Charnley Total Hip Arthroplasty Research Articles

Thirty-Year Results of a Prospective Study of Charnley Total Hip Arthroplasty by the Posterior Approach

We present the results of 228 consecutive Charnley low friction hip arthroplasties, performed in 193 patients, between July 1972 and December 1976. Unusually for this time, all hips were inserted by the posterior approach without a trochanteric osteotomy. All patients were enrolled into a prospective study; both preoperative and postoperative clinical and radiologic findings were recorded. This series was independently reviewed in 1985 (Atrah SGK. Long-term follow-up of Charnley total hip replacement through posterior approach. MSc thesis, University of London, 1987) and again in 2002. The preoperative and perioperative findings were similar to contemporary series. Implant positioning was also assessed. Because of our stable population, only 2 patients were lost to follow-up. Our survivorship results show a 10-year survival of 93% deteriorating to a 30-year survival of 73% (±6.1). The survivors were assessed radiologically and scored clinically using the Merle d'Aubigné–Postel score with a mean value of 12. The reason for revision was also recorded. These results are comparable to other studies and justify the use of the posterior approach.

Prosthesis survival after total hip arthroplasty—does surgical approach matter? Analysis of 19,304 Charnley and 6,002 Exeter primary total hip arthroplasties reported to the Norwegian Arthroplasty Register

Background and purpose Controversies still exist about whether there is any effect of operative approach on survival of hip prostheses. We compared long-term survival of primary total hip arthroplasties in a welldefined study population from a national prospective population-based registry with regard to the three most commonly used surgical approaches.Methods We assessed prosthesis survival according to surgical approach (the lateral with or without trochanteric osteotomy, and the posterolateral) for 19,304 Charnley and 6,002 Exeter total hip arthroplasties performed from 1987 to 2004.Results For Charnley total hip arthroplasties, lateral approach with trochanteric osteotomy had a lower probability of revision than lateral approach without trochanteric osteotomy (RR = 0.6, 95% CI: 0.5–0.8). The lower revision rate was due to fewer revisions for aseptic loosening and dislocation. The differences had declined in the latest time period (1995–2004). We observed no differences between lateral approach without trochanteric osteotomy and posterolateral approach, except that there were more revisions due to dislocation in the posterolateral approach group (RR = 1.9, 95%CI: 1.1–3.2). No statistically significant differences were observed for Exeter total hip arthroplasties.Interpretation For Charnley prostheses, the lateral approach with trochanteric osteotomy gave a reduced revision risk compared to the other approaches, which was due to fewer revisions for dislocation, and in the first time period also fewer revisions due to aseptic loosening.

Minimal Surgical Approach for Recurrent Hip Dislocation Using the Posterior Lip Augmentation Device for the Charnley Hip Arthroplasty

We present the management of recurrent posterior dislocations in cemented Charnley total hip arthroplasties treated with acetabular augmentation. Certain patients are elderly with comorbid conditions and diminished reserves. We have used a minimal surgical approach to implant 21 posterior lip augmentation devices in elderly patients. Ninety percent of the hips are stable with follow-up of 1 to 3 years (mean, 1.9 years). Eighty-four percent of the patients were satisfied with the outcome. Two cases, which redislocated, were further stabilized by changing the position of the posterior lip augmentation device and are stable. Because of a minimal surgical approach, the time duration of surgery, blood loss, transfusion requirement, inpatient stay, and morbidity are reduced. Posterior lip augmentation device surgery with a minimal approach is a safe and effective procedure for elderly patients who do not have any obvious cause for dislocation.

Results of Charnley Total Hip Arthroplasty with Use of Improved Femoral Cementing Techniques

The current study was performed to determine the status, at a minimum of twenty-five years, of a prospective, single-surgeon series of patients treated with primary Charnley total hip arthroplasty with a contemporary femoral cementing technique that included use of a distal cement plug and a retrograde cement-delivery system. Since our review at a minimum of twenty years postoperatively, two primary total hip prostheses were revised (one because of acetabular loosening, and one because of femoral loosening). Of the original cohort of 357 hips (320 patients), ten (2.8%) had revision of the femoral stem because of aseptic loosening. Forty-nine patients (fifty-two hips, 14.6%) who had been in the initial study group were still living at the time of the present review. Five hips (10%) in living patients had required a femoral revision because of aseptic loosening. Including those that were revised, eight femoral components (17%) in living patients were seen to be loose radiographically. Although this study demonstrates the remarkable durability of the femoral fixation obtained with the polished flatback Charnley prosthesis and the contemporary cementing technique, there was some deterioration of the results with time. These results provide a standard for comparison with cementless fixation after hips treated with that technique have been followed for a similar duration. Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Genetic susceptibility to hip arthroplasty failure—association with the RANK/OPG pathway

