Hip Pelvis.  2013 Mar;25(1):21-29. 10.5371/hp.2013.25.1.21.

Simultaneous Bilateral Cementless Total Hip Arthroplasty: a Minimum 17-year Follow-up Study - Comparison Study with Unilateral Cementless Total Hip Arthroplasty -

• Hwang SK
• Park JH
• Yoon WS
• Cha JH

• KMID: 1425032
• DOI: http://doi.org/10.5371/hp.2013.25.1.21

Abstract

PURPOSE
Long-term follow-up results of concurrent bilateral or unilateral cementless hip arthroplasty were compared.
MATERIALS AND METHODS
Forty eight and 49 patients with concurrent bilateral and unilateral hip artrhoplasties who had more than a 17-year follow-up time were selected. At final follow-up, mean ages were 69.1 and 66.7 years old in the bilateral and unilateral groups, respectively. Mean follow-up times were 21.5 and 22.4 years in the bilateral and unilateral groups, respectively. Clinical results were attained using Harris hip score and standardized anteroposterior and lateral view X-rays.
RESULTS
The bilateral group had mean Harris scores of 44.3(standard deviation 3.78) preoperatively, and 81.2 (10.75) at final follow-up. For the unilateral group, the mean scores were 46.5(3.27) preoperatively, and 80.1 (12.05) at final follow-up. At final follow-up, an acetabular cup was securely located in 78.9% and 82.8% of the bilateral and unilateral groups, respectively, and all cases showed firm fixation of the femoral stem in both groups. Osteolysis around the cup and stem were found in 26.3% and 31.4% of the bilateral group and 16.6% and 17.1% of the unilateral group, respectively. Polyethylene wear rate was 0.17 mm/yr and 0.16 mm/yr in the unilateral and bilateral groups, respectively. Using the Kaplan-Meier method, 17-year survival rates for cup and stem were 78% and 89% in the bilateral group, respectively, and 78% and 86% in the unilateral group, respectively.
CONCLUSION
In 17-year long-term follow-up, concurrent bilateral hip arthroplasty was insignificantly different clinically and radiologically from the result of unilateral hip arthroplasty.

Keyword

Bilateral; Total hip arthroplasty; Cementless

MeSH Terms

Arthroplasty
Follow-Up Studies
Hip
Humans
Osteolysis
Polyethylene
Survival Rate
Polyethylene

Figure

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  Fig. 1 (A) The radiograph of 42-years-old male shows hip joint osteoarthritis bilaterally. (B) The immediate postoperative radiograph shows good press fit. (C) The Anteroposterior radiograph made 6 years after total hip surgery shows good position of prosthesis. (D) The radiograph taken 19 years later after surgery shows osteolysis bilaterally on acetabuar DeLee and Charnley Zone I and femur Gruen zone I. Acetabular cup angle was changed 35° to 60° and severe wear with femoral head superior migration was observed on Lt. acetabulum.

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  Fig. 2 (A) The radiograph of 43-years-old male shows hip joint avascular necoresis bilaterally. (B) The radiograph made after postoperative 9 years show good position. (C), (D) The radiograph after postoperative 25 years and 27 years show good position and no osteolysis and loosening.

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  Fig. 3 (A) The radiograph of 37-year-old male shows collapse of the both femoral head. (B) The immediate postoperative radiograph shows good position of prosthesis. (C) After 6 years, radiograph shows osteolysis around left acetabular and femoral component. (D) The acetabular and femoral component was revised. During the operation, there was a intertrochanter fracture and wiring was done. (E) The radiograph taken 6years later after revision shows bony union was observed on left intertrochanter area. (F) The radiograph taken 18 years later after primary surgery shows no osteolysis.

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  Fig. 4 Survivorship curves derived with Kaplan-Meier method with a 95% CI, revision for any reason was chosen as the end point. The survivorship probabilities for bilateral any revision as end points (17 years) was 68% (95% CI, 62-71%), unilateral any revision was 66% (95% CI, 59-69%), bilateral femoral revision was 89% (95% CI, 81-93%), unilateral femoral revision was 84% (95% CI, 78-88%), bilateral acetabular revision was 78% (95% CI, 70-83%), unilateral acetabular revision was 79% (95% CI, 72-85%).

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