title: Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: a 7- to 9-year follow-up study. Causes of early failure in a multicenter clinical trial of hip resurfacing. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. A comparison of total hip resurfacing and total hip arthroplasty - patients and outcomes. Patient relevant outcome 7 years after total hip replacement for OA - a prospective study Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. The results of primary Birmingham hip resurfacings at a mean of five years. An independent prospective review of the first 230 hips. Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study Patient Relevant Outcomes after total hip replacement. A comparison between different surgical techniques No differences in outcomes between cemented and uncemented acetabular components after 12–14 years: results from a randomized controlled trial comparing Duraloc with Charnley cups Changes in Proximal Femoral Bone Mineral Density around a Hydroxyapatite-Coated Hip Joint Arthroplasty Prevalence of heterotopic ossification in cemented versus noncemented total hip joint replacement in patients with osteoarthrosis: a randomized clinical trial. Clinical and radiographic outcomes of total hip arthroplasty with insertion of an anatomically designed femoral component without cement for the treatment of primary osteoarthritis. A study with a minimum of six years of follow-up. 100 Cemented Versus 100 Noncemented Stems With Comparison of 25 Matched Pairs The Bimetric cementless total hip replacement: 7–18 year follow-up assessing the influence of acetabular design on survivorship The Birmingham Hip Resurfacing: 5-year clinical and radiographic results from a District General Hospital Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series. Primary Total Hip Arthroplasty with a Porous-Coated Acetabular Component. Seven-to-Ten-Year Results* Is the Charnley evolution working? A five-year outcome study. Birmingham Hip Resurfacing in Patients who are Seventy Years of Age or Older Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years. Introduction of total hip arthroplasty in Lithuania: Results from the first 10 years Dislocation of Primary Total Hip Arthroplasty with 36 and 40-mm Femoral Heads What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial Cobalt and chromium levels in blood and urine following hip resurfacing arthroplasty with the Conserve Plus implant. Primary total hip arthroplasty with a proximally porous-coated femoral stem. Early clinical experience with the use of the Birmingham hip resurfacing system. Comparison of Total Hip Arthroplasty Performed with and without Cement: A Randomized Trial Matched-pair analysis of cemented and cementless acetabular reconstruction in primary total hip arthroplasty. Ten-year survivorship of the Anatomique Benoist Girard I total hip arthroplasty. Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results Resurfacing hip prostheses revisited: failure analysis during a 16-year follow-up. Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Followup
abstract: The first 100 consecutive primary hip arthroplasties with the Arthopor 2 acetabular component ( Joint Medical Products , Stamford , CT ) with supplemental screw fixation performed by the senior author were prospect ively studied . The mean patient age was 57 years . Seventy-seven cemented and 23 cementless stems were placed , with 32-mm femoral heads used in most of the patients . Eighty-six hips were review ed at 7 - 8.8 years ( mean , 7.8 years ) . The mean Harris hip score at final follow-up evaluation was 94 points . No cups have been revised , although 2 cups in patients with radiation osteonecrosis were loose radiographically . One patient underwent revision of a severely worn liner . Despite a relatively high mean linear wear rate of 0.27 mm/y ( range , 0.13 - 0.57 mm/y ) , no radiographic evidence of pelvic osteolysis was seen . The Arthopor 2 cup performed well with respect to pelvic osteolysis , despite the presence of substantial polyethylene debris . The relatively high polyethylene wear rate is attributed in part to the younger patient population and the use of 32-mm femoral heads paired with thin polyethylene liners The purpose of this study was to evaluate the clinical outcomes and possible causes of early failure in a multicenter trial of metal-on-metal hip resurfacing . Two hundred patients were prospect ively enrolled and followed for an average of 31.2 months ( range , 12 - 54 months ) . Of 200 patients , 14 ( 7.0 % ) required revision surgery at a mean time of 19.5 months ( range , 3 - 47 months ) . Patients with failures were significantly younger and heavier than the nonfailures , and all were male . Patients who were revised did not differ from those who were not revised in terms of radiographic outcomes , but they did report lower functional outcome scores at all preoperative and postoperative testing intervals . Most failures ( 10/14 ) were related to early acetabular loosening . The learning curve was likely a factor in these cup failures . This report highlights the importance of patient selection and surgical technique in hip resurfacing arthroplasty . It is anticipated that further surgical experience will lead to a reduction in this high early failure rate We describe the experience with the first consecutive 230 Birmingham hip resurfacings at our centre . At a mean follow-up of three years ( 25 to 52 months ) survivorship was 99.14 % with revision in one patient for a loose acetabular component and one death from unrelated causes . One patient developed a fracture of the femoral neck at six weeks which united unremarkably after a period of non-weight-bearing . The Harris hip score improved from a mean of 62.54 ( 8 to 92 ) to 97.74 ( 61 to 100 ) . The mean flexion improved from 91.52 degrees ( 25 to 140 ) to 110.41 degrees ( 80 to 145 ) . Most patients ( 97 % ) considered the outcome to be good or excellent . Our preliminary experience with this implant is encouraging and the results are superior to the earlier generation of resurfacings for the same length of follow-up A comparison of pertinent preoperative and postoperative data relative to total hip resurfacing versus total hip arthroplasty ( THA ) would assist in evaluating current perceptions in outcome . We compared 50 consecutive metal-metal resurfacing replacements in 50 patients with 44 consecutive conventional total hip arthroplasties in 35 patients , who were implanted during the same time period , by the same surgeon , and followed prospect ively for 2 to 4 years . The patients undergoing hip resurfacing were 62 % male , 9 years younger , and 3.2 inches taller , with a lower mean body mass index and American Society of Anesthesiologists ( ASA ) grade than patients undergoing total hip arthroplasty .  