J Korean Orthop Assoc.  2018 Dec;53(6):490-497. 10.4055/jkoa.2018.53.6.490.

Cementless Total Hip Arthroplasty Using Ceramic Femoral Head on Cross-Linked Ultra-High-Molecular Weight Polyethylene Liner in Patients Older than 65 Years: Minimum Five-Year Follow-Up Results

• Yun HH
• Cheong JY
• Sim HB
• Park JH

• KMID: 2430055
• DOI: http://doi.org/10.4055/jkoa.2018.53.6.490

Abstract

PURPOSE
To evaluate the utility of ceramic-on-polyethylene articular bearing surface when cementless total hip arthroplasty is performed in patients older than 65 years through an analysis of the minimum five-year follow-up results using the ceramic femoral head and cross-linked polyethylene liner.
MATERIALS AND METHODS
From March 2010 to September 2012, 51 patients (56 hips) who were older than 65 years were enrolled in this retrospective study. The mean age at surgery was 70.9±5.1 years old. A clinical assessment was analyzed using the Harris hip score. For the radiographic assessment, the cup inclination and anteversion, stem alignment, and wear amount were measured. The postoperative complications were also determined.
RESULTS
The mean Harris hip score was improved from preoperative 48 points to postoperative 87 points (p < 0.05). The mean cup inclination was 40.9°±6.4° and the mean cup anteversion was 20.3°±8.1°. The mean cup anteversion of the elevated liner-used group (16 cases) was 14.3°±7.9° and the mean cup anteversion of the neutral liner used group (40 cases) was 22.4°±9.1° (p < 0.05). The mean stem alignment angle was 0° (range, varus 4°-valgus 4°). The mean linear wear amount was 0.458±0.041 mm and the average annual linear wear rate was 0.079±0.032 mm/yr. Six cases (10.7%) of intraoperative periprosthetic femoral fractures were encountered.
CONCLUSION
Based on these results, the use of a ceramic-on-polyethylene articular bearing surface in elderly patients with cementless total hip arthroplasty is beneficial. On the other hand, careful effort is needed to prevent intraoperative periprosthetic femoral fractures.

Keyword

total hip arthroplasty; artificial bearing surface; ceramic femoral head; cross-linked polyethylene liner

MeSH Terms

Aged
Arthroplasty, Replacement, Hip*
Ceramics*
Femoral Fractures
Follow-Up Studies*
Hand
Head*
Hip
Humans
Polyethylene*
Postoperative Complications
Retrospective Studies
Polyethylene

Figure

• 

  Figure 1 (A) Preoperative radiography of a 75-year-old male shows osteoarthritic changes in the left hip joint. (B) Radiograph taken 6 years after total hip arthroplasty using a ceramic-on-polyethylene articular bearing surface shows no abnormal finding around the acetabular cup and femoral stem.

• 

  Figure 2 Postoperative 3 months (left side) and postoperative 6 years (right side) hip anteroposterior radiographs. Taking note of the overlay pattern on the left side, an attempt was made to move the other set of the acetabular templates to the right side, and match the same colored circle to the margin of the acetabular cup on the left side.

• 

  Figure 3 Direct measurements can be taken from the PowerPoint normal working window at 400% magnification. In this case, the black circle has moved below the white circle and the liner wear amount was 0.432 mm, as measured using a digital caliper. Therefore, the annual linear wear rate was 0.432 mm/5.75 yr=0.075 mm/yr.

• 

  Figure 4 (A) Preoperative radiography of a 73-year-old female shows advanced avascular necrosis of the left femoral head. (B) Radiograph and computed tomographic images taken 3 days after surgery shows TL and B1 intraoperative periprosthethic femoral fracture. Acetabular cup anteversion was 5° and a 10° elevated liner was used. (C) Radiograph taken 5 years after total hip arthroplasty shows no subsidence of the femoral stem and healing of the fracture sites.

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