The long-term outcome of the cemented Weber acetabular component in total hip replacement using a second-generation cementing technique

Clinical and functional outcomes of total hip arthroplasty in patients with cerebral palsy: A systematic review

Hip joint subluxation and dislocations are very common in cerebral palsy (CP) patients and are directly related to a patient's degree of spasticity. Hip dislocation and subluxation leads to hip pain and difficulty in hygiene maintenance by a caregiver. Most cases require surgical intervention to improve the quality of life in these patients. For many years pelvic and proximal femoral osteotomies with soft tissue releases were the mainstay of treatment for affected hips in CP patients. Recently, hip arthroplasty has been proposed as a very successful operation which provides a pain free and mobile joint in CP patients. The purpose of this review is to evaluate the current evidence for effectiveness of total hip arthroplasty in CP patients.

Cementation technique for elbow arthroplasty; an international survey

Background

Modern cementation techniques have markedly improved survivorship in lower limb arthroplasty, which have been heavily researched in the hip and knee but less so for upper limb procedures. Aseptic loosening is a leading cause of failure in total elbow arthroplasty (TEA) which could be related to the quality of cementation. The aim of this study was to investigate the cementation techniques used for TEA among practicing elbow surgeons.

Methods

An electronic questionnaire was emailed to members of the British elbow and shoulder society (BESS) and PubMed identified experts. Questions focused on the type of prosthesis, operative rates for elective and trauma cases, nature of cement used, canal preparation and cement insertion. Opinions regarding satisfaction with current techniques and mantle quality were also collected.

Results

A total of 26 surgeons completed the questionnaire. The Coonrad-Moorey was the most popular device amongst respondents. Most cemented both components, used antibiotic loaded cement, washed the canal with saline and inserted the cement retrograde. There was wide variation in cementation techniques used for the humerus and ulna, particularly regarding cement preparation, insertion, and use of a restrictor and pressurisation.

Conclusion

Modern cementation techniques are not being utilised in TEA which could be contributing to implant loosening rates and longevity.

Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second- and third-generation techniques

BACKGROUND

Techniques of cemented total hip arthroplasty have developed over time. We present the outcomes of Charnley total hip arthroplasty performed using improved second- and third-generation cementing techniques.

METHODS

We reviewed the radiologic results of 91 Charnley total hip arthroplasties performed using second- and third-generation cementing techniques. Second-generation techniques involved making multiple anchor holes, a double-cementing method on the acetabular side and an intramedullary plug, and retrograde filling with a cement gun on the femoral side in 57 hips. Third-generation techniques involved additional vacuum mixing and cement pressurization in 34 hips.

RESULTS

Joint survival rates at 20 years when using second-generation techniques were 89% for the socket and 94% for the stem with aseptic loosening as the end point; the survival rates at 10 years when using third-generation techniques were 97 and 100%, respectively. According to our radiographic evaluation system for the clear zone at 5 years, there was less clear zone in the acetabular side with the third-generation techniques than with second-generation techniques. In the femoral side, there was very little development of the clear zone, but the difference between generations was not significant.

CONCLUSIONS

Second- and third-generation cementing techniques showed excellent survivorship. The clear zone scores at 5 years indicated that third-generation techniques were effective, especially in the acetabular side, and may produce better long-term results than second-generation techniques.

Long-term followup of total hip arthroplasty in patients with cerebral palsy

BACKGROUND

Patients with cerebral palsy (CP) are at risk for hip arthrosis secondary to the loss of joint congruity.

QUESTIONS/PURPOSES

We asked whether THA relieved pain, improved function, and provided durable improvements.

METHODS

We retrospectively identified 56 patients (59 hips) with CP who had THAs for painful hips. Chart review determined the preoperative, postoperative, and current functional levels. All patients or caregivers completed a questionnaire, including a modified Gross Motor Function Classification System mobility scale and qualitative reports of pain and satisfaction. Pain levels were measured on a visual analog scale at three times: preoperative, postoperative, and current. The average age of the patients at the time of surgery was 30.6 years. Minimum followup was 2 years (average, 9.7 years; range, 2-28 years).

RESULTS

Pain relief was obtained in all patients. All patients returned to preoperative function (59) and 52 patients returned to prepain functional status (88%). Seven patients underwent acetabular component revisions, and two patients had a femoral stem component revision. The 2-year implant survival was 95%, and 10-year survivorship was 85%.

CONCLUSIONS

THA can provide durable relief and improved function in patients with CP with severe coxarthrosis.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.