Primary Hybrid Total Hip Arthroplasty Research Articles

Collarless Taper Slip and Collared Composite Beam Stems Differ in Failure Modes and Reoperation Rates

Cemented femoral components are used in older patients based on lower risk of periprosthetic fracture and implant loosening. This study reports the survivorship free of periprosthetic femoral fracture (PPFX), femoral loosening, all-cause revision, and reoperation between 2 philosophies of cemented stems. In total, 1,306 primary hybrid total hip arthroplasties were performed for osteoarthritis between 2000 and 2018 in a retrospective single center study. Cemented stems included 798 EON composite beam (CB) and 508 Exeter collarless taper slip (CTS) stems. Mean age was 77 years. An inverse treated probability weighted model was utilized to control for risk factors including age, gender, body mass index, year, and surgeon. There was no difference in risk of PPFX at 10 years (CTS 9% vs CB 5%; hazard ratio [HR] 1.4, P= .47). There was an increased risk of intraoperative fractures requiring fixation in the CB cohort (7/798 [5 calcar, 2 greater trochanter] vs 0/508, P < .001), while there was an increased risk of Vancouver B2 PPFX in the CTS cohort (7/508 vs 0/798; P < 001). There was a higher risk of femoral loosening in the CB cohort (6/798 vs 0/508; P < .0001). Higher survivorship free of revision (98% vs 91%; HR 4, P= .001) and free of reoperation (96% vs 88%; HR 2.5, P= .002) was seen at 10 years in the CB cohort. The risk of PPFX requiring implant revision was increased in the CTS cohort, while there was an increased risk of femoral component loosening and intraoperative fractures seen in the CB cohort. Surgeons should be aware of the different failure modes when choosing implant design for their patient.

Closed suction drainage is not beneficial in hybrid total hip arthroplasty with intra-articular administration of tranexamic acid: a propensity score-matched cohort study.

This retrospective study aimed to evaluate the benefits of closed suction drainage (CSD) in hybrid total hip arthroplasty (THA) with intra-articular administration of tranexamic acid (TXA). We included 369 hips that underwent primary hybrid THA between November 2015 and September 2020. We compared peri-operative blood test results, blood loss, and post-operative complications including transfusion, wound complications, and venous thromboembolism (VTE) with or without CSD. Propensity score matching was performed to balance baseline patient demographics. Transfusion, wound complications, and VTE were observed in 1.9% (seven), 2.4% (nine), and 2.2% (eight) of hips, respectively. There were no significant differences in transfusion, blood loss, wound complications, and deep venous thrombosis in both overall patients and propensity score-matched patients with or without CSD. The calculated total blood loss was approximately 600ml and showed no significant difference between the two groups in the matched cohort (p = 0.59). CSD does not provide any benefits and is not needed in primary hybrid THA with intra-articular administration of TXA.

Primary hybrid THA using a polymethyl methacrylate-precoated stem: A single-center experience with a 10-year minimum follow-up.

The high failure rate of cemented femoral components in the 1970s facilitated the improvement of the cementing technique and surface finishes such as polymethylmethacrylate (PMMA)-precoated stems, reporting a survival rate of >95% at 10 years from some studies. However, controversy persists regarding whether precoated femoral stems are associated with a longer revision-free prosthesis survival. The purpose of this study was to evaluate the clinical and radiological outcomes of PMMA-precoated femoral stems, and analyze factors associated with implant survival. We retrospectively reviewed 73 primary hybrid total hip arthroplasties performed using PMMA-precoated femoral stems. The mean age of the patients was 61 years. During the mean follow-up period of 13 years, 18 hips (24.7%) underwent aseptic loosening, and all of the loosened stems were subjected to revision surgery 8.8 years (range 4.6-15.5 years) from the index surgery. Younger age and poor cementing were significantly associated with aseptic loosening (P = 0.013 and P < 0.001, respectively). However, the aseptic loosening rate was also high at 13.1% even with a good cementing technique. In conclusion, the PMMA-precoated stem failed to show expected advantages and needs to be replaced with other surface finish stem designs. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1300-1306, 2017.

