Reverse Hybrid Total Hip Arthroplasty Research Articles

Cemented and hybrid total hip arthroplasty lead to lower blood loss in primary total hip arthroplasty: a retrospective study.

Little scientific evidence exists on blood loss and transfusion rates depending on the fixation technique. The hypothesis of this study was that the blood loss and transfusion rate are lower in cemented and hybrid total hip arthroplasty (THA) compared to cementless THA. We retrospectively compared a total of 1500 patients who received either cementless, cemented, hybrid or reverse hybrid THA. All patients underwent THA in 2021 at a single orthopedic center in Germany. The lowest blood loss was found in patients who received a fully cemented THA (695 ± 74ml). Hybrid THA with a cemented stem showed a blood loss of 845 ± 30ml and reverse hybrid THA showed the highest blood loss with an average of 994 ± 74ml. Cementless THA caused an average blood loss of 957 ± 16ml. There was a significant difference between cementless THA, hybrid THA (cemented stem), and fully cemented THA (p < 0.05). Transfusion rates ranged from 1.3% (cementless THA) to 7.9% (cemented THA) between the groups with a transfusion rate of 2.5% overall. We found significantly lower blood loss in cemented THA and hybrid THA compared to cementless THA. Although blood loss was lower in cemented and hybrid THA, this did not result in lower transfusion rates. This could be due to other confounders such as age, comorbidities, and preoperative anemia.

Comparable mortality but higher revision rate after uncemented compared with cemented total hip arthroplasties in patients 80 years and older: report of 43,053 cases of the Dutch Arthroplasty Register.

Background and purposeMortality and revision risks are important issues during shared decision-making for total hip arthroplasty (THA) especially in elderly patients. We examined mortality and revision rates as well as associated patient and prosthesis factors in primary THA for osteoarthritis (OA) in patients ≥ 80 years in the Netherlands.Patients and methodsWe included all primary THAs for OA in patients ≥ 80 years in the period 2007–2019. Patient mortality and prosthesis revision rates were calculated using Kaplan-Meier survival analyses. Risk factors for patient mortality and prosthesis revision were analyzed using multivariable Cox regression analysis adjusted for age, sex, ASA class, fixation method, head size, and approach.ResultsMortality was 0.2% at 7 days, 0.4% at 30 days, 2.7% at 1 year, and 20% at 5 years. Mortality was higher in males and higher ASA class, but did not differ between fixation methods. The 1-year revision rate was 1.6% (95% CI 1.5–1.7) and 2.6% (CI 2.5–2.7) after 5 years. Multivariable Cox regression analysis showed a higher risk of revision for uncemented (hazard ratio [HR] 1.6; CI 1.4–1.8) and reverse hybrid THAs (HR 2.9; CI 2.1–3.8) compared with cemented THAs. Periprosthetic fracture was the most frequently registered reason for revision in uncemented THAs.InterpretationMortality is comparable but revision rate is higher after uncemented compared with cemented THA in patients 80 years and older, indicating that cemented THA might be a safer option in this patient group.

Reverse hybrid total hip arthroplasty, a good alternative to uncemented total hip arthroplasty

Total hip arthroplasty is the treatment of choice for primary and secondary arthritis of the hip joint. Uncemented total hip is the implant of choice in young adults with good bone stock in the acetabulum and femur. Correspondingly, cemented implants are preferred in patients with poor bone quality and in elderly. Uncemented prosthesis are relatively expensive when compared to cemented but have longer viability. A prospective study conducted at Vydehi institute of medical sciences between July 2016 and may 2018 on 21 patients using reverse hybrid total hip arthroplasty and follow up was done post op, 6, 12, 24 weeks and 1 year post operatively. Functional outcome assessed using Modified Harris Hip score. The data was analyzed using a Chi square test for equal proportions was applied for categorical variables and Independent sample t test was applied. The mean pain score during pre-operative period was 11.43±3.59 and during post-operative period was 41.71± 4.26. The difference between the pre and post-operative pain scores was statistically significant. The mean functional gait score during pre-operative stage was 10.24±8.23 & during post-operative stage was 41.71 ± 4.26, the t value corresponding to this mean difference was -8.609 and its corresponding p value was 0.000

Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women — data from 66,995 primary total hip arthroplasties in the Norwegian Arthroplasty Register

