Uncemented total hip arthroplasty using alumina ceramic bearings at a minimum of 14 years of follow-up.

INTRODUCTION: The effectiveness of modern ceramic bearings has been well established in reducing the osteolysis associated with wear of the bearing surfaces in total hip arthroplasty (THA). However, there are limited mid- to long-term follow-up data for complications associated with ceramic bearings. MATERIALS AND METHODS: This case series analyzed 124 consecutive primary uncemented THAs in 108 patients with a mean age of 61 years using alumina ceramic-on-alumina ceramic bearing couples. Seventy THAs (56%) were evaluated at a minimum 14 years of follow-up; the mean follow-up period was 16 ± 1 years (14-20 years). Kaplan-Meier survivorship was determined with revision surgery for any reason as the end point. Complications were recorded focusing on osteolysis, ceramic fracture, and abnormal sounds until the final follow-up. Clinical data were scored according to the Merle d'Aubigne and Postel hip score at 14 years after THA. RESULTS: The survivorship was 93.5% (95% CI 86.7-97.0%) at 14-years postoperatively. Five patients (4.0%) underwent revision surgery due to instability or infection before 1-year postoperatively. Two patients (1.6%) underwent revision surgery due to ceramic liner fracture at 9- and 12-years postoperatively, respectively. There was no radiographic evidence of osteolysis. A total of 27 complications occurred: dislocations (n = 7/124), squeaking sounds (n = 3/124), clicking sounds (n = 6/124), ceramic liner fractures (n = 2/124), periprosthetic fractures (n = 4/124), deep infections (n = 2/124), transient sciatic nerve palsy (n = 2/124), and femoral stem breakage (n = 1/124). The Merle d'Aubigne and Postel hip score was 16.8 ± 1.4 points. CONCLUSIONS: The survivorship analysis demonstrates the uncemented THA using alumina ceramic bearings may provide favorable clinical outcome and can offer minimal wear at a minimum 14-year follow-up. Revision surgery was mostly required due to instability and infection in the short-term, and implant breakage in the mid- to long-term.

Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out.

BACKGROUND: Fixed angle sliding hip screw devices allow controlled impaction between the head neck fragment and the femoral shaft fragment in the surgical treatment of pertrochanteric fractures. This study was performed to evaluate the frequency and pattern of comminution at the fracture site, which may prevent the intended impaction. MATERIALS AND METHODS: Three-dimensional computed tomography was used to investigate 101 pertrochanteric fractures treated with fixed angle sliding hip screw devices, with emphasis on the comminuted cortex. A comminuted fracture was defined as a fracture that had a third fracture fragment at the main fracture line. RESULTS: There were 40 fractures without comminution and 61 with comminution. All 61 comminuted fractures had a comminuted posterior cortex, and 3 of 61 fractures also had comminution at the anterior cortex. The prevalence of cutting out of the implant from the femoral head was significantly higher in cases involving comminution at both the posterior and anterior cortices than in cases involving comminution only at the posterior cortex (66.7 % and 3.4 %, p < 0.0001). CONCLUSION: The posterior cortex was comminuted in 60.4% of pertrochanteric fractures and the anterior cortex in 3.0%. Intended impaction at the fracture site could not be obtained at any cortex in cases with comminution at both the anterior and posterior cortices; comminution at the anterior cortex may be a predictor of cutting out.

High tibial osteotomy using two threaded pins and figure-of-eight wiring fixation for medial knee osteoarthritis: 14 to 24 years follow-up results.

BACKGROUND: High tibial osteotomy (HTO) is an established surgical treatment for medial knee osteoarthritis (OA). Several studies have reported the deterioration of clinical results with time, especially after more than 10 years. The purpose of this study was to evaluate the long-term results after HTO using our originally developed fixation method and to clarify the factors affecting the long-term clinical outcome. METHODS: Sixty-eight HTO treatments in 55 patients were evaluated. Eighteen patients were unable to be analyzed, thus reducing the study to 48 knees in 37 patients. The follow-up rate of the knee joint was 70.6% and the mean follow-up period was 17.1 years. The first evaluation was performed at a mean of 6.5 years postoperatively, and the most recent evaluation was done at more than 10 years postoperative follow-up. A closing-wedge osteotomy was performed, and the osteotomy site was fixed with two threaded pins and a figure-of-eight wiring technique. The Japanese Orthopaedic Association knee rating score (JOA score) was used for the clinical assessment. The change of the femorotibial angle (FTA) and progression of knee OA were radiographically analyzed. The whole knees were subsequently divided into two groups, satisfactory group and unsatisfactory group, according to the JOA score at the most recent follow-up. RESULTS: The mean JOA score was 59.1 before HTO and 83.1 at the most recent evaluation. In comparing the satisfactory and unsatisfactory groups, the JOA score before HTO was the same, but the JOA score of the unsatisfactory group was significantly lower at the first evaluation. The FTA in the unsatisfactory group was the same as in the satisfactory group preoperatively, but it was significantly larger after HTO. The radiographic OA was significantly progressed at the most recent evaluation, but no difference was observed in the distribution of the preoperative OA grade between the two groups. CONCLUSIONS: HTO with two threaded pins and figure-of-eight wiring fixation showed an acceptable clinical outcome, but careful attention was needed for correction loss in early postoperative periods. In addition, the proper correction angle is necessary in order to achieve satisfactory long-term results.