Fifteen-year Results of Precoated Femoral Stem in Primary Hybrid Total Hip Arthroplasty

BackgroundThere has been controversy whether methylmethacrylate precoating of the cemented femoral stem is a solution for aseptic loosening or rather contributes to increased failure rates in cemented total hip arthroplasties.MethodsOn a retrospective basis, we analyzed 76 primary hybrid total hip arthroplasties from 63 patients with precoated, cemented femoral stems between October 1990 and December 1995. The mean age of the patients was 46.8 years (range, 22 to 77 years) with a minimum follow-up of 14 years (mean, 15.5 years; range, 14 to 19.5 years). Third generation cementing techniques were employed in all cases.ResultsTwenty-four out of 76 cases (31.6%) showed aseptic loosening of the femoral stems, of which 23 stems were revised at an average revision time of 8 years (range, 3 to 14.8 years). The main mode of loosening was cement-stem interface failure in 22 hips (91.7%). Twenty-one out of 24 failed hips (87.5%) demonstrated C2 cementing grades (p < 0.001). Kaplan-Meier survivorship analysis using radiographic aseptic loosening of the femoral stem as the endpoint for failure showed survival rates of 76.5% at 10 years (95% confidence interval [CI], 71.4 to 81.6) and 63.2% at 19 years (95% CI, 57.3 to 69.1).ConclusionsAn early failure of the precoated femoral stem in this study was mainly due to an insufficient cementing technique. Achievement of good cement mantle may improve the survival rates.

Tight Fit Technique in Primary Hybrid Total Hip Arthroplasty for Patients with Hip Dysplasia

This article presents the midterm results of hybrid total hip arthroplasty for patients with hip dysplasia by use of a tight fit technique for the femoral component. We followed up 113 hips in 99 patients for a mean of 11 years. All final femoral rasps used in this study overrasped by 0.5 to 1.0 mm for stem insertion, resulting in relatively thin cement mantles. Both components of one hip were removed because of infection. The other 5 acetabular components were revised for osteolysis, recurrent dislocation, or dislodgement of the polyethylene liner. No femoral component was revised for aseptic loosening. We conclude that the tight fit technique using a canal-filling stem may produce good long-term results for patients with hip dysplasia.

Ipsilateral Stress Fracture of the Proximal Tibia After Primary Hybrid Total Hip Arthroplasty

Ipsilateral Stress Fracture of the Proximal Tibia After Primary Hybrid Total Hip Arthroplasty

Fifteen-year survivorship of a collarless, cemented, normalized femoral stem in primary hybrid total hip arthroplasty with a modified third-generation cement technique

This prospective review aimed to evaluate 15-year survivorship of the collarless, third-generation cemented, normalized, Omnifit (Osteonics, Allendale, NJ) femoral stem in hybrid total hip arthroplasty (THA). Between January 1986 and June 1990, a single surgeon prospectively implanted 250 consecutive hybrid THAs (215 patients) using a modified third-generation cement technique in selected patients. A Harris-Galante (I or II) (Zimmer, Warsaw, IN) cementless shell with modular polyethylene (4150 resin) liners gamma-sterilized in air were implanted. Kaplan-Meier survivorship of the femoral or acetabular component with mechanical failure (revision for aseptic loosening) as the end-point was 100% ± 0% at 15 years. Wear couple exchange and bone grafting was performed in 1 case (0.4%) for progressive acetabular osteolysis. This report supports femoral component centralization and good cement mantle to ensure durability of the collarless, cemented, normalized femoral stem with a surface roughness of 30–40 microinches.

Intermediate-term results after hybrid total hip arthroplasty for the treatment of dysplastic hips.

