Consecutive Primary Total Hip Replacements Research Articles

Does Hospital Consumer Assessment of Healthcare Providers and Systems survey correlate with traditional metrics of patient satisfaction? The challenge of measuring patient pain control and satisfaction in total joint replacement.

BackgroundMedicare reimbursements have been tied to patient satisfaction measures. Despite these measures' influence on reimbursements, the relationship between pain management and patient satisfaction remains unclear. This study aims to evaluate the relationship between traditional patient perception of pain control and their overall satisfaction after joint replacement.MethodsThis study is a retrospective review of consecutive primary total hip and total knee replacements. A total of 286 patients who underwent primary total hip (N = 106) and total knee (N = 196) replacements with completed Hospital Consumer Assessment of Healthcare Providers and Systems surveys were evaluated. Pain control, communication, and hospital satisfaction were stratified into satisfactory or unsatisfactory groups. These 2 groups were compared in terms of visual analog scale (VAS), opioid use in morphine equivalents, length of hospital stay, anesthesia type, and demographics.ResultsAverage VAS and opioid use did not differ between patient groups for any of the questions evaluated. Those who responded “always” to pain domain questions had a statistically shorter length of stay compared to patients with other response. On average, those who endorsed “always” on communication question were younger.ConclusionsPatients who endorsed satisfactory pain control and communication with staff had shorter lengths of stay. There was no relationship between survey scores and traditional pain control measures such as VAS and opioid use. This questions the relevance of our primary pain measures in assessing patient perception of pain control. Length of stay may be a better surrogate marker for patient satisfaction of pain control.

Total hip replacement in sickle cell disorder: A preliminary report of challenges and early outcome of 21 consecutive patients

The aim of this study is to describe the pattern of presentation osteoarthritic patients with sickle cell disorder (SCD) in our environment, determine the implant sizes taking the peculiar nature of the pathology and our operating environment into consideration, highlight the challenges and technical difficulties encountered during the procedure, measure the functional outcome and observe complications of treatment, recommend ways of improving outcome. Between November 2008 and November 2012, 29 consecutive primary total hip replacements (THRs) were performed on 21 patients with avascular necrosis of the head of femur secondary to SCD. Patients' evaluation was performed at two different times of follow-up (1 and 5 years, respectively). Twenty-one patients were available at 1 year as well as 5-year follow-up. The mean preoperative Harris Hip Score was 20.17 ± 11. The mean postoperative Harris Hip Score was 92.25 ± 13 (P < 0.001) at 1 year and 88.75 ± 10 (P < 0.001) at 5 years. Eighteen patients had regional anesthesia while three had general anesthesia. The average cup size used was 49.43 with a range of 46-54. The average liner size was 49.43 with a range of 46-54. The head size used in all patients was 28. The average stem size was 6.57 with a range of 6-8. The offset used in all the patients was standard All the patients had 1-2 screw fixation of the acetabular shell. Four patients had complications as follows: periprosthetic fracture 1, superficial wound infection 1, pulmonary complication 1, and abdominal crisis 1. THR is a veritable means of treatment of patients with avascular necrosis of the femoral head arising from SCDs. The challenges encountered during the surgery are related to the quality of bone of the affected patient. Arthroplasty Surgeons in our environment must be fully prepared for the challenges by ensuring a preoperative plan that will take care of the technical problems such as recreating femoral canals, wiring of intraoperative fractures as well as treatment of acetabular defects. A detailed planned total hip arthroplasty can be performed in patients with SCD in younger patients with good clinical benefits.

Is there a risk of permanent renal dysfunction after primary total hip and knee joint replacements?

