The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more. Clinical and radiological short-term complications after single-stage bilateral uncemented total hip arthroplasty Revision total hip arthroplasty in patients 80 years or older. Cemented or cementless THA in patients over 80 years with fracture neck of femur: a prospective comparative trial Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study. Long-term results of cemented total hip arthroplasty in patients younger than 30 years and the outcome of subsequent revisions Primary Total Hip Arthroplasty with a Porous-Coated Acetabular Component. Seven-to-Ten-Year Results* Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results. Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Followup Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimun 6-year follow-up Total Hip Arthroplasty with the Charnley Prosthesis in Patients Fifty-five Years Old and Less. Fifteen to Twenty-one-Year Results* Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results Birmingham Hip Resurfacing in Patients who are Seventy Years of Age or Older
Primary arthroplasty may be denied to very elderly patients based upon the perceived outcome and risks associated with surgery . This prospect i ve study compared the outcome , complications , and mortality of total hip ( TKR ) and total knee replacement ( TKR )  in a prospect ively selected group of patients aged ≥ 80 years with that of a control group aged between 65 and 74 years . There were 171 and 495 THRs and 185 and 492 TKRs performed in the older and control groups , respectively . No significant difference was observed in the mean improvement of Oxford hip and knee scores between the groups at 12 months ( 0.98 , ( 95 % confidence interval ( CI ) -0.66 to 2.95 ) , p = 0.34 and 1.15 ( 95 % CI -0.65 to 2.94 ) , p = 0.16 , respectively ) . The control group had a significantly ( p = 0.02 and p = 0.04 , respectively ) greater improvement in the physical well being component of their SF-12 score , but the older group was more satisfied with their THR ( p = 0.047 ) . The older group had a longer hospital stay for both THR ( 5.9 versus 9.0 days , p < 0.0001 ) and TKR ( 6.2 versus 8.3 days , p < 0.0001 ) . The rates of post-operative complications and mortality were increased in the older group Abstract Purpose Economic crisis time gives to efficient procedures an important role in healthy system . Total hip replacement is a common bilateral orthopedic procedure , but there exists an important controversy to perform it in single or two stages . Our aim is to report our clinical and radiological short-term complications of bilateral uncemented total hip arthroplasty in a single time . Material s and methods We have retrospectively review ed the patients treated between 2000 and 2011 in our center by bilateral uncemented total hip replacement in a single time .  We have review ed the medical history and analyzed by age , diagnosis and ASA parameters related to the procedure , hospital stay , transfusion requirements and clinical complications . Radiological evaluation was made with anteroposterior hip radiograph evaluation ( acetabular radiolucencies and stem migration ) . Functional assessment was carried out by the Merle D’Aubigné score . Results Seventeen patients with mean age of 47.4 ( 18–68 ) years were review ed with a mean follow-up of 44.3 ( 6–172 ) months . ASA distribution : 29.4 % grade I ; 52.9 % grade II and 17.6 % grade III . Merlé D’Aubigné score improved from 11.01 to 16.45 . Hospital stay was 6 days . Transfusion requirements were two hematic concentrates for each patient . Two external popliteal sciatic nerve neurapraxias fully recovered at follow-up . Radiological results showed one case of axial migration . Conclusions With proper patient selection and multidisciplinary team , the bilateral uncemented total hip arthroplasty in a single time has low complication rates . Our results could be used in the development of future r and omized controlled trials or prospect i ve cohort studies .Level of evidence IV We evaluated all revisions performed from March 1996 to December 2008 and compared complications , mortality , and clinical outcomes between patients 80 years and older and patients younger than 80 years . Data were collected prospect ively . There were 325 revisions , 84 ( 25.8 % ) in patients 80 years and older and 241 in patients younger than 80 years ( 62 % revision for aseptic loosening in both groups ) . The mean follow-up was 4.3 years . The results , 80 years and older vs younger than 80 years , revealed the following : mortality , 5 % vs 0 % 3 months postoperatively ; medical complications in 23.8 % vs 6.2 % ; postoperative fractures , 9.5 % vs 2.5 % ; and improved Merle d'Aubigné scores from 9.6 to 13.0 vs 10.4 to 14.3 . Revision total hip arthroplasty in patients 80 years and older was associated with substantial clinical improvement and patient satisfaction . However , medical complications and 90-day mortality were higher , and postoperative fractures occurred more frequently Background Total hip arthroplasty is associated with a better long term outcome and lesser reoperation rates in the elderly but the risk of complications are beleived to be higher in very elderly patients . The study aims to compare the short-term results of cemented and cementless total hip arthroplasty ( THA ) in active patients > 80 years of age with femoral neck fractures . Methods Sixty-two consecutive patients underwent THA during the study period  ( cemented—31 and cementless—31 ) . The mean age was 84 years ( 81–94 years ) . Patients in both groups were comparable in their preoperative variables . Functional and radiological assessment s were carried out using vali date d outcome measures . Complications were recorded . Results Fifty-one patients were available for final analysis after accounting for deaths and cases lost in follow-up . Of the 51 patients , 25 ( 49 % ) regained their pre-injury mobility status and 36 ( 70 % ) were community ambulant . Cementless THA was associated with significantly less surgical time , blood loss , transfusion rates and hospital stay . The overall mortality rates , complications , functional and radiological results were similar in both groups though the number of deaths in the perioperative period was significantly high in patients undergoing cemented THA . ConclusionS atisfactory improvement in function with low reoperation rates can be achieved irrespective of the technique used . Complication rates are higher when compared to younger patients undergoing the procedure . Risks and benefits should be carefully assessed and explained before subjecting these patients to THA Studies suggest that  total hip arthroplasty ( THA )  performed through direct anterior ( DA ) approach has better functional outcomes than other surgical approaches . The immediate to very early outcomes of DA THA are not known . A prospect i ve , r and omized study examined the very early outcome of THA performed through DA versus direct lateral approach . The functional outcomes on day 1 , day 2 , week 6 , week 12 , 6 months , and 1 year were measured . Patients receiving DA THA  had significantly higher functional scores during the early period following surgery . The difference in functional scores leveled out at 6 months Background The number of total hip arthroplasties in patients under 30 years is increasing over the years . Almost all of them will face at least one or more future revisions in their life . Therefore , the implant used should have a high survival rate , and needs to be easily revisable result ing in a low re-revision rate . Several studies have evaluated the outcome of total hip arthroplasties in patients under 30 years . However , only a few reported on the follow-up outcome of 10 years or more . In addition , none of these reports published data of the subsequent revisions of these implants within their original report . Methods We studied historically prospect i ve collected data of 48 consecutive patients ( 69 hips ) younger than 30 years , treated with a cemented primary total hip prosthesis between 1988 and 2004 . Since the last evaluation of this cohort , two patients were lost to follow-up . For all hip revisions in this cohort , again cemented implants were used , mostly in combination with bone impaction grafting .  Kaplan-Meier survival curves at 10- and 15 years for the primary total hip arthroplasties and revisions were determined . Results The mean age at time of primary surgery was 25 years ( range , 16 to 29 years ) . Mean follow-up of the primary hips was 11.5 years ( range , 7 to 23 years ) . During follow-up 13 revisions were performed ; in 3 cases a two-stage total revision was performed for septic loosening and 9 cups were revised for aseptic loosening . There were no aseptic stem revisions . The 10 and 15-year survival rates with endpoint revision for aseptic loosening of the primary total hip were 90 % ( 95 % CI : 79 to 96 ) and 82 % ( 95 % CI : 65 to 92 ) respectively . None of our 13 subsequent revisions needed a re-revision within 10 years after re-implantation . Conclusions Cemented total hip implants in patients under 30 years have an encouraging outcome at 10 and 15 years after surgery in these young patients . The 13 revised hips , treated with bone grafting and the third generation cement technique , were performing well with no re-revisions within ten years after surgery One hundred and eighty-four patients who had been managed , between 1984 and 1985 , with a total of 204 consecutive primary total hip arthroplasties with insertion of a Harris-Galante type-I acetabular component without cement were prospect ively studied . There were eighty-two men ( 45 per cent ) and 102 women ( 55 per cent ) . The mean age at the time of the operation was fifty-two years ( range , twenty to eighty-four years ) . One hundred and fifty-seven patients ( 173 hips ) were available for clinical review at a mean of 104 months ( range , seventy-eight to 126 months ) . At this time , the mean preoperative Harris hip score of 52 points ( range , 12 to 79 points ) had improved to a mean of 90 points ( range , 44 to 100 points ) . Two patients ( two hips ) had had an exchange of an excessively worn polyethylene liner . One patient ( one hip ) had had débridement and grafting of an area of massive retroacetabular osteolysis . Two stable acetabular components ( 1 per cent ) had been revised at the time of femoral revision . None of the cups had been revised because of aseptic loosening . Radiographic examination of 150 patients ( 165 hips ) at a mean of 104 months ( range , seventy-eight to 126 months ) revealed that 156 cups ( 95 per cent ) were stable . Eight cups ( 5 per cent ) were considered to be possibly unstable , with a radiolucent line between the prosthesis and the bone that was one millimeter wide or less in at least four of five zones ; two of the eight had a complete radiolucent line in all zones . One component , which had been implanted with a bulk allograft from a femoral head , migrated more than two millimeters in the first two years and then stabilized without complication . Osteolysis was seen in seven acetabula ( 4 per cent ) and was limited to the periphery of the cup in six . Survivorship analysis at ten years revealed that the acetabular component had a 99 per cent chance of survival ( 95 per cent confidence interval , 0.98 to 1.0 ) with revision or aseptic loosening as the end point and a 97 per cent chance of survival ( 95 per cent confidence interval , 0.95 to 1.0 ) with revision , aseptic loosening , or reoperation because of a problem related to the acetabular component as the end point BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of  total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in 120 patients due to degenerative changes were evaluated prospect ively . 60 THAs were done through a minimal lateral approach and constituted a study group . 60 THAs were done through a direct lateral approach and constituted a control group . The mean age of the 120 patients ( 98 women and 22 men ) was 45 y.o . ( range : 32 - 67 y.o . ) . The duration of follow-up in the study group was from 6 to 12 months ( mean : 8.5 months ) . The duration of follow-up in the control group was from 10 to 16 months ( mean : 10.5 months ) . Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score . Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society , AAOS and SICOT . RESULTS 6 months after THA , clinical results were 92 pts in the study group and 88 pts in the control group . Radiographic outcomes were very good in all 120 patients from both arms : there were no differences between the control and study group . The incidence of complications was similar in both groups . CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of  degenerative changes of the hip joint  with regard to short-term outcomes . The clinical and radiographic outcomes were comparable between the st and ard and minimally invasive approaches . Success with THA using a minimally invasive approach depends on excellent operative technique and experience with st and ard hip approaches rather than on the use of special instruments Abstract Metal-on-metal total hip resurfacing arthroplasty has had excellent reported results at early to midterm followup , and some studies suggest that outcomes are comparable to conventional THA . We compared the clinical and radiographic outcomes of two closely matched groups of 54 patients who underwent resurfacing and conventional THA , respectively . Each group consisted of 36 men and 18 women who had a mean age of 52 years and a mean body mass index of 29 kg/m2 . At a minimum followup of 24 months ( mean , 40 months ; range , 24–60 months ) , the mean Harris hip scores increased similarly in both groups ( from 52 to 90 points and from 50 to 91 points for the resurfacing and conventional groups , respectively ) . Radiographic outcomes , revision rates , complications , pain scores , and satisfaction ratings of the two groups were similar . The patients who underwent resurfacing had higher postoperative weighted activity scores than the patients who underwent conventional THA , although they had higher preoperative weighted activity scores as well . The early outcomes of resurfacing are comparable to those of conventional THA . Level of Evidence : Level III , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature Background and purpose — Criticism of the lateral approach ( LA ) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach ( PA ) . However , there have been no controlled studies comparing patient-reported outcomes between them . In this r and omized controlled trial , we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty ( THA ) with PA  than in those who have undergone THA with LA , 12 months postoperatively . Patients and methods — 80 patients with hip osteoarthritis ( mean age 61 years ) were r and omized to THA  using  PA or the modified direct LA . We recorded outcome measures preoperatively and 3 , 6 , and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form ( HOOS-PS ) as the primary outcome . Secondary outcomes were HOOS-Pain , HOOS- Quality -Of-Life , EQ-5D , UCLA Activity Score , and limping . Results — We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up . All secondary outcomes showed similar results except for limping , where PA patients improved significantly more than LA patients . Interpretation — Contrary to our hypothesis , patients treated with PA did not improve more than patients treated with LA regarding physical function , pain , physical activity , and quality of life 12 months postoperatively . However , limping was more pronounced in the LA patients Background Hip replacement ( arthroplasty ) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint . For older patients , several design s of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money . However , in younger more active patients , there is approximately a 50 % failure rate at 25 years for traditional implants . Hip resurfacing is a relatively new arthroplasty technique . In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified , including the risk of femoral neck fracture and collapse of the head of the femur . The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty . Secondary aims include assessment of complication rates for both procedures as well cost effectiveness . Methods / design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study . A r and omisation sequence will be produced and administered independently . After consenting , all patients will be clinical ly review ed and hip function , quality of life and physical activity level will be assessed through question naires . The allocated surgery will then be performed with the preferred technique of the surgeon . Six weeks post-operation hip function will be assessed and complications recorded . Three , six and 12 months post-operation hip function , quality of life and physical activity level will be assessed . Additional information about patients ' out-of-pocket expenses will also be collected . Trial registration