Preoperatively , patients undergoing resurfacing had a lower Harris hip score ( 46 vs 52 points ) , more pain , higher UCLA ( University of California at Los Angeles ) activity scores ( 4.2 vs 3.6 ) , and better range of motion . Surgical time for resurfacing was 18 % longer , but there was less total blood loss and fewer transfusions . Postoperatively , there was no difference in Harris hip score ( 97 vs 96 ) . Patients undergoing resurfacing had higher function , Short Form-12 physical activity scores , and UCLA activity scores , but also a higher incidence of slight or mild pain . There were no differences in postoperative range of motion or dislocation ( one each ) . The preoperative characteristics and general health status of the average patient undergoing resurfacing are more favorable than that of the average patient undergoing conventional total hip arthroplasty . Caution should be applied in attributing differences in outcomes directly to the arthroplasty technology Background To investigate prospect ively the patient-relevant outcome 7 years after  total hip replacement ( THR ) for osteoarthritis ( OA ) . Methods 219 consecutive patients ( 120 women ) with primary OA , mean age 71 ( range 50 - 92 ) were assigned for THR .  They were examined preoperatively , at 3 , 6 , 12 months , and at 4 , 5 and 7 years postoperatively with the self-administered question naires SF-36 and WOMAC . Supplementary questions regarding postoperative complications , general co-morbidity , social circumstances and patient satisfaction were asked at the three last follow-ups . A reference group , 117 subjects ( 67 women ) , mean age 72 ( range 52 - 92 ) without hip complaints were recruited from the community and investigated at the same times . Results 151/170 ( 89 % ) of the patients and 65/74 ( 88 % ) of the reference group participated at the 7 year follow-up . The best postoperative result was reported one year postoperatively . At the 7 year follow up there was a significant difference between the patients and controls in SF-36 physical function ( PF ) and role physical ( RP ) but not of WOMAC function . There was no difference in frequency of co-morbid conditions between those operated and the reference group , but those operated were in greater need of walking aid ( 46 % vs. 8 % p < 0.0001 ) and reported more regional and widespread pain ( 68 % vs. 53 % p < 0.05 ) . Conclusion This study shows that in an unselected cohort the patients experience a similar health-related quality of life as a reference group of a similar age and sex structure 7 years after THR except for general physical function where the patients score worse OBJECTIVE To evaluate the effect of obesity on the incidence of main complications ( infection , dislocation , and revision ) , functional outcome , and patient satisfaction 5 years after primary total hip arthroplasty ( THA )  , and to determine whether results differ between obese women and men . METHODS We conducted a hospital-based prospect i ve cohort study including patients who underwent primary THA ( 2,495 hips ) between 1996 and 2005 . We used rates and rate ratios to compare the incidence of main complications in obese and nonobese patients , and we stratified the data for sex . Functional outcome was measured using the Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index . RESULTS The adjusted incidence rate ratio for infection ( obese versus nonobese ) was 4.4 ( 95 % confidence interval [ 95 % CI ] 1.8 , 10.8 ) . Obesity substantially increased the infection rate in women ( incidence rate ratio comparing obese with nonobese women 16.1 ; 95 % CI 3.4 , 75.7 ) , whereas obesity appeared to have no effect in men ( incidence rate ratio 1.0 ; 95 % CI 0.2 , 5.3 ) . The adjusted incidence rate ratio for dislocation ( obese versus nonobese ) was 2.4 ( 95 % CI 1.4 , 4.2 ) , with a higher rate increase in obese women . A total of 817 patients had a 5-year clinical followup visit . Functional outcome and satisfaction were slightly lower in obese women partly due to higher complication rates . No difference was seen in men . CONCLUSION Primary THA is a successful intervention in obese patients , but physician and patient must be aware of increased complications , particularly in women We report an independent prospect i ve review of the first 230 Birmingham hip resurfacings in 212 patients at a mean follow-up of five years ( 4 to 6 ) . Two patients , one with a loose acetabular component and the other with suspected avascular necrosis of the femoral head , underwent revision . There were two deaths from unrelated causes and one patient was lost to follow-up . The survivorship with the worst-case scenario was 97.8 % ( 95 % confidence interval 95.8 to 99.5 ) . The mean Harris hip score improved significantly ( paired t-test , p < 0.05 ) from 62.54 ( 8 to 92 ) pre-operatively to 97.7 ( 61 to 100 ) at a mean of three years ( 2.1 to 4.3 ) , then deteriorated slightly to a mean of 95.2 ( 47 to 100 ) at a mean of five years . The mean flexion improved from 91.5 degrees ( 25 degrees to 140 degrees ) to 110.4 degrees ( 80 degrees to 145 degrees ) at a mean of three years with no further improvement at five years ( 111.2 degrees ; 70 degrees to 160 degrees ) . On radiological review at five years , one patient had a progressive lucent line around the acetabular component and six had progressive lucent lines around the femoral component . A total of 18 femoral components ( 8 % ) had migrated into varus and those with lucent lines present migrated a mean of 3.8 degrees ( 1.02 degrees to 6.54 degrees ) more than the rest . Superolateral notching of the femoral neck and reactive sclerosis at the tip of the peg of the femoral component were associated with the presence of lucent lines ( chi-squared test , p < 0.05 ) , but not with migration of the femoral component , and are of unknown significance . Our results with the Birmingham hip resurfacing continue to be satisfactory at a mean follow-up of five years Objectives : To investigate prospect ively long term patient relevant outcomes after  unilateral total hip replacement ( THR ) for osteoarthritis ( OA ) . To identify non-responders to this intervention and patient related predictors of unsatisfactory outcome . Methods : A case-control study comparing health related quality of life of 219 patients ( mean age 71 ) after THR with that of a matched reference group of 117 subjects without hip complaints recruited from the community . Patients and reference group answered SF-36 and WOMAC question naires preoperatively , at 3 , 6 , 12 months , and at 3.6 years ( range 26–65 months ) postoperatively . Supplementary questions were asked at the final follow up . Results : 198/211 ( 94 % ) of the patients and 83/109 ( 76 % ) of the reference group participated at the final follow up . At follow up , the only difference between the two groups in the SF-36 was physical function , where patients scored worse . Patients also reported worse WOMAC function . 