BackgroundPermanent renal dysfunction is considered as being a serious complication which may occur after major surgery and which furthermore may lead to increased morbidity and mortality. The objective of this study was to analyze the incidence of long-term postoperative renal dysfunction after primary total hip and knee joint replacements.MethodsLong-term postoperative renal dysfunction was analyzed in a retrospective study of 1301 consecutive primary total hip and knee joint replacements performed between January 2009 and December 2013. According to the RIFLE criteria, increased serum creatinine was an indicative of postoperative renal injury. The highest serum creatinine during the first postoperative week was chosen as a sign for maximum acute renal injury and was compared to the highest serum creatinine during the following 4–12 months.ResultsOne hundred and forty two patients with an increase in postoperative serum creatinine were included in the follow-up study. Six patients (4.2 %) died due to non-renal causes during the follow-up period. One patient died of severe renal injury, which was relatively very early postoperatively, and another patient had a rise in serum creatinine to 316 μmol/l during the follow-up period. All the remaining 132 patients (94 %) had full recovery with serum creatinine which returned to preoperative levels.ConclusionsThis study did not confirm that patients who underwent primary total hip and knee joint replacement surgery were at risk of developing permanent renal dysfunction up to 1 year after the index surgery.

Value of Graduated Compression Stockings in Prevention of Venous Majeed H1* and Szypryt EP2Thromboembolism after Total Hip and Knee Arthroplasty

Introduction: Graduated compression stockings (GCS) are used for mechanical prophylaxis for VTE. The aim of our study was to compare the incidence of VTE with and without the use of compression stockings after total hip and knee arthroplasty. Methods: Data was collected retrospectively over 18 month’s duration, and included all consecutive primary total hip and knee replacements. Patients were divided into 2 groups; group І (patients in whom GCS were used) and group ІІ (patients in whom GCS were not used). Data was analyzed by excluding as well as including the patients with previous history of VTE. Results: 1875 patients underwent total hip and knee replacements, excluding the patients with previous history of VTE. Group І consisted of 982 patients (52.3%) and group ІІ consisted of 893 patients (47.7%). In total, 23 patients (1.22%) had a VTE diagnosed postoperatively (DVT: 8, PE: 15). In group І, 11 patients (1.12%) suffered from VTE (DVT: 4, PE: 7). In group ІІ, 12 patients (1.34%) had VTE (DVT: 4, PE: 8). Including the patients with previous VTE; in total, 2020 patients underwent hip and knee arthroplasty. Group I comprised of 1040 patients with 14 patients (1.34%) diagnosed with VTE (DVT: 5, PE: 9). Group II comprised of 984 patients with15 patients (1.52%) diagnosed with VTE (DVT: 5, PE: 10). Conclusion: We did not find any obvious benefit of compression stockings in the prevention of VTE after primary total hip and knee arthroplasty in the presence of enoxaparin prophylaxis.

Fully hydroxyapatite-coated total hip replacement: ten-year results

We assess 254 consecutive primary total hip replacements (THRs) using a fully hydroxyapatite (HA)-coated stem and socket (Furlong; JRI, London, UK). Minimum follow-up was 10 years. Harris hip score (HHS) increased from 49.8 preoperatively to 86.2 at follow-up. The most remarkable clinical finding was the near absence of thigh pain. After 10 years of follow-up, all stems met stability criteria and none needed revision for aseptic loosening. Three cups (1.2%) were revised for aseptic loosening. Two more cups were revised for recidivant dislocation. Varus placement of the femoral stem was present in 63 hips (24.8%) and valgus in 13 hips (5%). None of these technical defects showed radiologic progression, and there was no measurable correlation between them and the clinical score. Intraoperative femoral fractures occurred in 25 cases (9.8%) with no further influence on implant evolution. These findings strongly support the use of the JRI Furlong system for primary THR because it provides excellent clinical and radiologic results, with 0% and 1.2% cup and stem aseptic loosening, respectively, at 10 years. In addition, its tolerance to technical implantation defects makes it suitable even for less experienced hip surgeons.

