Charnley Total Hip Arthroplasty Research Articles

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.

What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.

The purpose of this study was to determine the lifetime risk of revision surgery for patients undergoing Charnley cemented total hip arthroplasty (THA), with 40-year follow up, using death as a competing risk. We retrospectively reviewed 2000 cemented Charnley THAs, with 51 living hips available at 40 years. The cumulative risk of revision or removal for any reason was 13% (95% confidence interval (CI) 12 to 15). Patients aged under 50 years at the time of surgery had a 35% (95% CI 28 to 42) risk of revision or removal for any reason (Hazard Ratio (HR) 3.6; 95% CI 2.5 to 5.2; p<0.001), patients 50 to 59 years old had a 20% risk (95% CI 16 to 24) (HR 2.1; 95% CI 1.5 to 2.8; p < 0.0001), patients aged 60 to 69 years had a 9% risk (95% CI 7 to 11) (reference point), and patients ≥ 70 years old had a 5% risk (95% CI 4 to 7) (HR 0.96; 95% CI 0.6 to 1.5; p = 0.86) during their lifetime. Men had a higher risk of revision or removal for any reason (HR 2.1; 95% CI 1.7 to 2.7; p < 0.001). With almost all the patients in this series followed up till either death or revision, we have been able to develop a 'rule of thumb' for lifetime likelihood of revision or implant removal for the Charnley THA: one in three for patients < 50 years, one in five for patients 50 to 59 years, one in ten for patients 60 to 69 years, and one in 20 for patients ≥ 70 years. The results provide a benchmark for comparison of outcomes, for the newer designs of THA. Cite this article: Bone Joint J 2016;98-B:1436-40.

Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database

Background and purpose — According to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65–74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA based on the NARA database, which has not been done previously.Patients and methods — We determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression to assess survival and hazard ratios (HRs), with revision for any reason as endpoint and with adjustment for age, sex, diagnosis, and femoral head material.Results — Spectron EF THA (89.9% (CI: 89.3–90.5)) and Elite THA (89.8% (CI: 89.0–90.6)) had the lowest 10-year survivorship. Lubinus (95.7% survival, CI: 95.5–95.9), MS 30 (96.6%, CI: 95.8–97.4), and C-stem THA (95.8%, CI: 94.8–96.8) had a 10-year survivorship of at least 95%. Lubinus (revision risk (RR) = 0.77, CI: 0.73–0.81), Müller (RR =0.83, CI: 0.70–0.99), MS-30 (RR =0.73, CI: 0.63–0.86), C-stem (RR =0.70, CI: 0.55–0.90), and Exeter Duration THA (RR =0.84, CI: 0.77–0.90) had a lower risk of revision than Charnley THA, the reference implant.Interpretation — The Spectron EF THA and the Elite THA had a lower implant survival than the Charnley, Exeter, and Lubinus THAs. Implant survival of the Müller, MS 30, CPT, and C-stem THAs was above the acceptable limit for 10-year survival.

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.

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).

Thirty-five-year results after Charnley total hip arthroplasty in patients less than fifty years old. A concise follow-up of previous reports.

We report the updated results for a previously described cohort of patients who were less than fifty years old at the time of the index Charnley total hip arthroplasty with cement. The original cohort consisted of ninety-three consecutive hips in sixty-nine patients. The patients were followed for a minimum of thirty-five years after surgery or until death. At the latest follow-up evaluation, there were forty-one total hip replacements (44%) in thirty-two living patients. Thirty-four (37%) of the ninety-three total hip replacements in the original cohort had been revised or removed. Twenty acetabular (22%) and seven femoral (8%) components had been revised for aseptic loosening. Since the twenty-five-year follow-up, the average six-minute-walk distance decreased from 395 m to 171 m, and this decrease correlated with increasing comorbidity. This study demonstrates the durability of cemented total hip replacements in a young patient population. Although 63% (fifty-nine) of the ninety-three original hip replacements were functioning at the latest follow-up or at the time of death, a significant decrease in activity level was seen over time (p < 0.001). Of the forty-one original implants in the patients who were alive at the time of the thirty-five-year follow-up, only 46% (nineteen) were retained.

