Mean 16-Year Results of Total Hip Arthroplasty With Alumina Ceramic Femoral Heads on Highly Cross-Linked Polyethylene in Patients 50 Years or Less.

BACKGROUND: Highly cross-linked polyethylene (HXLPE) is a widely used bearing surface in total hip arthroplasty (THA); long-term results in young patients are limited. We previously demonstrated excellent results in HXPLE on cobalt-chrome femoral heads at 15-year mean follow-up. The purpose of the present study was to investigate polyethylene wear rates, implant survivorships, wear-related revisions, and patient-reported outcomes (PROs) in a young patient cohort who had alumina ceramic on HXPLE coupling at an average 16-year follow-up. METHODS: This was a retrospective study of 128 hips that underwent THA with HXLPE on alumina ceramic bearings between March 1, 2004, and April 15, 2007. The patient's mean age was 38 years (range, 13 to 50). All THAs utilized HXPLE liners with alumina ceramic heads. The University of California, Los Angeles activity score and modified Harris hip scores were collected preoperatively and at each follow-up. Martell hip analysis suite was used for wear calculations. RESULTS: At average 16 years (range, 13 to 18), aseptic revision survivorship was 93.3% and osteolysis/wear survivorship was 99.2%. The mean linear wear rate was 0.0191 mm/year and mean volumetric wear rate was 19.43 mm3/y, both of which were clinically undetectable. We observed excellent PROs with a significant increase in mean modified Harris hip scores (43.6 to 87.4, P < .0001) and the University of California, Los Angeles activity scores (4.0 to 6.0, P < .0001). There were no statistically significant differences in PROs or wear rates between ceramic and cobalt-chrome groups. CONCLUSION: At a mean 16-year follow-up, young patients who had HXLPE on ceramic coupling had excellent wear properties, PROs, and acceptable survivorships.

Presentation Coagulopathy and Persistent Acidosis Predict Complications in Orthopaedic Trauma Patients.

OBJECTIVES: To evaluate the ability of measures of coagulopathy and acidosis to predict complications. We hypothesize that increased coagulopathy and acidosis over the first 60 hours of hospitalization will result in increased rates of infection and mortality. DESIGN: Prospective, observational. SETTING: Level 1 trauma center. PATIENTS: Three hundred seventy-six skeletally mature patients with an Injury Severity Score greater than 16, who were surgically treated for high-energy fractures of the femur, pelvic ring, acetabulum, and/or spine. MAIN OUTCOME MEASUREMENTS: Data included measures of acidosis, pH, lactate, and base excess, and measures of coagulopathy, Prothrombin (PT), Partial Throunboplastin Time (PTT), International Normalized Ratio (INR), and platelets. Complications including pneumonia, deep venous thrombosis, pulmonary embolism, infection, organ failure, acute renal failure, sepsis, and death were documented. RESULTS: Acidosis was common on presentation (88.8%) and decreased over 48 hours (50.4%). Incidence of coagulopathy increased over 48 hours (16.3%-34.3%). Coagulopathy on presentation was associated with complications (54.0% vs. 27.7%) including pneumonia, acute renal failure, multiple organ failure, infection, sepsis, and death. Acidosis was associated with complications if it persisted later in the hospital course. CONCLUSION: Coagulopathy on presentation is a stronger predictor of complications, sepsis, and death than acidosis. During the first 48 hours, unresolved acidosis increased the risk of complications and sepsis. Complications were most related to higher Injury Severity Score. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.