We assessed 90 total hip arthroplasties (THAs) performed with the Metasul metal-on-metal hip system (Zimmer, Warsaw, Indiana); the patients were monitored for >10 years. The average Harris Hip Score of the patients was 40.5 points preoperatively and 85.8 points at final follow-up. No adverse reactions to the metal debris were observed in patients presenting with symptoms or phenomena such as unexplained pain, joint effusion, bursitis, or pseudotumor. Radiographically, the acetabular component fixation was stable in 86 hips, possibly unstable in 3 hips, and unstable in 1 hip. The unstable hip required revision of the acetabular component. The femoral component was bone-ingrown in 81 hips and stable-fibrous in 9 hips. Distal femoral cortical hypertrophy was seen in 34.4% of hips.Postoperatively, 6 hips dislocated, of which 2 developed recurrent dislocation and required revision of the acetabular component. Dissociation of the polyethylene liner occurred in 2 hips 6 and 12 years postoperatively, respectively, and required revision of the polyethylene liner and the articular head. The survival rate with the endpoint defined as revision surgery and radiologic loosening was 94.4% at mean follow-up (12.3 years). This study found that the Metasul metal-on-metal THA produces excellent long-term results.

We compared the results of 1-stage uncemented bilateral total hip arthroplasty (THA) performed in 49 patients (98 hips) with those of 2-stage uncemented bilateral THA performed during the same hospital stay in 40 patients (80 hips). There was no significant difference in mean Harris Hip Score preoperatively and at final follow-up between the 2 groups. Radiographic evaluation of patients in the 1-stage group revealed the acetabular component was stable in 95 hips and possibly unstable in 3. The femoral component was bone-ingrown in 91 hips and stable fibrous in 7. In the 2-stage group, the acetabular component was stable in 77 hips and possibly unstable in 3. The femoral component was bone-ingrown in 71 hips and stable fibrous in 9. In both groups, no patients exhibited clear signs of loosening, migration or osteolysis.In the 1-stage group, postoperative dislocation occurred in 2 hips and 1 patient had developed deep venous thrombosis and pulmonary embolism. In the 2-stage group, no complications were observed. The incidence of complications was not significantly different between the 2 groups.There was no significant difference in the total blood loss and mean hemoglobin level preoperatively and at discharge between the 2 groups. However, in the 1-stage group, operative time, intraoperative blood loss, procedure cost, and hospital stay were significantly reduced compared with the 2-stage group. Therefore, 1-stage bilateral THA is a safe and effective option for patients with significant arthritic disease of both hips.

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BackgroundKnee size and body size differ in Asians compared with Caucasians. Nevertheless, many total knee arthroplasty (TKA) prostheses used worldwide are made for Western Caucasian subjects. As a result, an Asian's knee might not fit these prostheses. We studied the Flexible Nichidai Knee (FNK) system, a new model of TKA for Asian patients. The purpose of this report is to investigate the outcomes of this prosthesis retrospectively.MethodsWe investigated 1055 primary TKAs in 595 patients who underwent FNK for osteoarthritis (OA) in Japan and were followed for > 5 years. The knee score and function score were used for clinical evaluation. We examined the range of motion (ROM) preoperatively and at final follow-up and radiographic assessments. In addition, postoperative complications were investigated. A survivorship analysis was also conducted using two endpoints: revision for any reason and aseptic failure.Results890 knees in 502 patients were available for study (follow-up rate of 96.0%). The mean follow-up term was 8.3 years (range, 5.0-14.1 years). The knee and function score significantly improved from 41.3 to 90.3 and from 39.1 to 76.2 points, respectively (p < 0.001). The mean ROM in FNK posterior cruciate retaining (CR) type and FNK posterior-stabilized (PS) type ameliorated significantly from 107.8° and 95.6° to 110.7° and 110.4°, respectively (p < 0.01). Ten knees underwent revision surgery (infection in 3 cases, instability in 2, loosening in 2, and non-union of femoral supracondylar fracture, severe pain, and recurrent hemarthrosis in 1 each). The survivorship rate was 99.4% (95% CI, 99.0-99.8) at 5 years (n = 952 patients at risk) and 96.2% (95% CI, 91.9-100) at 12.5 years (n = 49 patients at risk).ConclusionThe FNK prosthesis for Asians achieved excellent mid- to long-term survivorship and clinical results.

