TOTAL HIP-ARTHROPLASTY WITH USE OF 2ND-GENERATION CEMENTING TECHNIQUES - AN 18-YEAR-AVERAGE FOLLOW-UP-STUDY

In this report, we present the results of a further follow-up of a ser ies of 140 consecutive patients (161 hips) who had had a primary total hip arthroplasty with insertion of a bead-blasted monoblock femoral c omponent with use of so called second-generation cementing techniques. The average age of the patients at the time of the arthroplasty was s ixty-one Sears (range, twenty-one to eighty-five years), Sixty-seven p atients (seventy-seven hips) died less than seventeen years after the index operation. The remaining seventy-three patients (eighty-four hip s) were followed for an average of eighteen years (range, seventeen to twenty years), No patient was lost to follow-up, In the entire group of 161 hips, over the twenty-year span of the study eight femoral comp onents (5 percent) and twenty-eight acetabular components (17 percent) had been revised because of aseptic loosening, Of the seventy-seven h ips in the sixty-seven patients who died, four had been revised becaus e of aseptic loosening of the acetabular component only; one, because of aseptic loosening of the femoral component only; and one, because o f aseptic loosening of both components. Of the eighty-four hips in the seventy-three patients who were alive at least seventeen years after the index arthroplasty, twenty-four hips (29 percent) in twenty-one pa tients had had revision of one or both components for any reason, Twen ty-three acetabular components (27 percent) and six femoral components (7 percent) had been revised because of aseptic loosening, An additio nal two hips (2 percent) in two patients were loose according to radio graphic criteria but had not been revised, Of the sixty-five all-polye thylene acetabular components that had been inserted with cement and w ere in patients who were alive at least seventeen years postoperativel y, fifteen (23 percent) had been revised because of aseptic loosening. An additional seventeen cups (26 percent) were loose according to rad iographic criteria. Thus, a total of thirty-two cups (49 percent) had been revised because of loosening or were loose but had not been revis ed at the time of the latest follow-up. The femoral components that ha d been inserted with use of second-generation cementing techniques far ed better than did the acetabular components that had been inserted wi th these techniques during the same time-period. We found that assessm ent of all postoperative radiographs rather than only those that had b een made immediately postoperatively increased the accuracy of the gra ding of the cement around the femoral component, Subsequent radiograph s frequently had been made at different projections, which revealed ne w findings, consisting primarily of previously undetected voids, areas of thin cement, and; defects in the cement mantle, Thus, we now use a ll available radiographs to determine the grade of the cement.