Fully hydroxyapatite-coated total hip replacement: ten-year results

We assess 254 consecutive primary total hip replacements (THRs) using a fully hydroxyapatite (HA)-coated stem and socket (Furlong; JRI, London, UK). Minimum follow-up was 10 years. Harris hip score (HHS) increased from 49.8 preoperatively to 86.2 at follow-up. The most remarkable clinical finding was the near absence of thigh pain. After 10 years of follow-up, all stems met stability criteria and none needed revision for aseptic loosening. Three cups (1.2%) were revised for aseptic loosening. Two more cups were revised for recidivant dislocation. Varus placement of the femoral stem was present in 63 hips (24.8%) and valgus in 13 hips (5%). None of these technical defects showed radiologic progression, and there was no measurable correlation between them and the clinical score. Intraoperative femoral fractures occurred in 25 cases (9.8%) with no further influence on implant evolution. These findings strongly support the use of the JRI Furlong system for primary THR because it provides excellent clinical and radiologic results, with 0% and 1.2% cup and stem aseptic loosening, respectively, at 10 years. In addition, its tolerance to technical implantation defects makes it suitable even for less experienced hip surgeons.

Exeter-Ogee total hip replacement using the Hardinge approach; the ten to twelve year results

We reviewed 131 consecutive primary total hip replacements implanted into 127 patients between 1995 and 1997. Surgery was performed through a Hardinge approach using the Exeter universal stem in combination with the Ogee Elite acetabular component.Five of 131 hips have required revision. The ten year survival analysis demonstrates: 95.3% survival with revision for any cause as the end point; 98.9% with revision for aseptic loosening of the stem as the endpoint, 98.1% revision for aseptic loosening of the acetabular component as the endpoint. There were no cases of dislocation.Our findings show that the Exeter universal stem in combination with the Ogee Elite acetabular component can be inserted through a Hardinge approach in a district general setting with results comparable to surgery performed in a specialist unit and through a posterior approach.

Exeter-Ogee total hip replacement using the Hardinge approach; the ten to twelve year results

We reviewed 131 consecutive primary total hip replacements implanted into 127 patients between 1995 and 1997. Surgery was performed through a Hardinge approach using the Exeter universal stem in combination with the Ogee Elite acetabular component.Five of 131 hips have required revision. The ten year survival analysis demonstrates: 95.3% survival with revision for any cause as the end point; 98.9% with revision for aseptic loosening of the stem as the endpoint, 98.1% revision for aseptic loosening of the acetabular component as the endpoint. There were no cases of dislocation.Our findings show that the Exeter universal stem in combination with the Ogee Elite acetabular component can be inserted through a Hardinge approach in a district general setting with results comparable to surgery performed in a specialist unit and through a posterior approach.

Fatal Pulmonary Embolism, Death Rates and Standardised Mortality Ratios after Primary Total Hip Replacement in a Joint Replacement Centre

We determined retrospectively the postoperative mortality and fatal pulmonary embolism (PE) rates in 1275 consecutive primary total hip replacements (THR) in the six-week period after surgery at an orthopaedic hospital. Patients were traced by questionnaires, outpatient appointments and by telephone. Post-mortem records were used to verify cause of death. Follow-up was 100%. The death rate from PE was 0.16% (CI 0.04%-0.57%) and the all-cause mortality rate was 0.47% (CI 0.22%-1.02%). All deaths were within the first 10 days during the initial hospitalisation. The patient mortality was compared with the population mortality for England and Wales, using standardised mortality ratios (SMRs). The SMR for both sexes combined was 1.08 (CI 0.4-2.36). We observed a lower mortality in females (SMR=0.58; CI 0.07-2.09) but a higher mortality in males (SMR=1.91; CI 0.52-4.9) during the first 42 postoperative days compared to the general population. Fatal PE after THR without routine chemical thromboprophylaxis is uncommon. The death rate in patients undergoing THR appears to be similar to that in the general population.