Background and purpose — There is no consensus on best method of fixation in hip arthroplasty. We investigated different modes of fixation in primary total hip arthroplasty (THA) and the influence of age and sex, to assess need for a differentiated approach.Patients and methods — The study was based on data from the Norwegian Arthroplasty Register in the period 2005–2017. Included were all-cemented, all-uncemented, reverse hybrid (uncemented stem and cemented cup), and hybrid (cemented stem and uncemented cup) THA designs that were commonly used, contemporary and well documented, using different causes of revision as endpoints.Results — From the included 66,995 primary THAs, 2,242 (3.3%) were revised. Compared with all-cemented THAs, all-uncemented had a higher risk of revision due to any cause (RR 1.4; CI 1.2–1.6), mainly due to an increased risk of periprosthetic fracture (RR 5.2; CI 3.2–8.5) and dislocation (RR 2.2; CI 1.5–3.0). Women had considerably higher risk of revision due to periprosthetic fracture after all-uncemented THA (RR 12; CI 6–25), compared with cemented. All-uncemented THAs in women of age 55–75 years (RR 1.3; CI 1.0–1.7) and over 75 years of age (RR 1.8; CI 1.2–2.7), and reverse hybrid THAs in women over the age of 75 (RR 1.5; CI 1.1–1.9) had higher risk of revision compared with cemented. Hybrid THAs (RR 1.0; CI 0.9–1.2) and reverse hybrid THAs (RR 1.0; CI 0.7–1.3) had similar risk of revision due to any cause as cemented THAs.Interpretation — Uncemented stems (all-uncemented and reverse hybrid THAs) had increased risk of revision in women over 55 years of age, mainly due to periprosthetic fracture and dislocation, and should probably not be used in THA in these patients.

Reverse hybrid total hip arthroplasty

Background and purpose — The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA, have been sparsely described. The Nordic Arthroplasty Register Association (NARA) has already published 2 papers describing results of reverse hybrid THAs in different age groups. Based on data collected over 2 additional years, we wanted to perform in depth analyses of not only the reverse hybrid concept but also of the different cup/stem combinations used.Patients and methods — From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk of revision. The main endpoint was revision for any reason. We also performed specific analyses regarding the different reasons for revision and analyses regarding the cup/stem combinations used in more than 500 cases.Results — We found a higher rate of revision for reverse hybrids than for cemented THAs, with an adjusted relative risk of revision (RR) of 1.4 (95% CI: 1.3–1.5). At 10 years, the survival rate was 94% (CI: 94–95) for cemented THAs and 92% (95% CI: 92–93) for reverse hybrids. The results for the reverse hybrid THAs were inferior to those for cemented THAs in patients aged 55 years or more (RR =1.1, CI: 1.0–1.3; p < 0.05). We found a higher rate of early revision due to periprosthetic femoral fracture for reverse hybrids than for cemented THAs in patients aged 55 years or more (RR =3.1, CI: 2.2–4.5; p < 0.001).Interpretation — Reverse hybrid THAs had a slightly higher rate of revision than cemented THAs in patients aged 55 or more. The difference in survival was mainly caused by a higher incidence of early revision due to periprosthetic femoral fracture in the reversed hybrid THAs.

Clinical and radiographic evaluation of cemented socket fixation concomitant to acetabular bone grafting fixed with absorbable hydroxyapatite-poly-l-lactide composite screws

BackgroundThe durability of uncalcined and unsintered hydroxyapatite-poly-l-lactide composite screws is unclear when used for the fixation of acetabular bone graft in total hip arthroplasty under full-weight conditions. We have used this type of screw for the fixation of acetabular bone graft in cemented or reverse-hybrid total hip arthroplasty since 2003. Hence, we conducted a follow-up study to assess the safety and efficacy of these screws when used for cemented socket fixation. MethodsIn this study, 98 patients (106 cases) who underwent fixation of acetabular bone graft in cemented or reverse-hybrid total hip arthroplasty using hydroxyapatite-poly-l-lactide composite screws were followed up for over 5 years and evaluated clinically and radiographically. The patient population comprised 10 men and 88 women with a mean age of 60.3 years (range, 41–81 years) at the time of surgery. The original diagnosis for primary total hip arthroplasty was secondary osteoarthritis in 97 cases and high hip dislocation in nine cases. ResultsThe mean follow-up period was 7.6 years (range, 5–11 years). No patient in this series required revision surgery, and no radiographical loosening occurred during the follow-up period. The mean Japanese Orthopaedic Association score improved from 48 (range, 7–73) preoperatively to 87 (range, 50–100) at the final follow-up. Radiographically bone graft consolidation was confirmed in all cases, and no apparent osteolysis around the cemented socket or composite screws was detected. Kaplan–Meier survival analyses with socket revision surgery for any reason, socket loosening, and appearance of a radiolucent line >1 mm in any zone as the endpoints yielded survival rates of 100%, 100%, and 86.8% at 5 years, and 100%, 100%, and 81.0% at 10 years, respectively. ConclusionThis absorbable screw seems to have no negative effects on the mid-term clinical results of cemented socket fixation.

