When a first hip replacement fails, patients may be concerned that their options for a durable hip replacement are limited and that the prognosis is poor. However, a research study to be published in the February issue of the Journal of Bone and Joint Surgery suggests that this may not be the case.
Researchers from Rush University Medical Center examined their results using one of the first cementless metal cup designs and found that fixation of the implant to bone is extremely durable even twenty years after repeat or “revision” hip replacement. The implant utilized, the Harris-Galante-1 acetabular metal shell, which is designed to allow a patient’s bone to grow into the implant, remained fixed in place in 95 percent of hip revision cases at a minimum follow-up of 20 years.
The implant and its bone in-growth surface were originally developed in conjunction with Dr. Jorge Galante, an orthopedic surgeon at Rush University Medical Center and one of the present study’s investigators. The cup’s porous surface allows bone and tissue to grow into the device to keep the hip implant in place. Earlier generation implants relied on the use of bone cement to secure the implant to the patient’s pelvis and were associated with a higher rate of failure, particularly when used in patients who had previously had a hip implant that had failed.
“The study’s results indicate that even the first generation of this device has excellent clinical results and durability,” said Dr. Craig Della Valle, orthopedic surgeon at Rush and study investigator. “Even after 20 years, there is low rate of failure in terms of fixation.”
Researchers previously reported the results of the use of the Harris-Galante-1 cementless acetabular shell for total hip revision procedures in 138 hips at a minimum of three, seven, and fifteen years postoperatively. The current report presents the long-term outcomes of this group at a follow-up of 20 years.
Of the original cohort of 138 hips, researchers were able to follow 73 patients who were still living (77 hips) for 20 years or more. Of the 77 hips, 37 had both clinical and radiographic evaluation, 20 had a clinical evaluation via telephone questionnaire and 21 underwent a repeat revision of the acetabular metal shell.
Twenty of the 21 cementless cups were found to be well fixed at the time of repeat revision and only one had become loose. During the entire study period, four cups were identified radiographically as being loose. For the entire cohort of 138 hips, the 20-year survivorship of the acetabular component was 95 percent.
While the long-term fixation of the device performed very well, the study did find an increased rate of repeat surgery for wear-related complications compared to the 15-year report. Ten patients, or 18 percent, had a complication related to wear of the bearing surface as opposed to 3 percent at 15 years.
“Although we have seen more complications related to wear as we have continued to follow these patients, our studies have taught us valuable lessons regarding failure mechanisms and how to avoid them,” said Della Valle.
Despite the increasing prevalence of wear-related problems, the main modes of failure were infection and recurrent dislocations. The study authors recommend the use of larger diameter femoral heads and more wear-resistant bearings to decrease the risks of these complications.
“We can continue to make vast improvements in the quality of bearing and stability in the next generation of devices used in total hip replacements with the information we have gathered from this study,” said Galante. “More and more patients are living longer and we must continue to further develop sustainable devices that will give patients a better quality of life.”
Rush University Medical Center’s orthopedics program ranks tenth in the nation, according to U.S. News & World Report. Physicians from Rush serve as the team physicians for the Chicago Bulls and the Chicago White Sox. For more information on orthopedics at Rush, visit http://www.rush.edu/rumc/page-R11726.html or call (888) 352-RUSH.
Rush University Medical Center is an academic medical center that encompasses the more than 600 staffed-bed hospital (including Rush Children’s Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,730 students, is home to one of the first medical schools in the Midwest, and one of the nation’s top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.
Deborah Song | EurekAlert!
Norovirus evades immune system by hiding out in rare gut cells
12.10.2017 | University of Pennsylvania School of Medicine
Flexible sensors can detect movement in GI tract
11.10.2017 | Massachusetts Institute of Technology
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.
It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...
17.10.2017 | Event News
10.10.2017 | Event News
10.10.2017 | Event News
17.10.2017 | Life Sciences
17.10.2017 | Life Sciences
17.10.2017 | Earth Sciences