31 % of the patients had improved by < 10/100 WOMAC score points for pain and /or function at final follow up , compared with preoperatively . More pain preoperatively and higher age and postoperative low back pain predicted a worse outcome in WOMAC function . Conclusion : 3.6 years after THR for OA , health related quality of life was similar for patients and reference group except for function , where patients had worse function . Higher age and more pain preoperatively predicted a poor outcome . Patients with hip OA with musculoskeletal comorbidities , such as low back pain and OA of the non-operated hip , have less long term functional improvement after THR Objective To investigate differences in pre- and postoperative patient-relevant outcome between hybrid total hip replacement ( THR ) and cemented THR in patients with primary osteoarthritis ( OA ) . Methods 245 consecutive patients were included in the study . 68 of the patients ( mean age 62 ) were operated on with hybrid THR and 177 ( mean age 74 ) were operated on with cemented THR .  All patients were investigated preoperatively and 0.5 , 1 and 3.6 years postoperatively with two self-administered question naires , SF-36 and WOMAC ( Western Ontario and MacMaster Universities Osteoarthritis Index , LK 3.0 ) . Results Preoperatively , there was a difference in the SF-36 subscales RP ( role physical ) and GH ( general health ) where the patients with the hybrid THR attained better scores . At 3.6-years the patients with the hybrid THR reached better scores in all SF-36 subscales except BP ( bodily pain ) and GH . Further , they had better scores in WOMAC function . However , after adjusting for age , sex , follow-up time and baseline values there were no differences in outcome between the two different surgical techniques . Conclusion This medium term ( 3–5 years ) , controlled , open cohort study , using patient-relevant outcome measures , did not reveal any differences between hybrid THR and cemented THR for OA at 3.6 years after surgery . Since the study had 75–94 % power to detect the clinical ly significant score difference of 10 points , we suggest that any difference in outcome between these two methods is small and may require a large-scale , blinded , r and omized trial to show Background Even though there are multiple studies documenting the outcome of the Charnley low-friction arthroplasty as well as abundant studies on uncemented arthroplasties , there is a dearth of comparative studies of the uncemented acetabular component and a cemented component . In this study we aim ed to document the long-term clinical and radiographic outcome as well as component survival in a r and omized controlled trial . Material s and methods Two hundred fifteen patients ( 240 hips ) were r and omly allocated to receive a cemented Charnley cup or uncemented Duraloc 1200 cup . All patients received cemented Charnley stems and were evaluated clinical ly and radiographically after 6 months , and 2 , 5 , and 10 years . Results Harris Hip Scores improved from 48.3 [ 95 % confidence interval ( CI ) 45.0–51.6 ] to 90.2 [ 95 % CI 87.9–92.6 ] in the Charnley group and from 49.3 [ 95 % CI 86.9–91.3 ] in the Duraloc group at 6 months . After 10 years , the Charnley group ’s Harris Hip Score was 89.8 [ 95 % confidence interval ( CI ) 87.0–92.6 ] , and the Duraloc group ’s score was 87.3 ( 95 % CI 84.1–90.6 ) . In the radiographic analysis after 10 years , there was no statistical difference in the prevalence of radiographic signs of loosening . Nine cups were revised in the Charnley group , and five cups were removed in the Duraloc group . The difference was not statistically significant . There was no statistical difference between the cups when aseptic loosening was the end-point , nor in survival analyses . Conclusions There is no statistically significant difference in clinical or radiological outcome between the Charnley cup and the Duraloc after 10 years , and no difference in implant survival after 12–14 years . The uncemented Duraloc cup is as good as the cemented Charnley cup after 10 years Objective . To present the results of a prospect i ve analysis of proximal femoral bone mineral density changes around a hydroxyapatite-coated total hip joint replacement . Methods . 14 patients with osteoarthritis of the hip were enrolled in the study and treated with an uncemented ABG prosthesis . Dual energy X-ray absorptiometry scanning was performed in 9 patients preoperatively , and at 3 , 6 , 12 , and 24 months postoperatively . An orthopaedic software program was used to determine the bone mineral density in the proximal femur , expressed as a percentage of the preoperative value . Results . The values of Gruen zones 1 to 6 averaged between 96.0 % and 113.8 % of the preoperative value by 24 months ( overall average , 104.1 % ) . In zone 7 , however , there was a gradual decline in bone mineral density to an average of 72.1 % of the preoperative value by 24 months . This represented ongoing loss of bone from the calcar ; although this may not pose a problem to the prosthetic 's short-term stability , it may render potential revision surgery more difficult . Conclusion . The initial outcome of uncemented total hip replacement appears to be promising . There was excellent maintenance of bone around the femoral component in all regions other than the calcar and lesser trochanter . Further scans are required to see if these trends continue in the long term OBJECTIVE To determine the prevalence of heterotopic bone formation in cemented versus noncemented total hip joint replacement . DESIGN A prospect i ve r and omized controlled trial . Follow-up ranged from 2 to 6 years ( mean 4 years ) . SETTING A university hospital . PATIENTS Two hundred and twenty-six patients who had primary or secondary osteoarthrosis of the hip were stratified according to type of fixation , surgeon and age . Patients were r and omized within strata : 112 received noncemented total hip prostheses and 114 received cemented prostheses . The 2 groups were similar with respect to age and sex . INTERVENTION Primary total hip arthroplasty . A cemented ( methylmethacrylate ) or