Fatal pulmonary embolism, death rates and standardised mortality ratios after primary total hip replacement in a joint replacement centre

We determined retrospectively the postoperative mortality and fatal pulmonary embolism (PE) rates in 1275 consecutive primary total hip replacements (THR) in the six-week period after surgery at an orthopaedic hospital. Patients were traced by questionnaires, outpatient appointments and by telephone. Post-mortem records were used to verify cause of death. Follow-up was 100%. The death rate from PE was 0.16% (CI 0.04%-0.57%) and the all-cause mortality rate was 0.47% (CI 0.22%-1.02%). All deaths were within the first 10 days during the initial hospitalisation. The patient mortality was compared with the population mortality for England and Wales, using standardised mortality ratios (SMRs). The SMR for both sexes combined was 1.08 (CI 0.4-2.36). We observed a lower mortality in females (SMR=0.58; CI 0.07-2.09) but a higher mortality in males (SMR=1.91; CI 0.52-4.9) during the first 42 postoperative days compared to the general population. Fatal PE after THR without routine chemical thromboprophylaxis is uncommon. The death rate in patients undergoing THR appears to be similar to that in the general population.

The Exeter Universal stem

We reviewed 142 consecutive primary total hip replacements implanted into 123 patients between 1988 and 1993 using the Exeter Universal femoral stem. A total of 74 patients (88 hips) had survived for ten years or more and were reviewed at a mean of 12.7 years (10 to 17). There was no loss to follow-up. The rate of revision of the femoral component for aseptic loosening and osteolysis was 1.1% (1 stem), that for revision for any cause was 2.2% (2 stems), and for re-operation for any cause was 21.6% (19 hips). Re-operation was because of failure of the acetabular component in all but two hips. All but one femoral component subsided within the cement mantle to a mean of 1.52 mm (0 to 8.3) at the final follow-up. One further stem had subsided excessively (8 mm) and had lucent lines at the cement-stem and cement-bone interfaces. This was classified as a radiological failure and is awaiting revision. One stem was revised for deep infection and one for excessive peri-articular osteolysis. Defects of the cement mantle (Barrack grade C and D) were found in 28% of stems (25 hips), associated with increased subsidence (p = 0.01), but were not associated with endosteal lysis or failure. Peri-articular osteolysis was significantly related to the degree of polyethylene wear (p &lt; 0.001), which was in turn associated with a younger age (p = 0.01) and male gender (p &lt; 0.001). The use of the Exeter metal-backed acetabular component was a notable failure with 12 of 32 hips (37.5%) revised for loosening. The Harris-Galante components failed with excessive wear, osteolysis and dislocation with 15% revised (5 of 33 hips). Only one of 23 hips with a cemented Elite component (4%) was revised for loosening and osteolysis. Our findings show that the Exeter Universal stem implanted outside the originating centre has excellent medium-term results.

Are cementless acetabular components contra-indicated in the elderly?

The long-term success of primary total hip arthroplasty in elderly patients has been well documented. In addition, the use of uncemented acetabular components in younger patients has been well established. However, as yet, there has not been widespread use of uncemented acetabular components in older patients. This study reviews a single surgeon series of 179 consecutive primary total hip replacements using an uncemented acetabular component. Patients were followed up clinically, radiologically and by means of a postal questionnaire. Patients were divided into under-70 years (n = 80) and 70 years and older (n = 99). There were 88 males and 91 females who were followed up to a mean of 24.1 months. There were no significant differences between the groups with respect to the need for additional screw fixation, post-operative complications or implant loosening. Functionally, no differences were recorded in terms of pain, limp, mobility or ability to put on shoes and socks post-operatively. There was no significant difference between the two groups in the levels of satisfaction reported. These results justify the use of uncemented acetabular components in older patients.

