Richard C. Johnston

The outcome of Charnley total hip arthroplasty with cement after a minimum twenty-year follow-up. The results of one surgeon.

We evaluated the results of 330 total hip arthroplasties that were performed with use of the Charnley prosthesis and cement in 262 patients by the senior one of us between July 1970 and April 1972. All hips had been thoroughly assessed preoperatively to document the patients functional level. All patients had been disabled because of pain in the hip or a fracture of the hip, and 212 patients (81 per cent) had used walking aids. At a minimum of twenty years after the index operation, eighty-three patients (ninety-eight hips) were still living, 174 patients (224 hips) had died, and five patients (eight hips) had been lost to follow-up. The outcome of the arthroplasty was determined for all except the five latter patients. Thus, the outcome of 322 (98 per cent) of the 330 arthroplasties was known at the latest follow-up evaluation. Radiographs were available for sixty-three of the eighty-three patients (seventy-six [78 per cent] of the ninety-eight hips) who were alive for the entire follow-up period. Of the ninety-eight hips in the living patients, eighty-three (85 per cent) caused no pain, fourteen (14 per cent) caused mild pain, and one (1 per cent) caused moderate pain. Fifty-two hips (53 per cent) were in patients who did not use walking aids, and only seven (7 per cent) were in patients who used support for walking because of the hip. At the minimum twenty-year follow-up, thirty-two (10 per cent) of the 322 hips that had been followed had been revised: eight (2 per cent), because of loosening with infection; twenty-one (7 per cent), because of aseptic loosening; and three (1 per cent), because of dislocation. Of the ninety-eight hips of the patients who were still alive, fifteen (15 per cent) had been revised: three (3 per cent), because of loosening with infection; eleven (11 per cent), because of aseptic loosening; and one (1 per cent), because of dislocation. The rate of revision due to aseptic loosening of the acetabular component in all 322 hips was 6 per cent (eighteen hips), while in the ninety-eight hips of the patients who were alive at least twenty years after the arthroplasty, it was 10 per cent (ten hips). The rate of revision because of aseptic loosening of the femoral component in all 322 hips was 2 per cent (eight hips), while in the ninety-eight hips of the living patients, it was 3 per cent (three hips).(ABSTRACT TRUNCATED AT 400 WORDS)

A biomechanical investigation of the human hip

Abstract This paper describes a biomechanical investigation of the human hip during level walking, while climbing and descending stairs, and when rising from a sitting position. Triads of flashing, light-emitting diodes attached to the pelvis, thigh, shank, and foot are photographed by a biplanar technique to generate kinematic data. Kinetic data is collected using a piezoelectric force platform. The inverse dynamics problem associated with the three lower extremity segments is solved for the time variations of the intersegmental force and moment resultants at the hip, knee, and ankle. An optimization technique is used to distribute these resultants to the load-carrying structures in the neighborhood of the hip, and to the two-joint muscles that flex and extend the knee and ankle. Typical results for a group of normal volunteers are presented and discussed.

Posttraumatic osteoarthritis : A first estimate of incidence, prevalence, and burden of disease

Although posttraumatic osteoarthritis (OA) is a common and important entity in orthopedic practice, no data presently exist regarding its prevalence or its relative burden of disease. A population-based estimate was formulated, based on one large institutions experience in terms of its fraction of patients with OA presenting to lower-extremity adult reconstructive clinics with OA of posttraumatic origin. The relative proportion of these patients undergoing total joint replacement provided a basis for extrapolating institutional experience with posttraumatic OA to a populationwide estimate because the numbers of lower-extremity total joint arthroplasty procedures performed were reliably tabulated both within the institution and populationwide. By this methodology, approximately 12% of the overall prevalence of symptomatic OA is attributable to posttraumatic OA of the hip, knee, or ankle. This corresponds to approximately 5.6 million individuals in the United States being affected by posttraumatic OA sufficiently severe to have caused them to present for care by an orthopedic lower-extremity adult reconstructive surgeon. Further, based on the relative prevalence of OA versus rheumatoid arthritis, and their relative impacts as assessed by the SF-36 (Short-Form 36) lower-extremity physical composite scores, about 85.5% of the societal costs of arthritis are attributable to OA. The corresponding aggregate financial burden specifically of posttraumatic OA is

Reconstruction of the hip. A mathematical approach to determine optimum geometric relationships.

3.06 billion annually, or approximately 0.15% of the total U.S. health care direct cost outlay.

Charnley total hip arthroplasty with cement : Minimum twenty-five-year follow-up

The normal mechanical function of the hip is substantially altered by a variety of disorders. The surgical treatment of such conditions, particularly total hip replacement, offers the opportunity not only to replace the articular surfaces of the joint, but also to improve long-term mechanical function by reducing the loads on the joint. A mathematical model of the hip was developed to evaluate the effects of such surgically achievable mechanical alterations as acetabular placement, femoral shaft-prosthetic neck angle, neck length of the femoral prosthesis, and transfer of the greater trochanter. The loads on the hip were lowered significantly by placing the center of the acetabulum as far medially, inferiorly, and anteriorly as was anatomically feasible. Minimum joint contact forces occurred when the femoral shaft-prosthetic neck angles were small, while the minimum moments about the prosthesis stem-neck junction were found when the angles were 130 to 140 degrees. A neck length of the femoral prosthesis of thirty-five millimeters resulted in moments that were lower than those for a neck length of forty-five millimeters. Lateral transfer of the greater trochanter reduced hip-joint forces and moments but distal transfer had little mechanical effect.

Unicompartmental knee replacement. A minimum 15 year followup study.

Background: This report presents the results of the senior authors initial twenty-five-year experience with the use of Charnley total hip arthroplasty with cement. The purpose of this paper was to evaluate the long-term results of total hip arthroplasty. Methods: Between July 1970 and April 1972, the senior author (R. C. J.) performed 330 Charnley total hip replacements with cement using a hand-packing cement technique in 262 patients. Fifty-one patients (sixty-two hips) who were alive at least twenty-five years postoperatively were evaluated from a clinical standpoint with use of a standard-terminology questionnaire. The average age of this group at the time of surgery was fifty-six years (range, thirty-five to seventy-one years) compared with sixty-five years (range, twenty-one to eighty-nine years) for the entire group. All patients were evaluated for radiographic changes at the time of their most recent follow-up. Of the fifty-one patients (sixty-two hips) who were alive at least twenty-five years postoperatively, thirty-one (thirty-six hips) had a follow-up radiograph made at a minimum of twenty-five years after the surgery. The average duration of radiographic follow-up for the fifty-one patients was 22.7 years (range, two to twenty-seven years). Results: Of the sixty-two hips in the fifty-one patients who were alive at least twenty-five years postoperatively, fourteen (23 percent) had been revised. Three (5 percent) had the revision because of loosening with infection; eleven (18 percent), because of aseptic loosening; and none, because of dislocation. The prevalence of revision due to aseptic loosening of the acetabular component in all 316 hips (excluding those that were lost to follow-up or that were revised for infection or dislocation) was 6 percent (eighteen hips), whereas the prevalence in the fifty-nine hips (excluding the three revised for infection) in the patients who were alive at least twenty-five years after the arthroplasty was 15 percent (nine hips). The prevalence of revision because of aseptic loosening of the femoral component in all 316 hips was 3 percent (nine hips), and the prevalence in the fifty-nine hips in the living patients was 7 percent (four hips). In the group of living patients, osteolysis occurred in Gruen zone 1 or 7 in thirty-three hips and in Gruen zones 2 through 6 in two hips. Ballooning acetabular osteolysis occurred in five hips. Of the 327 hips for which the outcome was known after a minimum of twenty-five years, 295 (90 percent) had retained the original implants until the patient died or until the most recent follow-up examination. Of the sixty-two hips in patients who lived for at least twenty-five years after the surgery, forty-eight (77 percent) had retained the original prosthesis. Conclusions: Our follow-up study at twenty-five years following Charnley total hip arthroplasty with cement demonstrates the durability of the results of the procedure. These results should provide a means for comparison with the results of newer cementing techniques as well as those associated with newer cemented and cementless hip designs.

Cemented Rotating-platform Total Knee Replacement: A Concise Follow-up, At A Minimum Of Fifteen Years, Of A Previous Report*

One hundred forty Marmor cemented unicompartmental knee replacements were inserted in 103 patients between 1975 and 1982. Fifty-two patients were women and 51 were men. One hundred twenty-five were medial compartment knee replacements and 15 were lateral knee replacements. At minimum 15 year followup 34 patients with 48 knee replacements were living; only four patients with four knee replacements were lost to followup. Average preoperative and final followup Hospital for Special Surgery knee scores were 57 and 82 points, respectively for the knees of living patients. Average preoperative and final followup Knee Society clinical and Knee Society functional scores were 31 and 42, and 85 and 71 points, respectively. For all knees, 10.2% (14 knees) were revised [4.4% (six knees) for tibial loosening, 5.1% (seven knees) for disease progression, and .7% (one knee) for pain]. For patients living 15 years, 12.5% (six knees) were revised [2.1% (one knee) for tibial loosening, and 10.4% (five knees) for disease progression]. Revision for failure of fixation of these unicompartmental replacements was comparable with that reported for fixed bearing total knee replacement. Disease progression (46%; 62 of 136 knees) and tibial subsidence with wear (10.4%; 15 of 136 knees, five of which required revision) were the major long term problems in this group of patients.

