Abstract
Background
There has been a shift from cemented to uncemented hip arthroplasty. One popular uncemented combination is the R3 acetabular cup with Polarstem, having the lowest revision rate in the UK National Joint Registry. However, there are no medium-term clinical outcomes on this combination in the literature. The aim of this study is to review our centre’s outcomes with this combination using conventional bearings with a minimum of 7-year follow-up.
Methods
Using our centre’s arthroplasty database, we identified all patients that underwent a total hip arthroplasty using these implants from August 2009 to December 2010. One hundred and forty-four procedures were performed. The primary outcome was revision rate, and the secondary outcomes were clinical and radiological evaluation.
Results
The mean cohort age at surgery was 68.3 years. There were three revisions, of which only one underwent a cup revision. The mean Oxford Hip Score at 7-year follow-up was 38. Radiological evaluation of both acetabular and stem component did not show any radiolucency at 7-year follow-up. Kaplan–Meier survivorship analysis showed an implant survival rate of 97.69% at 7 years using revision for all causes as endpoint. The risk of revision was 1.47% at 7 years.
Conclusion
Our revision rates are comparable to the UK’s National Joint Registry, with excellent clinical and radiological outcome. Our results correlate with the allocated rating of 7A* by the Orthopaedic Data Evaluation Panel for both R3 acetabular cup and Polarstem.
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References
Knight SR, Aujla R, Biswas SP (2011) Total hip arthroplasty—over 100 years of operative history. Orthop Rev (Pavia) 3(2):e16. https://doi.org/10.4081/or.2011.e16
Hothi HS, Ilo K, Whittaker RK, Eskelinen A, Skinner JA, Hart AJ (2015) Corrosion of metal modular cup liners. J Arthroplast 30(9):1652–1656. https://doi.org/10.1016/j.arth.2015.03.022
National Joint Registry for England and Wales (2017) 14th annual report. http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2014th%20Annual%20Report%202017.pdf. Accessed 18 Apr 2018
Ilo KC, Derby EJ, Whittaker RK, Blunn GW, Skinner JA, Hart AJ (2017) Fretting and corrosion between a metal shell and metal liner may explain the high rate of failure of R3 modular metal-on-metal hips. J Arthroplast 32(5):1679–1683. https://doi.org/10.1016/j.arth.2016.12.024
Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14(3):231–242
Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–1632
Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27
DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32
Kim YH, Kim JS, Park JW, Joo JH (2012) Periacetabular osteolysis is the problem in contemporary total hip arthroplasty in young patients. J Arthroplast 27(1):74–81. https://doi.org/10.1016/j.arth.2011.03.022
Jantzen C, Jørgensen HL, Duus BR, Sporring SL, Lauritzen JB (2013) Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties. Acta Orthop 84(3):229–236. https://doi.org/10.3109/17453674.2013.792034
The Australian Orthopaedic Association National Joint Replacement Registry (2017) Annual report 2017. https://aoanjrr.sahmri.com/documents/10180/397736/Hip%2C%20Knee%20%26%20Shoulder%20Arthroplasty. Accessed 29 June 2018
Lee PY, Evans AR (2014) Early failure of the Polarstem total hip arthroplasty—can the Australian NJR tell us the full story? J Arthroplast 29:609e11
Lau YJ, Sarmah S, Witt JD (2017) 3rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study. Hip Int 29:133. https://doi.org/10.5301/hipint.5000541
Gordon M, Green M, Frumento P, Rolfson O, Garellick G, Stark A (2014) Age- and health-related quality of life after total hip replacement: decreasing gains in patients above 70 years of age. Acta Orthop 85(3):244–249. https://doi.org/10.3109/17453674.2014.916492
Marx RG, Jones EC, Atwan NC, Closkey RF, Salvati EA, Sculco TP (2005) Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. J Bone Joint Surg Am 87(9):1999–2005
Harcourt WG, White SH, Jones P (2001) Specificity of the Oxford knee status questionnaire. The effect of disease of the hip or lumbar spine on patients’ perception of knee disability. J Bone Joint Surg [Br] 83-B:345–347
Arden NK, Kiran A, Judge A, Biant LC, Javaid MK, Murray DW, Carr AJ, Cooper C, Field RE (2011) What is a good patient reported outcome after total hip replacement? Osteoarthr Cartil 19(2):155–162. https://doi.org/10.1016/j.joca.2010.10.004
Buttaro MA, Oñativia JI, Slullitel PA, Andreoli M, Comba F, Zanotti G, Piccaluga F (2017) Metaphyseal debonding of the Corail collarless cementless stem: report of 18 cases and case-control study. Bone Joint J 99-B(11):1435–1441. https://doi.org/10.1302/0301-620x.99b11.bjj-2017-0431.r1
Lovelock TM, Broughton NS (2018) Follow-up after arthroplasty of the hip and knee: are we over-servicing or under-caring? Bone Joint J 100-B(1):6–10. https://doi.org/10.1302/0301-620x.100b1.bjj-2017-0779.r1
Rolfson O, Donahue GS, Hallsten M, Garellick G, Kärrholm J, Nemes S (2016) Patient-reported outcomes in cemented and uncemented total hip replacements. Hip Int 26(5):451–457. https://doi.org/10.5301/hipint.5000371
Dawson J, Fitzpatrick R, Murray D, Carr A (1996) Comparison of measures to assess outcomes in total hip replacement surgery. Qual Health Care 5:81–88
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Assaf, A., Manara, J.R., Teoh, K.H. et al. Mid-term clinical results of the cementless R3 cup and Polarstem total hip arthroplasty. Eur J Orthop Surg Traumatol 29, 827–833 (2019). https://doi.org/10.1007/s00590-018-2357-x
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DOI: https://doi.org/10.1007/s00590-018-2357-x