Revision Rate For Aseptic Loosening Research Articles

Hybrid Component Fixation in Revision Total Knee Arthroplasty

We retrospectively analyzed the midterm survivor rate of revision total knee arthroplasty using hybrid stem fixation. We included 33 patients, 21 women and 12 men with an average age of 68 years (range, 57-80 years). Revision was performed for aseptic loosening in 16 patients, aseptic loosening and knee instability in five patients, instability in seven patients, infection in three patients, and postoperative stiffness and pain in two patients. The average follow-up was 38 months. Three knees (9%) were revised during the follow-up period. Two patients (6%) underwent revision for aseptic loosening and one patient (3%) for deep implant infection. The average knee score improved from 42 points (range, 10 to 60) to 83 points (range, 60 to 100). The average functional score improved from 48 points (range, 15-65 points) to 76 points (range, 46-99 points). All patients had no pain (13%) or moderate/occasional pain (87%) during walking. The average ROM improved from 94 degrees (range, 45 degrees-125 degrees) to 105 degrees (range, 70 degrees-125 degrees). Hybrid component fixation is a useful treatment option in revision total knee arthroplasty. The revision rate for aseptic loosening within a three year follow-up is 6%. Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Long-term clinical and radiographic results of a pegged tibial baseplate in primary total knee arthroplasty

Tibial baseplates of total knee arthroplasty components use stems, fins, and pegs to augment fixation. A pegged design without a stem offers flexibility in tray orientation and ease of revision. These advantages would not be important if stemless designs resulted in a higher rate of aseptic loosening. This article presents an average 10.5-year follow-up of a system offering a pegged tibial baseplate. Good or excellent results in 91% of patients are cited with a revision rate for aseptic loosening of 1%. A pegged design may offer advantages without a higher rate of complications when compared with stemmed implants.

Minimum 10-Year Results of a Tapered Cementless Hip Replacement

Seventy-one total hip arthroplasties with a cementless, wedge fit, cobalt chrome femoral component were reviewed in 60 patients at a minimum 10-year followup (mean, 11.5 years). For the femoral component, the mechanical failure rate was 5% and the revision rate for aseptic loosening was 0%. The mean Charnley scores for pain, function, and motion changed from preoperative mean values of 3.0, 2.7, and 3.2 to followup mean values of 5.7, 5.5, and 5.2, respectively. The followup mean Harris hip Score was 91. The incidence of thigh pain was 1.4% at 10-year followup. Ninety-five percent of femoral components showed radiologic evidence of stable, bone ingrowth fixation, whereas loosening was seen in 5% of stems. Despite the high incidence of acetabular osteolysis, no osteolysis was seen on the femoral side distal to the lesser trochanter. Nonmodularity of the femoral component led to unavoidable revision of stably fixed femoral components in seven (9.8%) hips during the revision of a loose socket. Design features (collarless, tapered, wedge fit, and circumferentially porous coated) were thought to be crucial to the superlative results with the cobalt chrome femoral component.

How Outcome Studies Have Changed Total Hip Arthroplasty Practices in Sweden

The Swedish Hip Registry has defined the epidemiology of total hip replacement in Sweden. Most hip implants are fully cemented. Serious complications and rates of revision associated with total hip replacement have declined significantly despite an increasing number of patients at risk. During the past 5 years only 9% to 10% of hip replacement procedures are revision procedures. Aseptic loosening with or without osteolysis is the major problem and constitutes 73% of the revisions, but the incidence has decreased four times during the past 15 years to less than 3% at 10 years. Even septic complications can be prevented effectively. Demographics are important because male gender and young age increase the risk for revision because of aseptic loosening. Young female patients with rheumatoid arthritis and male patients with a previous hip fracture have five times higher revision rates than elderly patients. The quality of the surgical technique is the most important factor for reducing the risk for revision because of aseptic loosening, but choice of implant is also important. The variations among hospitals in type of surgical technique used is big enough to cause a 100% difference in revision rate for aseptic loosening. Total hip replacement practice in Sweden has improved based on information from this Registry about individualized patient risks, implant safety, and the efficacy of improving surgical and cementing techniques.