Early Complications of Primary Total Hip Replacement Performed with a Two-Incision Minimally Invasive Technique

Total hip replacement performed through a small incision theoretically results in less trauma to the underlying structures, reduced blood loss, less pain, and a shorter hospital stay, but it may result in increased complications, particularly early in a surgeon's experience with a new technique. In the present study, we reviewed the early results of two techniques involving the use of smaller incisions; specifically, we evaluated one series of primary total hip replacements that had been performed through two small incisions and another series of total hip replacements that had been performed through a single small incision. Eighty-nine consecutive primary total hip replacements were performed with use of the two-incision technique as described by Mears and Berger; all procedures were performed without cement and with use of fluoroscopic guidance. Outcomes data were reviewed at a minimum of six months following the procedure. The results of these procedures were retrospectively compared with those of a historical control series of ninety-six total hip replacements that had been performed by the same surgeon with use of a single miniincision technique. No special attempt was made to discharge any patient early from the hospital. In preparation for the use of the two-incision technique, the surgeon attended a two-day seminar that included cadaveric training and mentoring by surgeons who had experience with this technique. In the two-incision group, nine patients (nine hips; 10%) required repeat surgery because of a femoral fracture that had been identified postoperatively (two hips), dislocation (one hip), a wound complication (two hips), or subsidence and loosening of the femoral implant (four hips). Twenty-two patients (twenty-two hips; 25%) sustained an injury of the lateral femoral cutaneous nerve, and one patient (one hip) had a neuropraxia of the femoral nerve. In the comparative series of ninety-six total hip arthroplasties that had been performed with use of a single mini-incision and a direct lateral exposure of the hip joint, the overall complication rate was 6% (six of ninety-six) and the reoperation rate was 3% (three of ninety-six). The rate of complications associated with the two-incision technique decreased significantly as the surgeon gained experience with the procedure (p = 0.0202). Although total hip arthroplasty with use of the two-incision technique was performed by a surgeon who was experienced in the performance of total hip replacement surgery with use of a single small incision, the rates of complications and repeat surgery associated with the two-incision technique initially were very high. While the rate diminished with increasing experience, total hip replacement with use of two incisions and fluoroscopic guidance is a technically demanding procedure that may be associated, especially initially, with higher rates of complications and repeat surgery.

Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement

Sciatic nerve palsy is a recognised complication of primary total hip replacement. In our unit this complication was rare with an incidence of < 0.2% in the past ten years. We describe six cases of sciatic nerve palsy occurring in 355 consecutive primary total hip replacements (incidence 1.69%). Each of these palsies was caused by post-operative haematoma in the region of the sciatic nerve. Cases, which were recognised early and surgically-evacuated promptly, showed earlier and more complete recovery. Those patients for whom the diagnosis was delayed, and who were therefore managed expectantly, showed little or no recovery. Unexpected pain and significant swelling in the buttock, as well as signs of sciatic nerve irritation, suggest the presence of haematoma in the region of the sciatic nerve. It is, therefore, of prime importance to be vigilant for the features of a sciatic nerve palsy in the early post-operative period as, when recognised and treated early, the injury to the sciatic nerve may be reversed.

Early Complications of Primary Total Hip Replacement Performed with a Two-Incision Minimally Invasive Technique

Total hip replacement performed through a small incision theoretically results in less trauma to the underlying structures, reduced blood loss, less pain, and a shorter hospital stay, but it may result in increased complications, particularly early in a surgeon's experience with a new technique. In the present study, we reviewed the early results of two techniques involving the use of smaller incisions; specifically, we evaluated one series of primary total hip replacements that had been performed through two small incisions and another series of total hip replacements that had been performed through a single small incision. Eighty-nine consecutive primary total hip replacements were performed with use of the two-incision technique as described by Mears and Berger; all procedures were performed without cement and with use of fluoroscopic guidance. Outcomes data were reviewed at a minimum of six months following the procedure. The results of these procedures were retrospectively compared with those of a historical control series of ninety-six total hip replacements that had been performed by the same surgeon with use of a single mini-incision technique. No special attempt was made to discharge any patient early from the hospital. In preparation for the use of the two-incision technique, the surgeon attended a two-day seminar that included cadaveric training and mentoring by surgeons who had experience with this technique. In the two-incision group, nine patients (nine hips; 10%) required repeat surgery because of a femoral fracture that had been identified postoperatively (two hips), dislocation (one hip), a wound complication (two hips), or subsidence and loosening of the femoral implant (four hips). Twenty-two patients (twenty-two hips; 25%) sustained an injury of the lateral femoral cutaneous nerve, and one patient (one hip) had a neuropraxia of the femoral nerve. In the comparative series of ninety-six total hip arthroplasties that had been performed with use of a single mini-incision and a direct lateral exposure of the hip joint, the overall complication rate was 6% (six of ninety-six) and the reoperation rate was 3% (three of ninety-six). The rate of complications associated with the two-incision technique decreased significantly as the surgeon gained experience with the procedure (p = 0.0202). Although total hip arthroplasty with use of the two-incision technique was performed by a surgeon who was experienced in the performance of total hip replacement surgery with use of a single small incision, the rates of complications and repeat surgery associated with the two-incision technique initially were very high. While the rate diminished with increasing experience, total hip replacement with use of two incisions and fluoroscopic guidance is a technically demanding procedure that may be associated, especially initially, with higher rates of complications and repeat surgery.