noncemented prosthesis was inserted by a lateral surgical approach . MAIN OUTCOME MEASURE The Brooker classification was used to grade heterotopic bone formation from postoperative radiographs . RESULTS Overall , 148 ( 66 % ) hips had no heterotopic ossification , 56 ( 25 % ) were Brooker class I , 14 ( 6 % ) were class II , 8 ( 3 % ) were class III and none were class IV . In the noncemented group of patients , 76 ( 68 % ) hips had no heterotopic ossification , 25 ( 22 % ) were Brooker class I , 7 ( 6 % ) were class II , 4 ( 4 % ) were class III and none were class IV . In the cemented group of patients , 72 ( 63 % ) hips had no heterotopic ossification , 31 ( 27 % ) hips were Brooker class I , 7 ( 6 % ) were class II , 4 ( 4 % ) were class III and none were class IV . CONCLUSION There was no significant difference in the prevalence of heterotopic ossification between cemented and noncemented total hip replacements in patients with osteoarthrosis We evaluated the clinical and radiographic outcomes of 100 consecutive primary total hip arthroplasties in which a proximally coated anatomically design ed femoral component was fixed without cement for the treatment of primary osteoarthritis . The minimum duration of follow-up was six years ( average , 7.1 years ) . The eighty-eight patients who had the arthroplasties were followed prospect ively with a st and ard clinical evaluation that involved use of the Harris hip score and a radiographic evaluation based on the criteria of the Hip Society . Bone ingrowth was evaluated with the method of Engh et al. The average age of the patients at the time of the operation was 62.6 years ( range , thirty-nine to eighty-four years ) . Fifty-one patients were men and thirty-seven were women . The average preoperative Harris hip score was 48 points , with an average pain score of 15 points and an average function score of 26 points . Nonmechanical complications that necessitated a revision operation included one deep hematogenous infection , one late periprosthetic fracture , and a 0.5-inch ( 1.27-centimeter ) limb-length discrepancy . At the time of the most recent follow-up , the average Harris hip score was 96 points , with an average pain score of 42 points and an average function score of 45 points . The prevalence of pain in the anterior part of the thigh was 5 percent ( five hips ) . One patient had a revision of the femoral component because of aseptic loosening , and one had a revision of the acetabular component because of recurrent dislocations . Radiographic assessment revealed consistent evidence of proximal bone ingrowth . No complete radiolucent line was identified , except around the stem that had loosened . Twenty-seven femoral components were associated with slight pedestal formation . No osteolytic lesion of the femur was identified . Nonprogressive pelvic osteolysis was identified in four hips , but none of the lesions were more than two millimeters in diameter . None of the acetabular components migrated , and no radiolucent line of more than two millimeters in thickness was seen around any acetabular cup . The data from this study , in which the minimum duration of follow-up was six years , indicate that the anatomically design ed prosthesis can provide good results , with low prevalences of pain in the thigh and loosening of the component , in younger , active patients Two series of 100 consecutive primary total hip arthroplasties , each using a single design of noncemented or cemented femoral component ( all 28 mm heads ) , were compared . One cemented and two noncemented stems underwent revision for aseptic loosening . Of unrevised hips , outcome data statistically favored cemented , rather than noncemented , stems . The data for cemented and noncemented stems , respectively , were : An excellent to good result in 97 % versus 88 % ; thigh pain in 3 % versus 40 % ; subsidence in 0 % versus 22 % ; and endosteal cavitation in 6 % versus 12 % . For patients with 25 unrevised matched pairs , selected by gender , age , diagnosis , and weight , outcome data also statistically favored cemented over noncemented stems , respectively : an excellent or good result in 25 versus 20 hips ; thigh pain in two versus eight hips ; and subsidence in none versus six hips . Midterm followup data for these concurrent total hip arthroplasty series of a mid1980s design revealed prevalence of mechanical failure of 1 % for cemented stems and 4 % for noncemented stems . Corroborating matched pair comparison neutralized selection bias as a causative factor for these differences . These data indicate contemporary cemented femoral stem fixation is superior to second generation noncemented femoral stem fixation . Controlled comparative studies at midterm to long term followup , such as in this report , are needed to define outcome and indications for current third generation noncemented stem fixation The purpose of this study was to evaluate the mid- to long-term survivorship of Bimetric cementless total hip replacement and assess how it is affected by the acetabular design . This was a retrospective analysis of 127 Bimetric cementless total hip replacements in 110 patients with a follow-up of 7–18 years . A single design stem and three different cementless metal-backed acetabular design s were used . Patients were assessed clinical ly using the Harris hip score and radiologically by independent review of current hip radiographs . There was only one case of aseptic loosening of the femoral stem . The earliest acetabular design showed a high failure rate whilst the latter two design s showed a 96 % survivorship at a mean of 9.5 years . We conclude that a combination of the bimetric stem with either of the latter acetabular cup design s has a good mid- to long-term performance . Résumél’étude de l’évaluation à moyen ou à long terme de la survie d’une prothèse sans cimentde type Bimétric . il s’agit d’une étude prospect i ve de 127 prothèses totales de hanche chez110 patients avec un suivi moyen de 7 à 18 ans . Un seul dessin de tige fémorale et troisdessins différents de cupule métal back sans ciment ont été utilisés . Les patients ont étéévalués sur le plan clinique ( score de Harris ) et sur le plan radiologique . Un seul cas de descellement aseptique de tige fémorale a été retrouvé . Sur les troismodèles de cupule , le premier modèle montre un taux d’échec très important alors que les deuxderniers modèles ont un taux de survie de 96 % à 9,5 ans de recul . En conclusion , nous pouvons affirmer que la combinaison d’une tige de type bimétric associéeaux modèles acétabulaires les plus tardifs ont permis un bon résultat moyen à long terme We