The goal of this study was to evaluate the long-term survivorship of primary cementless total hip arthroplasty (THA) using Harris-Galante porous I acetabular and Harris-Galante porous femoral components. From July 1985 to December 1991, we performed primary cementless THA on 76 hips (70 patients). Twenty-nine patients (31 hips) died due to causes unrelated to the THA, and 6 patients (7 hips) were lost to follow-up. Of 76 hips (70 patients) studied, 38 hips (35 patients) were available for follow-up at a mean 22.5 years (range, 19-25 years) postoperatively. Mean patient age at index procedure was 51.2 years (range, 42-65 years). Average Harris Hip Score was 40.5 points preoperatively and 85.8 points at final follow-up. No patient had an early or late postoperative deep infection. Radiographically, the acetabular component fixation was stable in all 38 hips. The femoral component was bone-ingrown in 26 hips, stable-fibrous in 10, and unstable in 2. One unstable hip required revision of the femoral component. Dissociation of the polyethylene liner occurred in 3 hips without fractures of the metal locking tines and required revision of the polyethylene liner and the articular head. A total of 4 hips had documented revision, and 1 femoral component failed radiographically. The survival rate with the endpoint defined as revision surgery and radiographic loosening was 86.8% at 22.5 years of follow-up. Mean polyethylene wear was 0.085 mm/year (range, 0.031-0.15 mm). This study found that the Harris-Galante porous I acetabular and Harris-Galante porous femoral components produce excellent long-term results.

This article reports a case of bilateral fatigue fracture of the femoral components in a cruciate-retaining uncemented total knee arthroplasty (TKA). A 75-year-old woman (height, 158 cm; weight, 72 kg; body mass index, 29.2) had undergone one-stage bilateral TKA for osteoarthritis 11 years previously at the author's institution. Surgery was performed using an uncemented Flexible Nichidai Knee. Equal tension of the collateral ligaments and normal mechanical axis were achieved during the primary procedure. The patient was an ardent lover of the game of badminton and had higher activity levels with daily playing. At 8 years postoperatively, she started complaining of mild pain in both knees. The pain gradually increased, and at 11 years postoperatively, she had difficulty walking. Anteroposterior radiographs showed narrowing of the medial joint space, indicating wear of the polyethylene insert. Lateral radiographs showed signs of broken implants in both knees. There were no signs of gross implant loosening or osteolysis. One-stage revision surgery was performed, and the knees were converted to cemented posterior-stabilized TKAs. At revision, the bilateral femoral components were found to be fractured at the junction between the trochlear flange and the medial condyle, anteriorly to the medial peg. The polyethylene insert showed mild wear at the medial middle portion. In the majority of case reports, stress fractures of the femoral component have predominantly affected the medial condyle, following uncemented implantation of fixed-bearing knees. In this case, failure of bone ingrowth in uncemented components, higher body mass index, and a higher athletic activity led to fatigue fracture of the femoral components.

We evaluated the fate of bulk femoral head autograft in cementless total hip arthroplasty (THA) for developmental hip dysplasia. Of 87 hips (80 patients) studied, 37 hips (32 patients) were available for follow-up at a mean of 18.5 years (range, 15–24 years) postoperatively. The mean age of these 32 patients at the index procedure was 53.8 years (range, 40–65 years). The initial diagnosis was osteoarthritis in all 32 patients. The degree of acetabular dysplasia according to Crowe classification was type I in 18 hips (48.6%), type II in 14 (37.8%), type III in 5 (13.5%). The mean percentage of horizontal coverage of the acetabular components with graft bone was 34% (range, 25%–45%). Trabecular bridging across the graft–host interface was seen at a mean of 4 months (range, 2–6 months) postoperatively. Trabecular reorientation of the grafted bone was seen in all hips at a mean of 27 months (range, 12–36 months) postoperatively. There was no evidence of collapse and bony resorption of the grafted bone in the weight-bearing portion. Acetabular component fixation was stable in all hips at final follow-up. Of the 37 hips (32 patients), 2 acetabular components required revision: 1 for a late postoperative deep infection and 1 for dissociation of the polyethylene liner. The survival rate was 94.5% (95% confidence interval, 91.3–96.5) for the acetabular component at 18.5 years of follow-up. This study found that bulk femoral head autograft in cementless THA for developmental hip dysplasia produces excellent long-term results.

This article presents a case of femoral corrective osteotomy for malunited supracondylar femoral fracture after total knee arthroplasty (TKA) in a patient with rheumatoid arthritis. The patient underwent 1-stage bilateral TKA and 2-stage bilateral total hip arthroplasty 17 years prior at our institution. Her fall 10 years before led to a supracondylar femoral fracture that was treated nonoperatively for 3 months and led to malunion. Complaints of mild right knee pain and remarkable varus deformity were observed. On examination, the right knee was not swollen and tender. Range of motion (ROM) of the right knee was 0° to 130°. The patient needed crutches to ambulate. Knee score and function scores, according to the Knee Society clinical rating system, were 65 and 25 points, respectively. Radiographs after malunion showed remarkable varus knee and the femorotibial angle was 197°. At the time of surgery, the components were stable and bone union was completed. Valgus corrective osteotomy of the femur was performed using a retrograde intramedullary nail, with satisfactory results at 10-year follow-up. The patient is able to walk without a cane and has 0° to 130° ROM. Knee and function scores were 88 and 80 points, respectively. Radiographs showed complete bone union and the femorotibial angle was 179° with no loosening of the prostheses. Femoral corrective osteotomy is recommended for malunited supracondylar femoral fracture after TKA.