EARLY COMPLICATIONS OF PRIMARY TOTAL HIP REPLACEMENT PERFORMED WITH A TWO-INCISION MINIMALLY INVASIVE TECHNIQUE

Background: Total hip replacement performed through a small incision theoretically results in less trauma to the underlying structures, reduced blood loss, less pain, and a shorter hospital stay, but it may result in increased complications, particularly early in a surgeon's experience with a new technique. In the present study, we reviewed the early results of two techniques involving the use of smaller incisions; specifically, we evaluated one series of primary total hip replacements that had been performed through two small incisions and another series of total hip replacements that had been performed through a single small incision. Methods: Eighty-nine consecutive primary total hip replacements were performed with use of the two-incision technique as described by Mears and Berger; all procedures were performed without cement and with use of fluoroscopic guidance. Outcomes data were reviewed at a minimum of six months following the procedure. The results of these procedures were retrospectively compared with those of a historical control series of ninety-six total hip replacements that had been performed by the same surgeon with use of a single mini-incision technique. No special attempt was made to discharge any patient early from the hospital. In preparation for the use of the two-incision technique, the surgeon attended a two-day seminar that included cadaveric training and mentoring by surgeons who had experience with this technique. Results: In the two-incision group, nine patients (nine hips; 10%) required repeat surgery because of a femoral fracture that had been identified postoperatively (two hips), dislocation (one hip), a wound complication (two hips), or subsidence and loosening of the femoral implant (four hips). Twenty-two patients (twenty-two hips; 25%) sustained an injury of the lateral femoral cutaneous nerve, and one patient (one hip) had a neuropraxia of the femoral nerve. In the comparative series of ninety-six total hip arthroplasties that had been performed with use of a single mini-incision and a direct lateral exposure of the hip joint, the overall complication rate was 6% (six of ninety-six) and the reoperation rate was 3% (three of ninety-six). The rate of complications associated with the two-incision technique decreased significantly as the surgeon gained experience with the procedure (p = 0.0202). Conclusions: Although total hip arthroplasty with use of the two-incision technique was performed by a surgeon who was experienced in the performance of total hip replacement surgery with use of a single small incision, the rates of complications and repeat surgery associated with the two-incision technique initially were very high. While the rate diminished with increasing experience, total hip replacement with use of two incisions and fluoroscopic guidance is a technically demanding procedure that may be associated, especially initially, with higher rates of complications and repeat surgery. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Medium-term results of the Charnley low-offset femoral stem

A reduced femoral offset in total hip replacement has been thought to be disadvantageous. We reviewed the results of 54 consecutive primary total hip replacements in 49 patients (mean age of 68 years) performed between August 1990 and December 1994, with a mean follow-up of 8.8 years (sd 2.1). The mean pre-operative femoral offset for these hips was 41 mm (sd 7.4). All patients received a low-offset Charnley stem and a polyethylene cup inserted by a single surgeon. At their latest follow-up, surviving patients had a significant improvement in the performance of their hip. Three had undergone revision, one each for deep infection, recurrent dislocation and late pain with subluxation. No hips had been revised, or were at risk of revision, for aseptic loosening. The mean annual linear rate of wear was 0.2 mm (sd 0.08) for the whole group. There was no correlation between the pre-operative femoral offset and the post-operative rate of wear. Our survivorship estimate was 91% when revision for any reason was taken as an end-point, but 100% if aseptic loosening was considered as the end-point. Our study demonstrates that a low-offset femoral stem can produce good, medium-term results.