In recent studies, good intermediate-term results have been reported after primary hybrid total hip arthroplasty (a cementless acetabular component with a cemented femoral stem) for the treatment of primary osteoarthritis. However, few studies have described the results of this technique in patients with developmental dysplasia of the hip. One hundred primary hybrid total hip replacements were performed in ninety patients to treat degenerative arthritis of the hip secondary to developmental dysplasia. Seventy-one patients (eighty-one hips) were available for clinical and radiographic evaluation. The average duration of follow-up was 10.6 years. There were ten men and sixty-one women. Seventy hips were classified as type 1 (dysplasia); seven, as type 2 (low dislocation); and four, as type 3 (high dislocation), according to the classification system of Hartofilakidis et al. At the time of the final follow-up, the average Harris hip score was 86 points. Structural autograft was used in fifteen hips to supplement acetabular coverage. Within five years postoperatively, the acetabular component in six of the fifteen hips had an average of 4.5 mm of vertical migration and an average increase in vertical rotation of 3 degrees, but the position appeared to stabilize thereafter. Revisions were performed in two hips because of recurrent dislocation. No acetabular or femoral component was revised because of aseptic loosening. Osteolysis was identified around two acetabular components and two femoral components. The average rate of polyethylene wear was 0.09 mm per year. Hybrid total hip arthroplasty for the treatment of symptomatic degenerative arthritis secondary to developmental dysplasia provides favorable results at intermediate-term follow-up. With lower grades of dysplasia, the majority of patients can be treated effectively without a structural bone graft by placement of the cementless acetabular component at a medial or high position.

Primary hybrid total hip arthroplasty with a roughened femoral stem: Integrity of the stem-cement interface

One hundred and two consecutive cemented femoral stems were evaluated in 92 patients at an average 9-year follow-up and a minimum 5-year follow-up (range, 5-14 years). The stem used was cobalt chromium with a collar, normalization steps, and a roughened surface (Ra 40); the stem was inserted using contemporary cementing techniques. This series demonstrated a femoral component aseptic loosening rate of 2.0% and a femoral component survivorship of 97.2 ± 2.0% at 10 years. One of 2 failed stems was revised at 95 months for failure at the cement-bone interface. The second failed stem showed failure at the cement-bone interface with incomplete debonding radiographically at 65 months. The remaining femoral components did not demonstrate any evidence of debonding at the stem-cement interface. These results compare favorably with other series of cemented femoral stems, as well as with those with a polished surface. © Elsevier Inc. All rights reserved.

Precoated femoral component in primary hybrid total hip arthroplasty: Results at a mean 10-year follow-up

This is a mid-term report at 10 years' mean follow-up of a study of a precoated femoral component used in primary hybrid total hip arthroplasty (THA). Of an original cohort of 98 hips undergoing THA performed by one surgeon, 75 hips in 65 patients (mean age, 67 years) were prospectively followed up for 7 to 12 years (mean, 10 years). All hips had the same porous coated acetabular component and a precoated femoral component (with an oval cross-section) implanted using Simplex bone cement (Howmedica, Rutherford, NJ). There was no femoral component loosening or revision. Two acetabular components in patients with rheumatoid arthritis and protrusio acetabulae had radiographic loosening; however, only 1 was symptomatic and was revised. Acetabular osteolysis was seen in 4 hips (5.3%), and minor femoral osteolysis was seen in 3 hips (4%). Used in this manner in this patient population, precoating is not detrimental to successful fixation at 10 years' mean follow-up of primary hybrid THA. Copyright 2003, Elsevier Science (USA). All rights reserved.

Bone density adjacent to press-fit acetabular components. A prospective analysis with quantitative computed tomography.