Total Hip Arthroplasty in Teenagers: An Alternative to Hip Arthrodesis

Debilitating arthritis in teenage patients is a complex problem with limited surgical options. Hip arthrodesis is unpopular amongst patients, and contemporary total hip arthroplasty (THA) may be a promising alternative. We report on the outcomes of THA in patients less than 20 years of age. All consecutive teenage patients undergoing THA at a tertiary referral centre were reviewed. Mean follow-up was 3.4 years (range 0.6-6.8) and 9 patients had at least 5 years follow-up. There were 51 THAs in 43 patients with a mean age of 17 years (range 12-19). The commonest indication was osteonecrosis (35 cases), mostly secondary to slipped upper femoral epiphysis (15 cases). Forty-six were uncemented and 5 were reverse hybrid THAs of which 7 were computer assisted design/manufacture (CADCAM) components. The commonest bearing surface used was ceramic on ceramic (40 cases). The survival rate was 96% and there were 2 complications. At latest follow-up, the mean Harris hip score was 90 (range 68-99) and UCLA activity score was 6 (range 4-9). Radiological analysis showed 2 patients with lucent lines around the acetabular component, but no signs of osteolysis or wear. We report good short to intermediate term survivorship and outcomes, and feel THA represents a valid alternative option to hip arthrodesis.

Validity and reliability of preoperative templating in total hip arthroplasty using a digital templating system

To evaluate the validity, interobserver reliability, and intraobserver reproducibility of a digital templating system, the Mdesk™ in preoperative templating in cemented and reverse hybrid total hip arthroplasty (THA). Validity was evaluated by comparing the planned cup size, stem size, CCD angles, and neck length with the components used in 129 patients operated with cemented and reverse hybrid THA. The reliability was measured by comparing the templating results of two surgeons with each other (interobserver) and the results of two templatings carried out by first surgeon (intraobserver). The leg length discrepancy was measured before and after the operation to assess the templating ability to correct it. The Mdesk™ system showed good validity (kappa value ranged from 0.64 to 0.96), especially when one size over and under the planned size were included. No difference between cemented and cementless stems was found. The interobserver reliability ranged from fair (kappa 0.23) to substantial (kappa 0.61) while the intraobserver reproducibility ranged from substantial (kappa 0.70) to excellent (kappa 0.82). Templating and intraoperative measures succeeded to restore the leg length. The Mdesk™ system has comparable validity and reliability with other templating systems used in clinical practice. We recommend that the same surgeon who does the preoperative radiographic templating to also perform the operation. Further studies are required to evaluate the results of succeeded templating in the long run.

Reverse hybrid total hip arthroplasty in select patients

Abstract Purpose To report the result of cemented cups and cementless stems (reverse hybrid) in 17 total hip arthroplasties (THAs). Methods From January 2003 to January 2008, 17 hips (17 patients) received reverse hybrid THAs and were included in this study. The mean patient age was 70 years (range, 52–81 years). The reasons for a reverse hybrid THA were an acetabulum too small to accommodate a metal shell, a severely osteoporotic acetabulum with thin subchondral bone, in which press-fit and screw fixation of the metal shell was deemed unstable, irradiation arthritis, and sequelae of sepsis, while the proximal femoral canal is normally shaped for a press-fit stem. Demographic data, surgical techniques, reasons for surgery, Harris hip score, and complications were reported. Results The average Harris hip score was 84.4 (range, 48–100) points at an average follow-up of 40.1 months (range, 24–73 months). One patient had a Vancouver type 2B fracture and received reoperation with open reduction. The patient had a 3-cm subsidence of the stem and thigh pain at follow-up. Another patient had an asymptomatic 1.5-cm subsidence of the stem. No loosening, migration, or progressive radiolucent lines around the cup were noted in any patient. Conclusion Reverse hybrid THA was associated with good clinical and radiographic results of the cemented cups in patients with the four selection criteria. It is noteworthy that one periprosthetic femoral fracture and one asymptomatic stem subsidence occurred. The lower average hip score with reverse hybrid THA than with ordinary THA is attributable to major comorbidities in the patients.