prospect ively examined the functional and radiographic outcomes of a serial cohort of 104 Birmingham Hip Resurfacings in an independent centre . Final follow-up was to a mean of 61 months , and six cases were lost to follow-up . Excellent results were obtained in 91 % , but obese patients had significantly ( p < 0.03 ) poorer post-operative outcomes . Whilst there were no cases of neck fracture neck narrowing of up to 20 mm was noted . Radiolucent lines were present in a single zone in 9.4 % ( 9/96 ) acetabular and 3.1 % ( 3/96 ) femoral components . However , no components were definitely loose and there were no revisions for any reason during the period of the study . This independent series confirms that the Birmingham Hip Resurfacing gives excellent early clinical results and little early evidence of radiographic failure . The high rate of neck narrowing gives us cause for concern and we would recommend regular radiographic follow-up We performed a prospect i ve study in 108 consecutive patients ( 116 hips ) who were followed for a minimum of 10 years ( 10 - 12 years ) after primary total hip arthroplasty using an uncemented porous-coated anatomic ( PCA ) hip prosthesis . The average age of the patients at operation was 48.4 years ( range , 19 - 85 years ) , and the diagnosis was avascular necrosis of the femoral head in 46 hips , neglected femoral neck fracture in 27 , osteoarthrosis secondary to childhood pyogenic arthritis in 24 , childhood tuberculous arthritis in 5 , and miscellaneous in 14 . The average preoperative Harris Hip Score was 55 points , which improved to 87 points at 11 years . Seventy-five hips ( 65 % ) were excellent , 11 ( 9 % ) were good , and 30 ( 39 % ) were poor . The overall rate of revision was 15 % ( 17 of 116 hips ) . The rate of revision of the femoral component was 11 % ( 13 of 116 hips ) , and the rate of revision of the acetabular component was 15 % ( 17 of 116 hips ) . The prevalence of thigh pain was 28 % at 11 years . The increase in the incidence of aseptic loosening of the femoral component was found to explain the high incidence of severe thigh pain at 11 years ' follow-up . At 11 years , there was femoral osteolysis in 69 hips ( 59 % ) and acetabular osteolysis in 65 hips ( 56 % ) . At 6 years , 20 hips ( 17 % ) showed definite wear of the polyethylene liner . At 11 years , 81 hips ( 70 % ) showed definite wear of the polyethylene liner . Because the complication rate of the PCA hip prosthesis with respect to loosening , osteolysis , and excessive wear in the polyethylene liner is high , we ab and oned the use of this implant One hundred and eighty-four patients who had been managed , between 1984 and 1985 , with a total of 204 consecutive primary total hip arthroplasties with insertion of a Harris-Galante type-I acetabular component without cement were prospect ively studied . There were eighty-two men ( 45 per cent ) and 102 women ( 55 per cent ) . The mean age at the time of the operation was fifty-two years ( range , twenty to eighty-four years ) . One hundred and fifty-seven patients ( 173 hips ) were available for clinical review at a mean of 104 months ( range , seventy-eight to 126 months ) . At this time , the mean preoperative Harris hip score of 52 points ( range , 12 to 79 points ) had improved to a mean of 90 points ( range , 44 to 100 points ) . Two patients ( two hips ) had had an exchange of an excessively worn polyethylene liner . One patient ( one hip ) had had débridement and grafting of an area of massive retroacetabular osteolysis . Two stable acetabular components ( 1 per cent ) had been revised at the time of femoral revision . None of the cups had been revised because of aseptic loosening . Radiographic examination of 150 patients ( 165 hips ) at a mean of 104 months ( range , seventy-eight to 126 months ) revealed that 156 cups ( 95 per cent ) were stable . Eight cups ( 5 per cent ) were considered to be possibly unstable , with a radiolucent line between the prosthesis and the bone that was one millimeter wide or less in at least four of five zones ; two of the eight had a complete radiolucent line in all zones . One component , which had been implanted with a bulk allograft from a femoral head , migrated more than two millimeters in the first two years and then stabilized without complication . Osteolysis was seen in seven acetabula ( 4 per cent ) and was limited to the periphery of the cup in six . Survivorship analysis at ten years revealed that the acetabular component had a 99 per cent chance of survival ( 95 per cent confidence interval , 0.98 to 1.0 ) with revision or aseptic loosening as the end point and a 97 per cent chance of survival ( 95 per cent confidence interval , 0.95 to 1.0 ) with revision , aseptic loosening , or reoperation because of a problem related to the acetabular component as the end point Two hundred consecutive primary total hip arthroplasties ( 196 patients ) carried out between January 1994 and May 1995 using the Elite Plus cemented femoral components ( DePuy International , Leeds , UK ) were enrolled in a prospect i ve study . Fifteen patients were lost to follow-up . The patients were evaluated clinical ly using the Harris Hip Score ( HHS ) and radiographically . The mean HHS was raised from 39.3 preoperatively to 89.6 at 5 years . Radiologically the mean femoral subsidence was 1.40 mm at 5 years . The mean annual rate of re-operation was 0.2 % . There were no revisions for aseptic loosening . In the present series , the Elite Plus hip arthroplasty has produced clinical and radiological results , which are comparable with the Charnley hip at five years There is no published literature to support mid to long term results of hip resurfacing ( HR ) arthroplasty in patients over the age of 70 years . The purpose of our study was to evaluate the function HR in this age group ( 70 or older at the time of surgery ) at medium to long term follow-up . Between July 1997 and November 2002 , the Oswestry Outcome Centre independently and prospect ively collected data on 5000 Birmingham Hip Resurfacings ( BHRs ) . 