The modern, hybrid total hip arthroplasty for primary osteoarthritis at the Hospital for Special Surgery

Abstract

We describe our technique and rationale using hybrid fixation for primary total hip arthroplasty (THA) at the Hospital for Special Surgery. Modern uncemented acetabular components have few screw holes, or no holes, polished inner surfaces, improved locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented sockets can be combined with highly cross-linked polyethylene liners, which have demonstrated very low wear and osteolysis rates after ten to 15 years of implantation. The results of cement fixation with a smooth or polished surface finished stem have been excellent, virtually eliminating complications seen with cementless fixation like peri-operative femoral fractures and thigh pain. Although mid-term results of modern cementless stems are encouraging, the long-term data do not show reduced revision rates for cementless stems compared with cemented smooth stems. In this paper we review the conduct of a hybrid THA, with emphasis on pre-operative planning, surgical technique, hypotensive epidural anaesthesia, and intra-operative physiology.

The Current Concepts of Total Hip Arthroplasty

“…That was the reason why the use of the cemented acetabular cups has decreased 161718). By comparison, the cemented femoral component is still being used in many cases, and has revealed favorable clinical performance for more than 15 years as the concept of hybrid THA192021). This is because that this component has secured satisfying durability along with improvements in cemented femoral component designs and cementing techniques.…”

“…And cementing techniques have a low risk of complications associated with cementless THA such as periprosthetic fracture and thigh pain19). Currently, cementless THA is predominantly performed because of the rapid progression of cementless design, shorter operating time, and technical difficulties of cementing23).…”

Biomechanical behaviour of a French femoral component with thin cement mantle

“… 1 This suggests that a taper slip design with a polished finish stem enables cement creep and are less prone to mechanical failure than rough surface stems. 2 - 4 Reported outcomes are generally more favourable for cement thicknesses of at least 2 mm, and this thickness is now widely accepted as optimum for the cement mantle. 5 - 7 However, some reports have suggested that French-designed cemented stems are associated with favourable outcomes in the presence of a thin cement mantle.…”

Porous-coated metaphyseal sleeves and MBT implant for severe bone loss in revision total knee arthroplasty: a mean 2.4-year follow-up

“…In addition, preoperative radiographs and intraoperative findings were assessed to classify tibial and femoral bone loss according to the Anderson Orthopaedic Research Institute (AORI) bone defect classification (Table 3 ) . The Knee Society Score (KSS) [ 16 ], the Hospital for Special Surgery (HSS) Knee Score [ 17 ], and range of motion (ROM) [ 18 ] were also collected.…”