The status of periprosthetic bone stock is an important concern when revision total hip arthroplasty is undertaken. Remodeling of periprosthetic femoral bone after total hip arthroplasty has been studied extensively, and the phenomenon of femoral stress-shielding has been well characterized. Finite element analysis and computer-simulated remodeling theory have predicted that retroacetabular bone-mineral density decreases after total hip arthroplasty; however, remodeling of periprosthetic pelvic bone in this setting has yet to be well defined. This study was conducted to evaluate the short-term natural history of periacetabular bone-mineral density following primary total hip arthroplasty. Periacetabular bone-mineral density was studied prospectively in a group of twenty-six patients who underwent primary hybrid total hip arthroplasty for the treatment of advanced osteoarthritis. Density within the central part of the ilium (directly cephalad to a press-fit acetabular component) was assessed with serial quantitative computed tomography. Baseline density was measured within the first five days following the total hip arthroplasty. Ipsilateral density measurements were repeated at an average of 1.28 years postoperatively. Density values at corresponding levels of the contralateral ilium were obtained at both time-points in all patients to serve as internal controls. Bone-mineral density decreased significantly (p< or =0.001) between the two time-points on the side of the operation. The mean absolute magnitude of the interval density reduction (75 mg/cc) was greatest immediately adjacent to the implant (p<0.001), but it was also significantly reduced (by 35 mg/cc) at a distance of 10 mm cephalad to the implant (p = 0.001). Relative declines in mean density ranged from 33% to 20% of the baseline values. No focal bone resorption (osteolysis) was detected at the time of this short-term follow-up study. With the numbers available, no significant interval alteration in bone-mineral density was found on the untreated (internal control) side (p> or =0.07). We suggest that the observed decline in bone-mineral density represents a remodeling response to an altered stress pattern within the pelvis that was induced by the presence of the acetabular implant. This finding corroborates the predictions of finite element analysis and computer-simulated remodeling theory. It remains to be seen whether this trend of atrophy of retroacetabular bone stock will continue with longer follow-up or will ultimately affect the long-term stability of press-fit acetabular components.

Precoated femoral component in total hip arthroplasty. Results of 5- to 9-year followup.

One hundred nineteen consecutive primary hybrid total hip arthroplasties with a precoated femoral component were performed by one surgeon in 100 patients and followed up prospectively. Ninety-eight hips in 82 patients (mean age, 67 years) were evaluated clinically and radiographically at a mean of 6.5 years (range, 5-9 years). The hips were evaluated clinically using the Harris hip score, and radiographs were evaluated for femoral cement grade, loosening, and osteolysis. Ninety-five hips remained in place at the most recent followup. Two femoral components were revised for definite loosening, and one well fixed femoral component was removed because of late hematogenous infection. Excluding the three hips that were revised, the clinical result was excellent or good in 79 hips (83%), fair in 12 hips (13%), and poor in four hips (4%). All other femoral components were well fixed. There were defects of the cement mantles (C1 and C2) in 90 hips. No femoral component had a stem and cement radiolucent line. Focal femoral osteolysis was seen in only two hips. One acetabular component was removed at 5 years because of late hematogenous infection. One acetabular component had asymptomatic migration. The remaining 96 acetabular components were well fixed. Focal acetabular osteolysis was present in four hips. The mean linear polyethylene wear rate was 0.06 (+/- 0.05) mm per year. In contrast to other reports of early failure and osteolysis, the use of a precoated femoral component in this study did not adversely affect the fixation of hybrid total hip arthroplasty, with definite failure of only 2% (two of 98) of the femoral components.

Venous thromboembolic disease after hybrid hip arthroplasty with negative duplex screening.