106 had been implanted in elderly patients who were 70 years of age or older . The post-operative Harris and Merle D'Aubigné and Postel ( MDP ) hip scores and causes for revision were used to ascertain function and implant survival . Hip scores for the older BHR patients were compared with those from younger patients . The average age at surgery of the elderly BHR cohort was 73.2 years ( range , 70.0 to 87.9 years ) with a mean follow-up of 7.1 years ( range , 0.5 to 10.9 years ) . Four patients had a femoral neck fracture and required conversion to a conventional total hip replacement . There were no patients lost to follow-up and no dislocations in this series . The median Harris hip score ( HHS ) was significantly better in the younger BHR group compared with the elderly BHR group , ( 96 vs. 94 p=0.008 ) . There was no significant difference in recovery rates after surgery . There was a significantly higher rate of revision in women than men among the elderly patients ( male= 1 of 65 ( 1.5 % ) ; women = 3 of 19 ( 15.8 % ) , p=0.03 ) . At latest follow-up the elderly patients continued to function well when compared with the younger BHR patients . There was a high mid to long term success rate after HR in patients who were 70 years of age or older , without the failure burden possibly anticipated . Elderly patients had a poorer functional outcome , but a difference in HHS of two points may be of only minor clinical significance There have been comparatively few studies of the incidence of osteolysis and the survival of hybrid and cementless total hip replacements ( THRs ) in patients younger than 50 years of age . We prospect ively review ed 78 patients ( 109 hips ) with a hybrid THR having a mean age of 43.4 years ( 21 to 50 ) and 79 patients ( 110 hips ) with a cementless THR with a mean age of 46.8 years ( 21 to 49 ) . The patients were evaluated clinical ly using the Harris hip score , the Western Ontario and McMaster Universities ( WOMAC ) osteoarthritis score and the University of California , Los Angeles ( UCLA ) activity score .  Radiographs and CT scans were assessed for loosening and osteolysis . The mean follow-up was for 18.4 years ( 16 to 19 ) in both groups . The mean post-operative Harris hip scores ( 91 points versus 90 points ) , the mean WOMAC scores ( 11 points versus 13 points ) and UCLA activity scores ( 6.9 points versus 7.1 points ) were similar in both groups . The revision rates of the acetabular component ( 13 % versus 16 % ) and the femoral component ( 3 % versus 4 % ) , and the survival of the acetabular component ( 87 % versus 84 % ) and the femoral component ( 97 % versus 96 % ) were similar in both groups . Although the long-term fixation of the acetabular metallic shell and the cemented and cementless femoral components was outst and ing , wear and peri-acetabular osteolysis constitute the major challenges of THR in young patients Background Hip replacement as a routine procedure was introduced in Lithuania in 1991 . At Klaipeda Hospital , one of the 2 hospitals at which this was begun , the arthroplasties were followed prospect ively from the start . This study concerns the 10-year results from a country with no previous experience of hip replacement . The results are compared with those from a hospital with considerable experience of total hip replacement . Methods We compared the revision rate for the first 658 primary ScanHip arthroplasties inserted at Klaipeda to that for the first 939 ScanHip primary arthroplasties inserted at Lund University Hospital , Sweden . Only patients with osteoarthritis were included , and the endpoint was revision for aseptic loosening with exchange of one or both components . Results We found that patients operated at Klaipeda Hospital had a significantly higher risk of revision ( 12 % ) than those operated in Lund ( 6 % ) . Interpretation Although we could not identify any specific reason for the Swedish results being better than the Lithuanian results , it is probable that previous surgical inexperience of hip replacement in Lithuania played a role . We believe that the findings will stimulate surgeons in Lithuania to analyze their failures and improve the results Some authors suggest the use of larger ( 36 and 40 mm ) femoral heads against highly cross-linked polyethylene acetabular liners will reduce the prevalence of early dislocation after primary total hip arthroplasty ( THA ) . We prospect ively followed 61 consecutive patients at high risk for dislocation to determine the prevalence of early dislocation after primary THA with 36 and 40 mm femoral heads .  We established specific indications for the use of these larger heads in primary arthroplasty . There were 65 hips in 61 patients with a minimum followup of 1 year ( mean 2 years , range 1 - 4 years ) . There were 55 36 mm heads and 10 40 mm heads . All arthroplasties were performed by the posterior approach with capsular repair . The prevalence of early dislocation was 4.6 % ( 3 of 65 ) . There was one patient with an anterior dislocation and two with posterior dislocation . No patient underwent reoperation for dislocation . There was no dislocation in the 10 hips that had a 40 mm head . We identified no complications related to the larger femoral heads . The use of larger femoral heads did not notably reduce the prevalence of early dislocation after primary THA in high risk patients compared to historical controls . Therapeutic study : Level IV , case series . See Guidelines for Authors for a complete description of levels of evidence Background  Total hip arthroplasty ( THA )  has been associated with high survival rates , but debate remains concerning the best fixation mode of THA . Questions / purpose sWe conducted a r and omized controlled trial ( RCT ) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation . Patients and Methods Patients were evaluated for revision of either of the components . One hundred twenty-seven patients had died ( 51 % ) and 12 ( 4.8 % ) were lost to followup . The minimum 17-year followup data ( mean , 20 years ; range , 17–21 years ) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation . Results Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA . The cementless tapered stem was associated with a survivorship of 99 % . Age younger than 65 years and male gender were predictors of revision surgery . Conclusions The efficacy of future RCTs can be enhanced by r and omizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs . Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required . A minimum 10-year followup should be anticipated , but this can be expected to be longer if the difference in level of quality between the compared implants is smaller . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND The purpose of the present study was to determine cobalt and chromium ion levels in the blood and urine of patients in whom a modern-generation metal-on-metal hip resurfacing device had been implanted . METHODS A total of ninety-seven patients with a Conserve Plus metal-on-metal hip resurfacing implant  were followed prospect ively for two years . Cobalt and chromium levels in erythrocytes , serum , and urine were measured preoperatively as well as three , six , twelve , and twenty-four months postoperatively . RESULTS The median serum cobalt and chromium ion levels were 1.04 μg/L ( range , 0.31 to 7.42 μg/L ) and 2.00 μg/L ( range , 0.28 to 10.49 μg/L ) , respectively , at one year after surgery and 1.08 μg/L ( range , 0.44 to 7.13 μg/L ) and 1.64 μg/L ( range , 0.47 to 10.95 μg/L ) , respectively , at two years after surgery . The corresponding mean levels ( and st and ard deviations ) of serum cobalt and chromium were 1.68 ± 1.66 μg/L and 2.70 ± 2.22 μg/L , respectively , at one year after surgery and 1.79 ± 1.66 μg/L and 2.70 ± 2.37 μg/L , respectively , at two years after surgery . CONCLUSIONS These levels compare favorably with other published ion results for metal-on-metal hip resurfacing and replacement implants . No pseudotumors or other adverse soft-tissue reactions were encountered in our study population . Further research is needed to determine the clinical importance of increased cobalt and chromium ion levels in serum and urine following metal-on-metal hip resurfacing BACKGROUND The use of cementless , proximally porous-coated femoral stems for total hip arthroplasty has increased in popularity . The purpose of the present report was to examine the five to ten-year results associated with the use of a so-called second-generation circumferentially proximally porous-coated titanium-alloy stem . METHODS Between 1991 and 1994 , 123 Harris-Galante Multilock femoral stems were implanted in 101 patients . The average age of the patients at the time of surgery was 53.8 years . The patients were followed prospect ively and were reevaluated at a minimum of five years postoperatively . No patient was lost to follow-up . Twenty-five patients ( thirty hips ) were interviewed by telephone , and four patients ( five hips ) died during the study period because of problems that were unrelated to the operation . The remaining seventy-two patients ( eighty-eight hips ) had a minimum of five years of clinical and radiographic follow-up . RESULTS The average duration of follow-up was seventy-eight months . At the time of the most recent follow-up , the average Harris Hip Score was 95 points . Eighty-seven ( 99 % ) of eighty-eight stems were biologically stable , with eighty-four hips ( 95 % ) having osseous ingrowth and three hips ( 3 % ) having stable fibrous fixation . One stem was revised because of loosening . Thirty-three hips ( 38 % ) had minimal proximal osteolysis , and no hip had diaphyseal osteolysis . Seventy-two hips ( 82 % ) had some degree of stress-shielding in the proximal metaphysis , but only two hips had cortical resorption . None of these patients required additional surgery , and all reported a satisfactory outcome . CONCLUSIONS Given the young age and high activity level of these patients , this stem fared well : the levels of patient function and satisfaction were high , the rates of loosening and revision were very low , and distal osteolysis did not occur . Osseous fixation occurred reliably . Proximal stress-shielding was seen but did not seem to be clinical ly important This study review s the early clinical experience with the  Birmingham Hip resurfacing system ( Smith & Nephew , Memphis , Tenn ) in the United States since its approval by the FDA . A total of 230 patients were followed for a mean of 16 months ( range , 6 months ) . There was a significant improvement in the mean preoperative Oxford hip score at the latest follow-up ( 44 points [ range , 30 - 58 points ] to 17 points [ range , 12 - 28 points ] ) . The most commonly used femoral component was 50 mm , and the mean duration of the procedures was 95 minutes ( range , 65 - 180 min ) . there were 3 revisions ( 1.3 % ) . Early results are favorable . As with any device , there is a continuing need for longterm monitoring and large-scale epidemiologic surveillance Background : This study was design ed to compare the fixation of a Mallory-Head total hip prosthesis with and without cement . Methods : Two hundred and fifty patients with osteoarthritis of the hip were r and omized to receive a Mallory-Head total hip prosthesis design ed for insertion with cement or the same prosthesis design ed for insertion without cement . Neither the patient nor the outcomes assessor was aware of the type of prosthesis . Outcomes were assessed with respect to mortality , revision arthroplasty , health-related quality of life ( evaluated with the Harris hip score , Merle d'Aubigné and Postel hip score , McMaster-Toronto Arthritis Patient Preference Disability Question naire ( MACTAR ) , Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) , and the time trade-off technique ) , and the six-minute-walk test . Patients were seen at three , six , and twelve months and yearly thereafter . Results : The prosthesis was inserted with cement in 124 patients and without cement in 126 patients . The mean age of the patients was sixty-four years , 48 % were female , and the mean duration of follow-up was 6.3 years . There were thirteen revisions in the group that had fixation with cement and six in the group that had fixation without cement ( p = 0.11 ) , and more femoral components were revised in the group that had fixation with cement ( twelve versus one ; p = 0.002 ) . All health-related quality -of-life measures improved postoperatively in both groups . Conclusions : In this r and omized trial , the group that had the cemented Mallory-Head hip prostheses required more revisions of the femoral component than did the group with the cementless Mallory-Head prostheses , which was perhaps related to the titanium-alloy femoral stem . Our findings are specific to the implants evaluated in this study In a matched-pair study of primary total hip arthroplasty , 45 all-polyethylene cemented acetabular components were compared with 45 cementless , hemispheric , titanium acetabular components .  At 9 to 12 years , 1 of the cemented acetabular components was revised for aseptic loosening , and 14 ( 31 % ) were radiographically loose . Nine ( 20 % ) cemented acetabular components had pelvic osteolysis . In the cementless acetabular component group , 2 well-fixed components were revised . No components were radiographically loose , and 3 ( 7 % ) had pelvic osteolysis . Thirty-eight ( 97 % ) of the patients in each group were satisfied with the surgery . The clinical results of the cemented and cementless components were excellent . The cementless components had less loosening ( P < .001 ) than the cemented components The Anatomique Benoist Girard ( ABG ) I total hip arthroplasty has been widely used in Europe since 1989 . Two recent midterm reports have shown high rates of component failure secondary to polyethylene wear . To further investigate this issue , our study prospect ively follows 157 consecutive primary total hip arthroplasties using the ABG I prosthesis at an average follow-up of 10 years .  