The OPG/RANK/RANKL system has been implicated in the biological cascade of events initiated by particulate wear debris and bacterial infection resulting in periprosthetic bone loss around total hip arthroplasties (THA). Individual responses to such stimuli may be dictated by genetic variation caused by single nucleotide polymorphisms (SNPs). Case control study of the osteoprotegerin and RANK genes for possible association with deep sepsis or aseptic loosening. All patients were Caucasian and had had a cemented Charnley THA and polyethylene acetabular cup. Cases consisted of 91 patients with early aseptic loosening and 71 patients with deep infection. Controls were 150 clinically and radiologically well-fixed THAs. DNA samples were genotyped using Taqman allelic discrimination. The A allele (p<0.001) and genotype A/A (p<0.001) for the OPG-163 SNP were associated with aseptic failure. Additionally, the RANK +575 (C/T SNP) T allele (p=0.004) and T/T genotype (p=0.008) frequencies were associated with aseptic failure. Comparing the septic group with the controls, the frequency of the A allele (p<0.001) and the genotype A/A (p<0.001) for the OPG-163 SNP were statistically significant. Aseptic loosening and deep infection of THA may be under the influence of susceptibility genes. SNP markers may serve as predictors of implant survival.

Charnley total hip arthroplasty with navigation system

Charnley total hip arthroplasty with navigation system

Validation of a digital image processing software package for the in vivo measurement of wear in cemented Charnley total hip arthroplasties

Computer-generated images were used to assess image processing software employed in the radiographic evaluation of penetration in total hip replacement. The images were corrupted using Laplacian noise and smoothed to simulate different modulation transfer functions in a range associated with hospital digital radiographic systems. With no corruption, the penetration depth measurements were both precise and accurate. However, as the noise increased so did the inaccuracy and imprecision to levels that may make changes in the penetration observed clinically difficult to discern between follow-up assessments. Simulated rotation of the wire marker produced significant bias in the measured penetration depth. The use of these simulated radiographs allows the evaluation of the software used to process the digital images alone rather than the whole measurement system.

Long-term Follow-up Studies of Total Hip Arthroplasty

Long-term follow-up studies of cemented total hip arthroplasty (THA) are restricted to a few successful designs. The most studied design, the Charnley THA, has demonstrated excellent, though not perfect, survivorship at long-term follow-up in most studies. Patient-related factors including age, gender, and patient diagnosis, affect implant survivorship.

A contemporary snapshot of the use of hydroxyapatite coating in orthopaedic surgery

The capacity for biological materials to combine with inorganic salts is well established. Bio-mineralisation was an evolutionary milestone, and a key contributor to the ‘cladogenesis of life’ which occurred in the early Cambrian period, 570 million years ago.[1][1] A protracted ice age in the

TOTAL HIP ARTHROPLASTY WITH CEMENT AND WITHOUT ACETABULAR BONE GRAFT FOR SEVERE HIP DYSPLASIA

We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery. Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% ± 8% with revision because of aseptic loosening as the end point and 82% ± 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Total Hip Arthroplasty with Cement and without Acetabular Bone Graft for Severe Hip Dysplasia

We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery. Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% +/- 8% with revision because of aseptic loosening as the end point and 82% +/- 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods.

Polyethylene wear rate and osteolysis: critical threshold versus continuous dose–response relationship

We studied the relationship between polyethylene wear and osteolysis in 230 subjects after cemented Charnley total hip arthroplasty in order to examine the validity of the wear rate threshold concept. Polyethylene wear measured using image analysis (EBRA) software was compared in 115 subjects with osteolysis versus 115 control subjects that were individually matched for age, sex, and follow up period. Subjects with osteolysis had almost twice the mean annual wear rate versus the controls. The incidence of osteolysis increased in a linear manner with each quintile increase in wear rate throughout the range 0.01–0.54 mm/year. The odds-ratio for osteolysis approximately doubled with each quintile increase in wear rate above the middle quintile (wear rate 0.08–0.11 mm/year), and decreased at a similar rate with each quintile decrease in wear rate below the middle quintile. Our data suggests that the association of osteolysis with polyethylene wear rate represents a continuous dose–response relationship and does not support the concept of a discrete critical wear rate threshold above which the risk of osteolysis is disproportionately increased.

Long-term results of total hip arthroplasty for femoral neck fracture nonunion.

Hip arthroplasty for the treatment of nonunion at the site of a femoral neck fracture has provided good short-term results. The purpose of the present study was to evaluate the long-term results and complications of total hip arthroplasty for the treatment of femoral neck nonunion. The records of ninety-nine patients who had been managed with total hip arthroplasty with use of a cemented Charnley acetabular component and a cemented Charnley monoblock femoral component for the treatment of a femoral neck nonunion were retrospectively reviewed. The average age at the time of the arthroplasty was sixty-eight years. Eighty-four patients (85%) were followed until death, revision, or component removal or for at least two years (mean, 12.2 years) postoperatively. Twelve patients were treated with revision (eleven) or resection arthroplasty (one), eleven were lost to follow-up, and four died less than two years postoperatively. Of the remaining seventy-two unrevised hips that were followed for at least two years, sixty-nine (96%) had no or mild hip pain at the time of the last follow-up. The rate of component survival free of revision or removal for any reason was 93% at ten years and 76% at twenty years. The risk factors that were significantly associated with revision for aseptic loosening included an age of less than sixty-five years at the time of the arthroplasty (p = 0.045), a body-mass index of >/=30 (p < 0.01), and male gender (p = 0.02). The second most common complication after loosening was dislocation, which occurred in nine patients (9%). Total hip arthroplasty is an effective method for the treatment of nonunion of the femoral neck and provides satisfactory long-term results. However, the rate of implant survival is poorer than that reported in most other studies of Charnley total hip arthroplasty in the general population.

Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report.

The purpose of the current study was to update the results of a prospective, single-surgeon series of primary Charnley total hip arthroplasties performed with cement. This investigation is one of the first studies in which hips treated with total hip arthroplasty with cement were followed for a minimum of thirty years. Twenty-seven patients (thirty-four [10.3%] of the hips in the initial study group) were alive at a minimum of thirty years postoperatively. These patients served as the focus of the present study. Revision because of aseptic loosening of the acetabular component was performed in 7.3% (twenty-three) of the hips from the original study group (excluding those revised because of infection or dislocation) and 26% (eight) of the hips in the living cohort. Revision because of aseptic loosening of the femoral component was performed in 3.2% (ten) of the hips from the original study group (excluding those revised because of infection or dislocation) and 10% (three) of the hips in the living patients. Since the twenty-five-year review, three hips were revised (one because of acetabular loosening, one because of femoral loosening, and one because of instability). This end-result study demonstrated the remarkable durability of cemented Charnley total hip replacements over a span of three decades, with 88% of the original prostheses intact at the time of the final follow-up or at the patient's death.

The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty.

A widely variable prevalence of dislocation after total hip arthroplasty has been reported, partly because of varying durations of follow-up for this specific end-point. The effect of demographic factors on the long-term risk of dislocation as a function of time after total hip arthroplasty is not well understood. The purpose of the present study was to determine the risk of dislocation as a function of time after Charnley total hip arthroplasty and to investigate the demographic factors that influence the cumulative risk of dislocation. Six thousand six hundred and twenty-three consecutive primary Charnley total hip arthroplasties were performed in 5459 patients at one institution between 1969 and 1984. The patients included 2869 female patients and 2590 male patients with a mean age of sixty-three years. All procedures were performed with a 22-mm femoral head, and all femoral and acetabular components were fixed with cement. The patients were followed at routine intervals and were specifically queried about dislocation. The cumulative risk of dislocation was calculated with use of the Kaplan-Meier method. Three hundred and twenty hips (4.8%) dislocated. The cumulative risk of a first-time dislocation was 1% at one month and 1.9% at one year and then rose at a constant rate of approximately 1% every five years to 7% at twenty-five years for patients who were alive and had not had a revision by that time. Multivariate analysis revealed that the relative risk of dislocation for female patients (as compared with male patients) was 2.1 and that the relative risk for patients who were seventy years old or more (as compared with those who were less than seventy years old) was 1.3. Three underlying diagnoses-osteonecrosis of the femoral head, acute fracture or nonunion of the proximal part of the femur, and inflammatory arthritis-were associated with a significantly greater risk of dislocation than osteoarthritis was. The cumulative long-term risk of dislocation after total hip arthroplasty is considerably greater than has been reported in short-term studies. The incidence of dislocation is highest in the first year after arthroplasty and then continues at a relatively constant rate for the life of the arthroplasty. Patients at highest risk are female patients and those with a diagnosis of osteonecrosis of the femoral head or an acute fracture or nonunion of the proximal part of the femur. Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Long-term results of Charnley total hip arthroplasty

Long-term results of Charnley total hip arthroplasty

Long-term function after Charnley total hip arthroplasty.

The purpose of this study was to report the functional results and mortality rates of a consecutive series of patients younger than 50 years after Charnley total hip arthroplasty. The original group of 69 patients (93 hips) was followed up until death or a minimum of 25 years after surgery. Of the original 93 hips, 29 had been revised at some point. Functional outcomes included the Short Form-36, Western Ontario and McMaster University University Osteoarthritis Index (WOMAC), 6-minute walk distance, Noyes activity scale, and Harris hip scores and included followup in 42 of 43 living patients. The functional outcome of patients was good, with comparable Short Form-36 scores compared with normative values of healthy age-matched subjects. The 6-minute walk distances and WOMAC scores were slightly lower than healthy normatives but were thought to be influenced by medical comorbidities. Although comorbid medical and musculoskeletal conditions significantly hindered most measures of function, revision surgery or radiographic loosening of components had no significant influence on function. The mortality rates of this cohort of patients were similar to normative values at both 10 and 25 years after surgery.

Human leukocyte antigen and aseptic loosening in Charnley total hip arthroplasty.

Human leukocyte antigen phenotypes and radiographic course were studied in 70 Japanese patients (90 hips) who had Charnley low friction arthroplasty. Of the 28 hips diagnosed as radiographically loose less than 15 years after surgery, seven hips (25.0%) were in patients who had a positive human leukocyte antigen A31(19). Of the 62 hips that were radiographically stable more than 15 years, two hips (3.2%) were in patients who had a positive human leukocyte antigen A31(19). Of the nine hips in patients who were positive to human leukocyte antigen A31(19), seven hips were diagnosed as radiographically loose (loosening rate was 77.8%) 15 years after surgery. On the other hand, of the 81 hips in the patients who were negative to human leukocyte antigen A31(19), only 21 hips were diagnosed as radiographically loose (loosening rate was 25.9%) 15 years after surgery. These data suggest that individual immune response to implant materials, linked to human leukocyte antigen, may participate in the process of aseptic loosening in Charnley low friction arthroplasty.

Twenty-five-year results after Charnley total hip arthroplasty in patients less than fifty years old: a concise follow-up of a previous report.

We report the updated results for a previously evaluated cohort of patients who were less than fifty years old when they underwent Charnley total hip arthroplasty with cement. The original cohort consisted of ninety-three total hip arthroplasties performed in sixty-nine patients. The patients were followed for a minimum of twenty-five years after surgery or until death. The present report describes the findings of the radiographic and functional follow-up, which was performed for forty-two of the forty-three living patients. At the time of the latest follow-up, twenty-nine (31%) of the ninety-three total hip replacements had been revised or removed. Eighteen acetabular and five femoral components were revised secondary to aseptic loosening. The combined prevalence of radiographic failure or revision because of aseptic loosening was 13% for the femoral components and 34% for the acetabular components. Comorbid medical conditions significantly hindered results on each functional subscale (p < 0.05). This study demonstrates the durability of cemented total hip replacements in a young patient population. Sixty-nine percent of the original hip replacements were functioning well at the latest follow-up examination or at the time of death, and only 5% required more than one revision arthroplasty.

Sir John Charnley's total hip arthroplasty: 23 years of follow-up after Schanz-Hass osteotomy for irreducible hip dislocation

Six patients (ten hips)with an irreducible hip dislocation were treated with Schanz-Hass osteotomy. Between 1978 and 1982, nine Charnley total hip prosthesis were performed because of severe secondary coxarthrosis. Twenty-two years later, the results of five hips are reported. There was no modification either on the acetabulum or on the femoral stem.