Postoperative duplex ultrasonography screening after total hip arthroplasty has been shown to identify patients who may require treatment or additional monitoring for venous thromboembolic disease. The potential for manifestation of venous thromboembolic disease subsequent to screening remains a concern. The objective of this study was to determine the prevalence of symptomatic venous thromboembolic disease after total hip arthroplasty and after inhospital prophylaxis, inhospital screening with negative results for proximal deep venous thrombosis, and no posthospitalization venous thromboembolic disease prophylaxis. One hundred fifty patients undergoing primary hybrid total hip arthroplasty and using pneumatic compression stockings and aspirin as prophylaxis against venous thromboembolic disease were screened for deep venous thrombosis with duplex ultrasonography on the fourth day after surgery. Duplex ultrasonography screening revealed 17 (11.3%) patients with asymptomatic proximal deep venous thrombosis. In response to duplex ultrasonography screening, these patients with proximal deep venous thrombosis received therapeutic anticoagulation. Of 133 patients with a duplex screen with negative results for proximal deep venous thrombosis, 131 (98.5%) continued to have no symptoms of venous thromboembolic disease and two (1.5%) began to have symptoms for venous thromboembolic disease (one with proximal deep venous thrombosis, one with nonfatal pulmonary embolism) during 12 months of clinical followup after total hip arthroplasty. The overall prevalence of venous thromboembolic disease requiring anticoagulation was 19 of 150 (12.6%) patients. The remaining 131 (87.4%) were not exposed to the risks of postoperative anticoagulation and did not have subsequent symptomatic venous thromboembolic disease.

Total Hip Arthroplasty In the Young Adult

The durability of cemented and hybrid total hip arthroplasty in the young adult was evaluated. A consecutive series of primary cemented total hip arthroplasties performed between 1970 and 1976, and a consecutive series of primary hybrid total hip arthroplasties performed between 1986 and 1991, were evaluated for revision and radiographic loosening of the components. All patients were younger than 50 years of age at the time of surgery and all surgery was performed by one surgeon. At minimum 20 years followup of the cemented group (93 hips in 69 patients) 22% of hips (21 hips) were revised for aseptic loosening (5% of femoral components, five hips, and 19% of acetabular components, 18 hips). At 5- to 10-year followup of the hybrid group (45 hips in 37 patients) 18% of hips (eight hips) were revised for aseptic loosening (18% of femoral components, eight hips, and 0% of acetabular components, 0 hips). Although the cemented femoral component used in the hybrid series showed a marked increase in revision and loosening compared with the cemented series, the excellent fixation obtained with uncemented acetabular components has encouraged the authors to continue the use of hybrid fixation in the young adult. However, the femoral component has been modified to incorporate a polished surface finish and a stem geometry similar to the Charnley flat back prosthesis used in the cemented series.

Effect of a centralizing device on cement mantle deficiencies and initial prosthetic alignment in total hip arthroplasty

Sixty consecutive patients undergoing a primary hybrid total hip arthroplasty were randomized to receive a femoral component either with or without a distal centralizing device. The group with a centralizer had significantly fewer patients with cement mantle deficiencies (excessively thin areas of cement) than the group without a centralizer ( P < .001). Furthermore, the centralizer group was, on average, in a neutral alignment, whereas the group without a centralizer was in a varus alignment ( P < .001). It was concluded that the distal centralizing device significantly decreases the incidence of cement mantle deficiencies and reproducibly aids in achieving a more neutral prosthetic alignment.

Primary Hybrid Total Hip Arthroplasty An Interim Followup

The senior authors' initial experience with primary hybrid hip replacement in patients with osteoarthritis was studied to evaluate the efficacy of the procedure. Hybrid total hip arthroplasty (uncemented Harris-Galante acetabular component and cemented Iowa precoated femoral component) was performed in 131 consecutive, nonselected hips in 118 patients with the diagnosis of primary osteoarthritis. Followup was performed at 8 to 9 years after the procedure. The average age at the time of the procedure was 68 years (range, 45-87 years). There were 50 men (55 hips) and 68 women (76 hips). At final followup 19 patients (22 hips) had died. The femoral component had been revised for aseptic loosening in 8 hips (6.1%). One additional hip showed definite radiographic loosening. Hence, the prevalence of radiographic femoral failure was 6.9% (9 hips). No acetabular component had been revised for aseptic loosening and no acetabular component had migrated. The senior author continues to perform hybrid total hip arthroplasty in all patients with primary osteoarthritis. However, design modifications have been made in the femoral component that is used.