Clinical outcomes have been excellent , although the incidence of thigh pain was 7.2 % . Radiographic evaluation of the cup showed eccentric polyethylene wear in 93.6 % of the patients . The average polyethylene linear wear was 2.40 mm , whereas the average annual wear rate was 0.25 mm/y . There were 7 hips ( 5.6 % ) with severe periacetabular osteolysis . Nine revisions were performed for loosening or wear . The overall component survival rate was 92.6 % . The overall survival rate was 92.6 % ( confidence interval , 78.55 - 96.47 ) for the acetabular component and 96.3 % ( confidence interval , 85.67 - 100 ) for the femoral component . Although the clinical and radiographic results of the ABG I total hip arthroplasty in this series have been acceptable , high rates of polyethylene wear , most likely related to sterilization by gamma-irradiation in air , have been the limiting factor in the long-term success of this design Background : Second-generation cementless femoral components were design ed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces . We examined the eight to eleven-year results of total hip arthroplasty with a cementless , anatomically design ed femoral component and a cementless hemispheric acetabular component . Methods : Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating ( Anatomic Hip ) and a cementless hemispheric porous-coated acetabular component ( Harris-Galante II ) were performed in eighty-five patients . These patients were prospect ively followed clinical ly and radiographically . Six patients ( seven hips ) died and five patients ( seven hips ) were lost to follow-up , leaving seventy-four patients ( seventy-eight hips ) who had been followed for a mean of ten years ( range , eight to eleven years ) . The mean age at the time of the arthroplasty was fifty-two years . Results : The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up ; 86 % of the hips had a good or excellent result . Thigh pain was reported as mild to severe after seven hip arthroplasties . No femoral component was revised for any reason , and none were loose radiographically at the time of the last follow-up . Two hips underwent acetabular revision ( one because of dislocation and one because of loosening ) . Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point . The ten-year survival rate was 96.4 % ± 2.1 % for the total hip prosthesis , 100 % for the femoral component , and 96.4 % ± 2.1 % for the acetabular component . Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight ( 93 % ) of the -seventy-three hips with complete radiographic follow-up . Femoral osteolysis proximal to the lesser trochanter was noted in four hips ( 5 % ) . No osteolysis was identified distal to the lesser trochanter . Periacetabular osteolysis was identified in twelve hips ( 16 % ) . Five patients underwent exchange of the acetabular liner because of polyethylene wear . Conclusions : This second-generation cementless , anatomically design ed femoral component provided excellent clinical and radiographic results with a 100 % survival rate at ten years . The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty We conducted a prospect i ve study of the clinical and radiographic variables related to the survival of 114 cementless resurfacing double-cup hip replacements ( RHR ) with a mean follow-up of 9 ( range : 1 - -16 ) years . Three patients died , and 22 were unavailable for the final review in 2003 . Sixty-one RHRs had to be revised to a total hip replacement . Failure analysis of these revised RHRs showed femoral head and neck resorption under the prosthesis in 33 , acetabular protrusion in seven , both femoral and acetabular resorption in 14 and a femoral-neck fracture in three . One hip had dislocated , and there were three hips with unexplained pain . The Kaplan-Meier 5-year mean survival was 92 % , the 10-year survival was 47 % ( 95 % CI 37 - -57 % ) and the 15-year survival was 30 % ( 95 % CI 20 - -40 % ) . Pre-operative joint destruction ( grade 1 ) , a high degree of radiological osteoporosis , a body mass index > 25 and prosthesis mismatch were significantly related to failure of the RHR . We believe that in young , non-obese patients with pre-operative radiological central destruction but without severe proximal femoral osteoporosis , a resurfacing arthroplasty may have some value . Our failures were mainly due to femoral resorption under the prosthetic femoral component Abstract Metal-on-metal total hip resurfacing arthroplasty has had excellent reported results at early to midterm followup , and some studies suggest that outcomes are comparable to conventional THA . We compared the clinical and radiographic outcomes of two closely matched groups of 54 patients who underwent resurfacing and conventional THA , respectively . Each group consisted of 36 men and 18 women who had a mean age of 52 years and a mean body mass index of 29 kg/m2 . At a minimum followup of 24 months ( mean , 40 months ; range , 24–60 months ) , the mean Harris hip scores increased similarly in both groups ( from 52 to 90 points and from 50 to 91 points for the resurfacing and conventional groups , respectively ) . Radiographic outcomes , revision rates , complications , pain scores , and satisfaction ratings of the two groups were similar . The patients who underwent resurfacing had higher postoperative weighted activity scores than the patients who underwent conventional THA , although they had higher preoperative weighted activity scores as well . The early outcomes of resurfacing are comparable to those of conventional THA . Level of Evidence : Level III , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence
target: Conclusions Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing , except when discontinued devices are removed from the analyses .
background: Background Metal-on-metal hip resurfacing was developed for younger , active patients as an alternative to THA , but it remains controversial .
  Study heterogeneity , inconsistent outcome definitions , and unst and ardized outcome measures challenge our ability to compare arthroplasty outcomes studies .
  Questions / purpose sWe asked how early revisions or reoperations ( within 5 years of surgery ) and overall revisions , adverse events , and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA  among patients with hip osteoarthritis .
  Secondarily , we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries .