Minimum 5 year follow-up of clinical and radiographic results of cemented acetabular components with an interface bioactive bone cement technique in primary cemented total hip arthroplasty

Survival outcomes of hybrid total hip replacement following failed proximal femoral nail antirotation: a retrospective study with a median 10-year follow-up

Background

This retrospective study evaluates the efficacy of hybrid total hip replacement (THR) in patients aged 50 to 70 years who have experienced failures following proximal femoral nail antirotation (PFNA) procedures. By addressing a significant gap in the current medical literature-characterized by inadequate data and inconsistencies regarding the effectiveness of hybrid THRs in revision settings-this research aims to provide valuable insights into the long-term viability and clinical outcomes of hybrid THR for this demographic.

Methods

In this retrospective observational study, we investigated 185 individuals aged 50 to 70 years who underwent hybrid THRs following PFNA procedures across two specialized Joint Surgery Centers. The primary objective of this study was to evaluate implant longevity, which was assessed using the Kaplan-Meier method, with a particular focus on revision surgeries. Additionally, we aimed to analyze secondary outcomes, including patient-reported experiences quantified by the EuroQol Visual Analogue Scale (EQ-VAS) and the Likert pain scale. Furthermore, this study sought to quantify the rates of major orthopedic complications within this patient cohort.

Results

A total of 124 individuals (124 THRs) were assessed, resulting in a median follow-up duration of 10 years (range: 3-15 years). The 10-year survivorship, defined as the rate of survival without revision for any reason, was found to be 87.1% (78.5%-90.1%). Stratified survival analysis by age groups (50-60 years and 60-70 years) revealed that the 50-60-year group had significantly higher survival rates compared to the 60-70-year group (p = 0.00026). Postoperative pain scores averaged 3.0 (95% CI, 2.9-3.1), indicating a significant reduction in pain. Furthermore, patient satisfaction was high, with an average satisfaction score of 3.7 (95% CI, 3.6-3.8). The mean EQ-VAS score was 77.4 (95% CI, 76.4-78.3), reflecting favorable post-surgical health perceptions. Among the 124 patients, 13 experienced a total of 19 implant-related complications, leading to an incidence rate of 10.4% for major orthopedic complications.

Conclusion

Hybrid THR shows durable efficacy in patients aged 50-70 with failed PFNA, achieving high revision-free survival and improved postoperative outcomes. Younger patients (50-60 years) had superior survival, while Staphylococcus/Enterococcus infections worsened prognosis. Non-infected individuals aged 50-60 achieved optimal 10-year survival. Complications like stem loosening were reduced, but cement degradation and infection risks remain challenges. Future efforts should target age-specific protocols and infection mitigation.

Comparison of clinical and radiographic results of mobile-bearing total ankle arthroplasty between osteoarthritis and rheumatoid arthritis

OBJECTIVES

Clinical results of mobile-bearing total ankle arthroplasty (TAA) for rheumatoid arthritis (RA) have been reported, but no studies have compared osteoarthritis (OA) and RA. Clinical and radiographic outcomes after at least 3 years were compared between OA and RA.

METHODS

Eleven ankles with OA and 22 ankles with RA were followed after mobile-bearing TAA (FINE total ankle system). Clinical outcomes were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic outcomes were evaluated by the angular position of the implant, radiolucent lines, migration, and subsidence. Operative and postoperative complications were assessed.

RESULTS

There were no significant differences in clinical outcomes, radiographic outcomes, or complications, except the final follow-up AOFAS total score (OA: 89.4 vs RA: 78.2; p = .044) and pain score (OA: 37.3 vs RA: 30.5; p = .041) at a mean follow-up of 83.4 months. Delayed wound healing occurred in 9.1% in RA and none in OA. Radiolucent lines were observed in 45% of both groups, and implant removal was performed in 9.1% and 18.2% of OA and RA, respectively; there were no significant differences.

CONCLUSIONS

The final follow-up AOFAS total score and pain score were significantly higher in OA after the FINE total ankle system. There was a discrepancy between radiographic abnormalities and implant removal in both OA and RA.

Implant survival of cemented arthroplasty following failed fixation of proximal femoral fractures in patients aged 30-60 years: a retrospective study with a median follow-up of 10 years

Background

Given the unremitting growth in the volume of failed fixations of proximal femoral fractures (PFFs) in recent years, it is predictable that total hip replacements (THRs) will be the preferred surgical procedure. The long-term survival of cemented THR (CTHR) revisions remains controversial in patients aged 30–60 years. The goal of this retrospective review was to evaluate the 10-year survival of CTHRs following prior failed primary fixations of PFFs in patients aged 30–60 years.

Methods

We retrospectively identified CTHR revisions implemented at four medical centres during 2008–2017 for a failed primary fixation of PFFs in consecutive patients aged 30–60 years. The primary endpoint was implant survival calculated using the Kaplan–Meier method with 95% confidence intervals (CIs); secondary endpoints included functional scores assessed by Harris hip scores (HHS) and main revision-related orthopaedic complications. Follow-up was executed at 1, 2, 3, and 8 years following revision and then at 1-year intervals until the revision, death, or study deadline, whichever occurred first.

Results

In total, 120 patients (120 hips) who met the eligibility criteria were eligible for follow-up. The median follow-up was 10.2 years (range, 8–12 years). Kaplan–Meier survivorship showed that implant survival with revision for any reason as the endpoint was 95% at 5 years (CI: 93–97%), 89% at 8 years (CI: 86–92%), and 86% at 10 years (CI: 83–89%). Patients treated with three hollow screws had better revision-free survival than patients treated with proximal femoral nail antirotation (PFNA), dynamic hip screw (DHS) or titanium plate plus screws (three p < 0.05). Functional scores were apt to decrease gradually, and at the final follow-up, the mean HHS was 76.9 (range, 67.4–86.4). The overall rate of main revision-related orthopaedic complications was 18.3% (22/120).

Conclusion

CTHR implemented following prior failed primary fixations of PFFs tends to afford an acceptable 10-year survival, along with advantageous HHS and a low rate of main revision-related orthopaedic complications, which may support an inclination to follow the utilisation of CTHRs, especially in revision settings for intracapsular fractures.