Measurement of Hip-joint Motion during Walking: Evaluation Of An Electrogoniometric Method

We previously evaluated 119 consecutive total knee arthroplasties that were performed in eighty-six patients with use of the cemented LCS (low contact stress) rotating-platform system with an all-polyethylene patellar component. The average age of the patients at the time of surgery was seventy years (range, thirty-seven to eighty-eight years). The purpose of this study was to report the updated results at a minimum follow-up of fifteen years. Thirty-seven patients (fifty-three knees) were living, and no patient was lost to follow-up. No knee was revised because of loosening, osteolysis, or wear. Three knees required a reoperation (two for periprosthetic fractures and one for infection). No component was revised as a part of the reoperations. Osteolysis was present in three knees. No knee had radiographic signs of component loosening, and there were no dislocated bearings. The average range of motion was from 1 degrees of extension to 105 degrees of flexion. The average clinical and functional Knee Society scores were 43 and 49, respectively, at the preoperative evaluation and 85 and 58 at the time of the final follow-up. We concluded that the cemented LCS rotating-platform knee performed well, with durable clinical and radiographic results at a minimum follow-up of fifteen years.

Cemented rotating-platform total knee replacement. A nine to twelve-year follow-up study.

An accurate, simple, and relatively inexpensive method for measuring hip-joint motion during walking with an electrogoniometer has been described. Average motion at the hip joint during walking for thirty-three normal subjects was 52 degrees in the sagittal plane, 12 degrees in the coronal plane, and 13 degrees in the transverse plane. Test-retest measurements for this method resulted in high coefficients of correlation. A typical normal pattern of motion was presented. We believe this method of measurement is practical and valuable for use in the study of hip disease.

Total hip arthroplasty with cement in patients who are less than fifty years old. A sixteen to twenty-two-year follow-up study.

Background: Although the LCS (low contact stress) rotating-platform mobile-bearing knee replacement has been used extensively, there have been few intermediate or long-term clinical and radiographic follow-up studies evaluating the device. The purpose of this study was to report the nine to twelve-year results of a consecutive series of patients who had a primary total knee replacement performed with this device. Methods: Between November 1985 and November 1988, the senior author (R. C. J.) performed 119 consecutive total knee arthroplasties in eighty-six patients with LCS rotating-platform femoral and tibial components and a Townley all-polyethylene dome patellar component. All components were fixed with cement. The average age of the patients at the time of the operation was seventy years (range, thirty-seven to eighty-eight years). Fifty-two patients (seventy-six knees) were female, and thirty-four patients (forty-three knees) were male. The patients were evaluated with clinical knee ratings and radiographic analysis nine to twelve years following the knee replacement. Results: At the time of the nine to twelve-year follow-up, sixty-four patients (eighty-six knees) were alive, eighteen patients (twenty-eight knees) had died, and four patients (five knees) had been lost to follow-up. Of the 114 knees in the eighty-two patients for whom the final outcome was known, none required a reoperation and none had a dislocation of the mobile-bearing prosthesis. For the forty-five patients (sixty-six knees) who returned for final clinical and radiographic follow-up examinations at nine to twelve years, the average clinical and functional Knee Society ratings were 30 points (range, 2 to 70 points) and 44 points (range, 0 to 80 points) preoperatively and 90 points (range, 63 to 102 points) and 75 points (range, 30 to 100 points) at the final follow-up evaluation. The average Hospital for Special Surgery knee rating was 57 points (range, 28 to 80 points) preoperatively and 84 points (range, 59 to 97 points) at the final follow-up evaluation. The average active range of knee flexion was from 0 degrees (range, 0 to 10 degrees) to 102 degrees (range, 15 to 120 degrees) at the final follow-up evaluation. Seven of the sixty-six knees were painful anteriorly. There was no periprosthetic osteolysis and no evidence of loosening on follow-up radiographs. Conclusions: After nine to twelve years of follow-up, the cemented LCS rotating-platform knee replacement was found to be performing well, with durable clinical and radiographic results.