ANTIBIOTIC PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY

We have assessed the effect of different regimes of antibiotic prophylaxis on the survival of total hip implants, comparing antibiotics administered both systemically and in the bone cement, systemically only, in the bone cement only and with no antibiotics given. We studied 10 905 primary cemented total hip replacements, performed for osteoarthritis of the hip and reported to the Norwegian arthroplasty register between 1987 and 1995. Cox-estimated failure-rate ratios (FRR) are presented with adjustment for gender, age, the brand of cement, the prosthesis, the type of operating theatre and the operating time. For revisions performed for infection (39 operations), the lowest rate of revision was found among patients receiving antibiotic-containing cement plus systemic antibiotics (n = 5804). The revision rate for the 4586 patients receiving systemic antibiotics only was 4.3 times greater (95% CI 1.7 to 11.0, p = 0.001); in 239 with antibiotics in the bone cement only it was 6.3 times greater (CI 1.6 to 25.0, p = 0.003); and in the 276 who did not receive antibiotics it was by 11.5 times greater (CI 2.1 to 63.0, p = 0.002). Adjustment for the total amount of systemic antibiotic administered did not change the results. We also observed an increased revision rate for aseptic loosening (109 operations) comparing the systemic-only (FRR = 1.8, CI 1.1 to 2.9, p = 0.01) and the cement-only regimes (FRR = 2.6, CI 1.2 to 5.9, p = 0.02) with the combined dosage. Our findings show that systemic antibiotics combined with antibiotic-containing bone cement led to fewer revisions than the other methods.

Primary Cementless Hip Arthroplasty With a Titanium Plasma Sprayed Prosthesis

One hundred two patients underwent 105 primary uncemented total hip arthroplasties and were reviewed at a minimum of 5 years after operation (mean, 6.1 years). The components were titanium alloy with a titanium plasma spray coating. The acetabular revision rate was 11.4%. Acetabular cavitary lytic lesions were identified in 25.5% at 5 years. All acetabular revisions were performed for a combination of wear and osteolysis. One femoral revision was performed to facilitate an acetabular revision, but the femoral revision rate for aseptic loosening was 0%. In addition, no femoral components had subsided or were thought to be loose radiographically. Thigh pain was present in 4% at 5 years. Despite the 25.5% incidence of acetabular osteolysis, distal femoral lysis was not seen and only 5% showed focal osteolysis in the trochanteric region proximal to the circumferential porous coating of the femoral component. Component design features were thought to be critical to the excellent performance of the femoral component and to the poor performance of the acetabular component.

Survival Analysis of T-28 Hip Arthroplasty with Clinical Implications

Seventeen years after its introduction, the T-28 and its successor (the TR-28) have proved to be a successful arthroplasty system, with very low long-term socket and femoral loosening rates, especially in older patients. The 10-year revision rate for aseptic loosening of the socket is only 2 per cent. This form of conventional cemented total hip replacement has provided pain relief and improved function in many individuals who have exhausted nonoperative treatment alternatives. Although there are still unsolved long-term problems for the young active patients, cemented hip arthroplasty continues to play an important role in joint replacement, and remains the treatment of choice in older and relatively inactive patients.

Long-term Results of Low-friction Arthroplasty Performed in a Community Hospital, Including a Radiologic Review

This report is a prospective review of 450 low-friction arthroplasties (LFAs) performed by a single surgeon from 1972 to 1983 in a community hospital. The clinical results show sustained quality of the result over a maximum follow-up period of 11 years. The radiologic review shows a slight increase in the number and size of radiolucent lines with time. Bacteriologic studies confirm that clean-air technology reduces the bacteriologic contamination of the operating room and the wound. Deep infections occurred in 1.6% of cases. The most notable complication was failure to obtain bony union of the osteotomized trochanter in 14% of cases. The revision rate for aseptic loosening of the cup was 0.7% and of the femoral prosthesis 0.0%.