the endpoint was 80 %, and the rate with revision was 93 %. Using a Cox proportional hazards model, cup design was a potential confounding factor for acetabular loosening (p = 0.001). The loosening rates were 31 % for Hylamer Ogee sockets at 9.4 years, 8 % for Wroblewski Offset Bore sockets at 7.4 years, and 0 % for Charnley Ogee sockets at 5.6 years. No factors were significantly related to acetabular revision and femoral loosening. ConclusionsThe results of Elite Plus stem THA were excellent in the medium term. The cup design was a potential confounding factor for acetabular loosening, and the Hylamer Ogee socket was associated with a poor result.

The Utility of MARS MRI in Patients with Metal-on-Metal Bearings

Metal-on-metal bearings for total hip arthroplasty have a long history of use that dates back to the introduction of the McKee-Farrar prosthesis in the 1960s. Metal-on-metal bearings ultimately fell out of favor because of the excellent clinical results of the Charnley low-friction arthroplasty concept, which employed metal-on-UHMWPE (ultra-high molecular weight polyethylene) bearing surfaces. However, the use of metal-on-metal bearings was revisited in the 1990s as polyethylene-associated periprosthetic osteolysis emerged as a major clinical problem limiting the longevity of hip reconstructions in high-demand patient populations. Within the last decade, numerous metal-on-metal designs for both total hip arthroplasty and hip resurfacing arthroplasty have been introduced into the marketplace. However, over the last several years it has become evident that contemporary metal-on-metal bearings are not immune to some of the problems, including periprosthetic osteolysis, that have plagued other bearing surface combinations. In addition, investigators described a distinct histological pattern, termed “aseptic lymphocyte-dominated vasculitis-associated lesion” (ALVAL), that was associated with symptomatic metal-on-metal bearings. More recently, investigators described local soft-tissue reactions termed “pseudotumors” in association with symptomatic metal-on-metal devices. Initially, studies of adverse local tissue reactions (including osteolysis, ALVAL, and pseudotumors) in retrospective studies of metal-on-metal implants did not indicate the prevalence. However, case-control studies and registries began to document that certain metal-on-metal bearing designs were associated with an unacceptably high failure rate, leading to high-profile device recalls that captured the attention of the worldwide media. In some cases, the adverse local tissue response …

Dual-Mobility Cup and Cemented Femoral Component: 6 Year Follow-Up Results

Use of a dual-mobility acetabular cup is associated with a lower risk of dislocation compared with conventional hip implants. The seleXys® DS acetabular cup combines the advantages of Charnley low-friction arthroplasty with those of dual mobility. We performed a non-randomised, prospective study of patients receiving primary hip arthroplasty, including an uncemented seleXys® DS dual-mobility acetabular cup with hydroxyapatite coating (Mathys AG, Bettlach, Switzerland) and a cemented femoral component (Stallion femoral stem Groupe Lepine, Lyon, France). The objective of the study was to evaluate longevity of the implant and the risk of dislocation. All operations were performed by a single surgeon using a posterior approach, with patients lying in the lateral decubitus position. The stem had a modular head diameter of 22.2 mm and was cemented in all patients. A total of 53 patients were studied, and the median duration of follow-up was 78.9 months. Implant survival 6 years after surgery was 98.4% (n=47; 95% CI: 89.3-99.8). There was one revision for sepsis 29 months after surgery, and one dislocation. The results of this study appear to demonstrate excellent implant survival and a low rate of dislocation using the chosen implants.

Tuberculous arthritis revisited as a forgotten cause of monoarticular arthritis

BACKGROUND AND OBJECTIVES:Tuberculosis (TB) continues to be a major concern for health care workers. The number of reported cases of extrapulmonary tuberculosis, particularly osteoarticular tuberculosis, is increasing. This fact is attributed to different factors such as underestimating the disease and difficulty in diagnosis, which requires tissue sampling and can lead to a delay in the diagnosis, and can result in significant morbidity and mortality. The aim of this study was to highlight the difficulties and delay in diagnosis of articular tuberculosis, raising the need to create awareness about the importance of early diagnosis to avoid major complications of joint destruction.DESIGN AND SETTING:Retrospective review of patients presenting to a tertiary care center between 2003 and 2009.PATIENTS AND METHODS:We reviewed cases who presented with monoarticular joint pain and swelling that failed to respond to treatment elsewhere and were eventually diagnosed as having articular tuberculosis. We collected the demographic data, history, data on clinical examination and the relevant laboratory investigations, in addition to the data on radiological studies. All patients were treated medically with antituberculosis chemotherapy and surgically according to the severity of joint destruction.RESULTS:Thirteen patients had a mean age was 40 years (range, 17-70 years). The average delay in diagnosis was 2 years. Only 1 patient had pulmonary TB. The hip, knee and elbow were the most common joints involved. Bacteriology was positive in 69% of the cases; and histopathology, in 92%. Fifteen percent of the patients had arthrodesis. None showed recurrence after follow-up of 4 years.CONCLUSION:A high level of clinical suspicion is essential for early diagnosis and treatment of osteoarticular TB to reduce its significant morbidity.

Survivorship Analysis of Socket after Charnley Low-friction Arthroplasty

Survivorship Analysis of Socket after Charnley Low-friction Arthroplasty

Radiological Study of Charnley Low-friction Arthroplasty of the Hip: A 5-to-15-year Follow-up Study

Radiological Study of Charnley Low-friction Arthroplasty of the Hip: A 5-to-15-year Follow-up Study

Long-term survivorship analysis of hip arthroplasty with vitallium mold cup

BackgroundCup arthroplasty was used in the initial attempts to preserve the bone stock of the femoral head and neck for hip reconstruction. However, little conclusive data are available regarding its long-term survivorship. MethodsWe present a long-term survivorship analysis (mean follow-up, 19.3 years; range, 5–36.6 years) after vitallium mold arthroplasty in 77 secondary osteoarthritic hips. ResultsKaplan–Meier survivorship analysis predicted a survival rate for vitallium mold arthroplasty of 81.6% (95% confidence interval [CI], 76.7–86.5) at 20 years and 59.1% (95% CI, 51.8–66.5) at 30 years, with conversion to total hip arthroplasty as the endpoint. The mean Merle d’Aubigné and Postel hip score showed a significant decrease in mobility from 4.12 (range, 3.18–5.86) 6 months after the operation to 3.19 (range, 1.7–4.6) at the last follow-up. No significant differences were observed for the pain score from 6 months after the operation (5.05; range, 4.2–5.9) to the last follow-up (4.46; range, 2.88–6.04)) or score for the ability to walk, from 6 months after the operation (2.5; range, 1.4–3.6) to the last follow-up (3.13; range, 1.59–4.67). Radiographically, the proximal and medial migration of the cup measured at the last follow-up was 10.4 ± 5.4mm (P < 0.01) and 0.2 ± 2.1mm (P > 0.05), respectively. ConclusionsOur results indicate inferior long-term survivorship after vitallium mold compared with that after Charnley low-friction arthroplasty.