Clinical Outcome of Current Generation Hydroxyapatite Coated Acetabular Design

Hydroxyapatite (HA) coatings for femoral stems have been successful in short- to intermediate-term follow up. However, the outcomes of HA-coated cups have not been as successful as comparable non-HA-coated designs. This has been attributed to component design and to poor quality HA-coating processes. This is a clinical outcome study of a newer generation acetabular design with an improved plasma-sprayed HA-coat. Ninety consecutive primary total hip replacements implanted with a HA-coated metal-backed cup were prospectively followed up for 2–5 years after surgery. Mean age was 69 years, male:female ratio was 36:47; mean-weight was 77 kg. Polyethylene wear was measured on digitized images. Component position, component migration, and implant-bone interface radiolucent lines were analyzed by computerized image analysis. Hip-scores improved from preoperative mean 59(±12) to a final follow-up mean of 91(±12). One hip was revised for recurrent dislocation. No hips were revised for aseptic loosening. Mean acetabular abduction angle was 46°(±8.5) and anteversion was 18°(±8.7). Incomplete lucent lines were noted on early postoperative radiographs in 5% of the cases. With ongoing follow up radiolucent line thickness decreased by mean 13% and radiolucent line density increased by 11%. No cup had complete continuous radiolucent lines or lysis. Mean polyethylene linear and volumetric wear rates were 0.14(± 0.15) mm/year and 73(± 70) mm3/year respectively. Wear rates were higher in males (p&lt;0.03). No other factor (age, body weight, cup abduction or anteversion angle) correlated significantly with wear rate. This study presents encouraging short-term results. The improvement in radiolucent lines suggests a beneficial effect of the HA-coat on bone ingrowth. None of the cups loosened or migrated. Wear rates were comparable to published reports of successful non-HA-coated cups. Long-term follow up is ongoing to corroborate these early findings.

The hydroxyapatite-coated JRI-Furlong hip

We present the clinical and radiographic outcome of 68 consecutive primary total hip replacements performed in 54 patients under the age of 55 years using a hydroxyapatite-coated femoral component and threaded cup with a modular ceramic head (JRI-Furlong). We reviewed 62 (91%) hips at a median follow-up of 8.8 years (5 to 13.8) after implantation; six (9%) were lost to follow-up. At review there had been four (6%) revisions but only one for aseptic loosening (acetabulum). Radiographic review of the remaining hips did not identify any evidence of femoral or acetabular loosening. The median Harris and Merle d'Aubigné and Postel hip scores were 95.9 (42.7 to 100) and 17 (3 to 18) respectively. The JRI-Furlong hip gives promising functional and radiographic results in young patients in the medium term.

High survival rate of hydroxyapatite-coated hip prostheses: 100 consecutive hips followed for 10 years.

We followed 100 consecutive primary total hip replacements with a proximal hydroxyapatite coating for 10 years. No patient was lost to follow-up. 29 patients (32 hips) died before the 10-year follow-up was done; none of their hips had been revised. Thigh pain on activity occurred in 3 hips. We found no radiographic signs of loosening of the femoral components. In course of time the location of dense bone around the femoral stem, which would suggest implant/bone stress transfer, moved distally in 51 of 67 stems after 10 years. No linear or distal osteolysis occurred around the stem. Revision of 1 stem was performed because of thigh pain, but it was found fixed to bone proximally, while 3 cups were revised because of acetabular osteolysis. The 10-year survival of the stem and cup, using revision or pending revision as endpoint, was 100% (95% CI: 99-100) and 97% (95% CI: 94-99), respectively.