Carlton G. Savory

The Porous-Coated Anatomic Total Hip Prosthesis, Inserted without Cement. A Prospective Study with a Minimum Ten Years of Follow-up*

One hundred consecutive primary total hip arthroplasties performed with use of a porous-coated anatomic total hip prosthesis, fixed without cement, in ninety-one patients were followed prospectively for a minimum of ten years. At the time of the most recent follow-up, twenty patients (twenty-three hips) had died and seventy-one patients (seventy-seven hips) were living. The average age of the living patients was sixty-six years (range, thirty-two to ninety-two years), and their average Harris hip score was 84 points (range, 33 to 100 points). Twelve percent (nine) of the seventy-seven hips were found to be associated with pain in the thigh when the patients were specifically questioned by the examiner. Eleven hips were revised during the follow-up period. Only the acetabular component was revised in six hips, only the femoral component was revised in one hip, and both the femoral and the acetabular components were revised in four hips. Of the ten acetabular revisions, one was performed because of acute dissociation of the component and eight, because of a combination of polyethylene wear, osteolysis, and loosening; the tenth acetabular revision consisted of exchange of the liner and curettage and bone-grafting of the osteolytic area. Of the five femoral revisions, two were performed because of loosening and three, because of extensive osteolysis of the proximal aspect of the femur. Including the revised components, twelve acetabular components and five femoral components had radiographic evidence of aseptic loosening. Acetabular osteolysis occurred in seventeen hips. Femoral osteolysis occurred in thirty-nine hips: in the proximal aspect of thirty-one hips, in the distal aspect of four, and in both the proximal and the distal aspect of four. The durability of the femoral fixation documented in this study is especially encouraging in view of the fact that this was our initial experience with devices fixed without cement and that a so-called first-generation femoral component was used. However, the study also demonstrated that not all acetabular components fixed without cement function well over the long term and that specific design considerations (adequate initial fixation, congruency between the liner and the shell, an optimum shell-liner capturing mechanism, and a smaller femoral head) are warranted.

Results of porous-coated anatomic total hip arthroplasty without cement at fifteen years: a concise follow-up of a previous report.

Abstract: The purpose of this study was to update the results of a prospective series of primary cementless total hip arthroplasties after a minimum of fifteen years of follow-up. It is one of the first studies of cementless total hip arthroplasties followed for a minimum of fifteen years.One hundred consecutive Porous Coated Anatomic (PCA) total hip replacements were implanted between October 1983 and January 1986. Fifty-five patients (sixty-four hips) that were alive at a minimum of fifteen years postoperatively are the focus of the present study. At this time of follow-up, at an average of 15.6 years (range, fifteen to seventeen years) after the total hip arthroplasty, 17% (seventeen hips) of the entire cohort and 23% (fifteen hips) of the living cohort had undergone revision because of loosening of the acetabular component or osteolysis. Seven percent (seven hips) of the entire cohort and 6% (four hips) of the living cohort had undergone revision for loosening of the femoral component or osteolysis. Only four femoral stems had been revised for isolated loosening (without osteolysis).The PCA femoral component proved to be durable at a minimum of fifteen years postoperatively, while the acetabular component was less durable.Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Evaluation of the learning curve associated with uncemented primary porous-coated anatomic total hip arthroplasty

The results of the first and second groups of 50 consecutive primary, uncemented porous-coated anatomic arthroplasties were analyzed to evaluate the learning curve associated with the procedure. Femoral fit, acetabular cup angle, femoral fracture rate, minimum two-year clinical hip ratings, and clinical symptoms were compared between the two groups. Significant improvement in achieving better femoral canal filling with the prosthesis and lower acetabular cup angle placements was documented in the second 50 cases. Although a definite learning curve in mastering the technique of uncemented total hip arthroplasty was observed, thigh pain rate and clinical ratings were not improved after two years.

A prospective comparison study of double contrast computed tomography (CT) arthrography and arthroscopy of the shoulder.

Thirty consecutive patients who underwent double con trast CT arthrography prior to shoulder arthroscopy were prospectively studied. Results from both studies were recorded with the radiologist blinded to the ar throscopic findings when making the final CT reading. The sensitivity, specificity, and accuracy, respectively, of CT arthrography findings compared to arthroscopy were 50%, 100%, 96% for rotator cuff; 66%, 100% 96% for bicipital labral complex; 100%, 100%, 100% for loose bodies; 50%, 100% 93% for Hill-Sachs le sions ; 90%, 73%, 83% for anterior labral defects; and 100%, 100%, 100% for posterior labral defects. We conclude that shoulder arthroscopy accurately deline ates abnormalities of the anterior and posterior labrum, bicipital labral complex, rotator cuff, joint synovium, and humeral head. CT arthrography accurately delineates capsular redundancy, loose bodies, hardware around joints, and bony glenoid rim abnormalities.

Nonoperative treatment of a postoperative fracture around an uncemented porous-coated femoral component

Ipsilateral femur fractures in patients who have had cemented total hip arthroplasty is an infrequent and hazardous complication. Operative treatment has been specifically recommended for type II fractures (those extending from the proximal portion of the femur shaft to beyond the distal tip of the prosthesis) because of the predictably unsatisfactory results with nonoperative treatment. The authors report the successful nonoperative treatment of a postoperative fracture around an uncemented porous-coated femoral component. They recommend nonoperative treatment for minimally displaced type II femoral shaft fractures around uncemented porous-coated prostheses.

Cardiac isoenzyme values after total joint arthroplasty.

The purpose of this study was to prospectively determine what effect total joint arthroplasty had on the myocardial-associated isoenzymes of serum creatine kinase (CK-MB) and lactate dehydrogenase (LD-1:LD-2). Fifty patients treated with total joint arthroplasty of the hip or knee had isoenzyme determinations using automated spectrophotometry and agarose gel electrophoresis. Skeletal muscle injury associated with the trauma of surgery resulted in significant elevations of the absolute value of CK-MB; however, the percentage of CK-MB comprising total CK activity and LD-1:LD-2 did not rise significantly in patients who did not experience postoperative myocardial infarction. It is important to determine both serum CK-MB and LD-1:LD-2 in suspected postoperative myocardial infarction since false positive elevations of CK-MB can occur. Elevations of CK-MB exceeding 50 International Units/liter or 5% of the total CK activity combined with LD-1:LD-2 exceeding 1.0 should not be attributed to skeletal muscle injury alone following total joint arthroplasty of the hip or knee.