Long-term clinical results of Charnley total hip arthroplasty using a matte satin-finished stem: a 30-year average follow-up study

Background Although 50 years have passed since Charnley started performing total hip arthroplasties, there are relatively few patient studies with a follow-up period of over 30 years. We studied radiograms of patients who had undergone Charnley total hip arthroplasty between 1975 and 1981 and evaluated the results at 26–35 years (mean 30.5 years) after the operation.Methods The operations were performed in 87 joints of 82 patients (26 males and 56 females) aged 26–81 years (mean age 56 years) at the time of surgery. A monoblock-type Charnley stem with a 22-mm head was used in all patients. The stem had a matte satin surface finish and a flange or round-back shoulder. The socket was made of ultra-high-density polyethylene without a flange. All operations were performed by one surgeon using the original Charnley method in all patients, excluding the first five.Results Thirty years after the operation, 48 patients have died, 5 had an infection, 9 were lost to follow-up, and 20 patients with 24 joints are still alive. In 77 patients (82 joints), after excluding the 5 with infection, the socket and stem survival rates were 54 and 75 % at 30 years after the operation when radiographic loosening or revision surgery was defined as the end point. With revision surgery as the end point, the rates were 68 and 82 %, respectively.Conclusions These results were as favorable as those with surgical techniques (including the first-generation cement technique) and implants in the early period. Although new techniques and implants have since been introduced, their long-term results should exceed those in this study. The results of this study should provide a valuable index with which to compare the long-term studies of current total hip arthroplasty.

Use of kernel-based Bayesian models to predict late osteolysis after hip replacement

We studied the relationship between osteolysis and polyethylene wear, age at surgery, body mass index and height in 463 subjects (180 osteolysis and 283 controls) after cemented Charnley total hip arthroplasty (THA), in order to develop a kernel-based Bayesian model to quantitate risk of osteolysis. Such tools may be integrated into decision-making algorithms to help personalize clinical decision-making. A predictive model was constructed, and the estimated posterior probability of the implant failure calculated. Annual wear provided the greatest discriminatory information. Age at surgery provided additional predictive information and was added to the model. Body mass index and height did not contain valuable discriminatory information over the range in which observations were densely sampled. The robustness and misclassification rate of the predictive model was evaluated by a five-times cross-validation method. This yielded a 70% correct predictive classification of subjects into osteolysis versus non-osteolysis groups at a mean of 11 years after THA. Finally, the data were divided into male and female subsets to further explore the relationship between wear rate, age at surgery and incidence of osteolysis. The correct classification rate using age and wear rate in the model was approximately 66% for males and 74% for females.

Femoral Remodeling Around Charnley Total Hip Arthroplasty Is Unpredictable

There are two unusual remodeling patterns of the proximal femur around well-fixed Charnley total hip arthroplasties: cortical thinning leading to endosteal widening around the femoral component and hypertrophy of the distal femoral cortex. Previous studies have shown remodeling patterns are affected by stem design and occur early postoperatively. It is unclear if these changes are related to patient demographics or if they progress throughout the lifetime of the implant. We determined if patient demographic variables influence remodeling patterns after cemented Charnley total hip arthroplasty and if the observed remodeling changes persist long-term. We retrospectively reviewed the radiographs of 106 well-fixed Charnley femoral components. Using a novel digital edge detection program, we determined the femoral remodeling pattern and time-related changes in femoral dimensions. The minimum followup was 20 years (mean, 25.3 years; range, 19.5-37 years). We found no association between remodeling type and age at surgery, sex, preoperative diagnosis, body mass index, or postoperative activity level. There was also no association between initial implant alignment and remodeling type. Cortical thickening in the distal hypertrophy group was an early phenomenon occurring primarily within the first 2 years, whereas cortical thinning begins later and is a more progressive process. These data show remodeling after cemented Charnley total hip arthroplasty is not related to patient demographic variables; however, distal cortical hypertrophy can be predicted in the early postoperative period.

The migration pattern of the Charnley femoral stem: a five-year follow-up RSA study in a well-functioning patient group

BackgroundImplant stability is considered vital to long-time implant survival in total hip arthroplasty (THA), since loose implants are reported to be a major cause of hip revision. There is an association between early implant micromotion and increased risk of revision. More implant-specific data are needed to establish acceptable levels of early implant movement.Materials and methodsThirty-five patients (36 hips) undergoing Charnley THA were followed with repeated clinical, radiographic, and radiostereometric analysis (RSA) over 5 years. Twenty-three patients attended 5 years postoperatively.ResultsThe patient group was well functioning based on the radiological and clinical evaluations. The stems constantly moved up to 5 years postoperatively, with subsidence, retroversion, and varus tilt, based on the RSA.ConclusionContinuous movement of the Charnley stem was observed up to 5 years postoperatively in a well-functioning patient group. The migration data presented herein could be useful when defining acceptable migration limits for certain types of cemented femoral stems.

Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second- and third-generation techniques

BackgroundTechniques of cemented total hip arthroplasty have developed over time. We present the outcomes of Charnley total hip arthroplasty performed using improved second- and third-generation cementing techniques. MethodsWe reviewed the radiologic results of 91 Charnley total hip arthroplasties performed using second- and third-generation cementing techniques. Second-generation techniques involved making multiple anchor holes, a double-cementing method on the acetabular side and an intramedullary plug, and retrograde filling with a cement gun on the femoral side in 57 hips. Third-generation techniques involved additional vacuum mixing and cement pressurization in 34 hips. ResultsJoint survival rates at 20years when using second-generation techniques were 89% for the socket and 94% for the stem with aseptic loosening as the end point; the survival rates at 10years when using third-generation techniques were 97 and 100%, respectively. According to our radiographic evaluation system for the clear zone at 5years, there was less clear zone in the acetabular side with the third-generation techniques than with second-generation techniques. In the femoral side, there was very little development of the clear zone, but the difference between generations was not significant. ConclusionsSecond- and third-generation cementing techniques showed excellent survivorship. The clear zone scores at 5years indicated that third-generation techniques were effective, especially in the acetabular side, and may produce better long-term results than second-generation techniques.

The long term results over 25 years follow-up of Charnley total hip arthroplasty

The long term results over 25 years follow-up of Charnley total hip arthroplasty

Long-term Radiographic Results of Charnley Total Hip Arthroplasty for Osteoarthritis of the Hip—A Study of the Mechanism of Component Loosening—

Long-term Radiographic Results of Charnley Total Hip Arthroplasty for Osteoarthritis of the Hip—A Study of the Mechanism of Component Loosening—

Long-term Outcome of Charnley Total Hip Arthroplasty Using First- to Third- Generation Cementing

Long-term Outcome of Charnley Total Hip Arthroplasty Using First- to Third- Generation Cementing

Individual susceptibility to periprosthetic osteolysis is associated with altered patterns of innate immune gene expression in response to pro‐inflammatory stimuli

Susceptibility to osteolysis after total hip arthroplasty (THA) varies between individuals. We examined whether patients susceptible to osteolysis (group I, n = 34 subjects) after cemented Charnley THA have quantitatively different innate immune responses to pro-inflammatory stimuli versus patients without this susceptibility (group II, n = 28 subjects) at a mean of 14 years after primary surgery. Extracted peripheral blood mononuclear cells were stimulated for 3 h using endotoxin (lipopolysaccharide-LPS, 100 ng/mL), endotoxin-stripped titanium particles (Ti) or endotoxin-stripped particles with adherent LPS added-back (TI + LPS). Subjects returned 1 week later and the experimental protocol was repeated. Assays for mRNA induction for interleukin (IL)-1alpha, IL-1beta, IL-1Ra, IL-6, IL-10, IL-18, and tumor necrosis factor (TNF) were made using quantitative real-time PCR. Although baseline levels of mRNA expression were slightly lower in group I, inducibility of mRNA expression was markedly greater in group I versus group II for all cytokines in response to LPS or Ti + LPS, and for IL-1alpha in response to Ti (P < 0.05). LPS or Ti + LPS stimulation also resulted in an increase in the IL-1/IL-1Ra mRNA ratio in group I versus group II (P < 0.05). mRNA induction was highly reproducible between subject visits (r > 0.7, P < 0.001). Osteolysis-susceptible patients show repeatable, quantitatively different patterns of innate cytokine gene expression in response to pro-inflammatory stimuli versus THA patients who do not display this susceptibility. These innate immune differences may contribute to the variation in osteolysis-susceptibility observed clinically between individuals.

A prospective randomised radiostereometric analysis trial of SmartSet HV and Palacos R bone cements in primary total hip arthroplasty

BackgroundIntroduction of new bone cements into clinical practice should include radiostereometric studies.Materials and methodsA prospective randomised radiostereometric study was performed, comparing SmartSet HV and Palacos R acrylic bone cements (without antibiotics) using third-generation cementing techniques in primary total hip arthroplasty. Thirty-five patients (36 hips) undergoing Charnley total hip arthroplasty were randomised to receive either of the two cements and were followed with repeated clinical, radiographic and radiostereometric examinations over 24 months. Twenty-seven patients (28 hips) attended 2 years postoperatively.ResultsThe mean distal translation observed was −0.15 mm for SmartSet HV and −0.16 mm for Palacos R. The mean rotation around the longitudinal axis was 0.9° for SmartSet HV and 1.2° for Palacos R. The Merle d’Aubigne Postel score was the maximum of 18 points for all patients in both groups.ConclusionsNo statistically significant difference in stem fixation with use of SmartSet HV and Palacos R was found at 2-year follow-up.

Survivorship of a Charnley Total Hip Arthroplasty

The purpose of this study was to update the results, at a minimum of thirty-five years, in a single-surgeon series of primary Charnley total hip arthroplasties performed with cement. Twelve patients (fifteen hips) were alive, 249 patients (314 hips) had died, and one patient (one hip) had been lost to follow-up. Seven of the hips in the living patients had required at least one revision; 290 (88%) of the original group of total hip prostheses either continued to function or were in patients who had died. Since the time of a thirty-year study of this cohort, one hip that had previously been revised because of acetabular loosening required an additional revision because of acetabular loosening and two additional hips had evidence of radiographic loosening (of one acetabular and one femoral component). The survival rate with revision for any reason as the end point was 78%. This end result study should provide a benchmark for subsequent procedures and designs with the caveat that patient life expectancy will likely continue to increase and modern-design implants are being used in younger patients.

Early loosening and secondary dislocation due to a broken trochanteric osteotomy wire following a Charnley total hip arthroplasty: a case report

We report a case of interposition of a broken trochanteric wire in the hip joint. This caused early wear of the prosthesis and dislocation of the Charnley total hip arthroplasty. The patient was treated with a revision total hip arthroplasty. This rare complication should be taken into consideration when performing a trochanteric osteotomy fixation with wiring in Charnley total hip arthroplasty.

Furlong Hydroxyapatite-Coated Hip Prosthesis vs the Charnley Cemented Hip Prosthesis

We report the results of a prospective trial comparing uncemented Furlong hydroxyapatite-coated total hip arthroplasty and cemented Charnley total hip arthroplasty. One hundred ninety-one patients were allocated into 2 groups depending on their year of birth. One group received a Furlong hydroxyapatite-coated total hip arthroplasty and the other group received a cemented Charnley total hip arthroplasty. At a mean follow-up of 14 years (12-16 years), Harris hip scores showed no difference between the 2 groups. The longitudinal multilevel model analysis shows that the mean slope of the change in the Harris hip score was −0.02 for the Furlong group and −0.05 for the Charnley group; the difference is 0.03 ( P = .002). The survival analysis using Kaplan-Meier regression analysis (the log-rank test λ 2 1 = 0.031, P = .58) does not show a significant difference between the 2 groups. Overall survival was 93.6% in the Furlong group and 94.8% in the Charnley group.