Current Controlled Trials IS RCT N33354155UKCLRN portfolio ID Background  Total hip arthroplasty ( THA )  has been associated with high survival rates , but debate remains concerning the best fixation mode of THA . Questions / purpose sWe conducted a r and omized controlled trial ( RCT ) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation . Patients and Methods Patients were evaluated for revision of either of the components . One hundred twenty-seven patients had died ( 51 % ) and 12 ( 4.8 % ) were lost to followup . The minimum 17-year followup data ( mean , 20 years ; range , 17–21 years ) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation . Results Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA . The cementless tapered stem was associated with a survivorship of 99 % . Age younger than 65 years and male gender were predictors of revision surgery . Conclusions The efficacy of future RCTs can be enhanced by r and omizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs . Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required . A minimum 10-year followup should be anticipated , but this can be expected to be longer if the difference in level of quality between the compared implants is smaller . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Aim Tissue sparing hip prostheses are becoming more and more popular especially for the treatment of younger patients . The objective of this study was to evaluate the clinical and radiological results after insertion of a tissue sparing hip prosthesis . Method In 47 consecutive non-selected patients ( 50 hips ) , the clinical and radiographic results of cementless total hip arthroplasty using a collum femoris preserving stem , a pressfit cup and an alumina – polyethylene pairing were prospect ively evaluated . The mean age at index-surgery was 58 ( 36–82 ) years , there were 38 women and 9 men . After a mean follow-up of 6.8 years ( minimum 6.1 years ) , two patients had died and one patient underwent revision surgery due to aseptic loosening of the stem . Results The overall survival rate of the acetabular component was 100 % and of the femoral component 98 % . The mean Harris hip score at follow-up was 94 points . Conclusion The mid-term survival with this type of total hip arthroplasty is excellent and compares equal with uncemented straight stems in this age group Data on 240 primary Charnley total hip arthroplasties , performed in 211 patients from October 1968 to July 1974 , were recorded prospect ively . Fifty-two prostheses were implanted in forty-six patients who were thirty-four to fifty-five years old , and 188 prostheses were implanted in 165 patients who were more than fifty-five years old . The results for the younger patients were compared with those for the older patients . Twenty hips were revised over-all , and all five of the infections and four of the five fractures of the femoral stem that occurred in this group were in the older patients . However , the rate of aseptic loosening was similar for the two age-groups ( three of the hips in the younger patients and five in the older patients ) . The probability of revision after twenty years for the two groups , as determined with Kaplan-Meier analysis , was 11.7 per cent for the younger patients and 10.7 per cent for the older patients . There was no significant difference between the two groups with regard to either the number of revisions or the percentage of patients who had radiographic signs of loosening . The median Charnley hip scores during the course of the study were also similar for the two groups . We recommend that Charnley low-friction arthroplasty be used even in younger patients , as the long-term results were excellent and were comparable with those in the elderly age-group Background : Second-generation cementless femoral components were design ed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces . We examined the eight to eleven-year results of total hip arthroplasty with a cementless , anatomically design ed femoral component and a cementless hemispheric acetabular component . Methods : Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating ( Anatomic Hip ) and a cementless hemispheric porous-coated acetabular component ( Harris-Galante II ) were performed in eighty-five patients . These patients were prospect ively followed clinical ly and radiographically . Six patients ( seven hips ) died and five patients ( seven hips ) were lost to follow-up , leaving seventy-four patients ( seventy-eight hips ) who had been followed for a mean of ten years ( range , eight to eleven years ) . The mean age at the time of the arthroplasty was fifty-two years . Results : The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up ; 86 % of the hips had a good or excellent result . Thigh pain was reported as mild to severe after seven hip arthroplasties . No femoral component was revised for any reason , and none were loose radiographically at the time of the last follow-up . Two hips underwent acetabular revision ( one because of dislocation and one because of loosening ) . Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point . The ten-year survival rate was 96.4 % ± 2.1 % for the total hip prosthesis , 100 % for the femoral component , and 96.4 % ± 2.1 % for the acetabular component . Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight ( 93 % ) of the -seventy-three hips with complete radiographic follow-up . Femoral osteolysis proximal to the lesser trochanter was noted in four hips ( 5 % ) . No osteolysis was identified distal to the lesser trochanter . Periacetabular osteolysis was identified in twelve hips ( 16 % ) . Five patients underwent exchange of the acetabular liner because of polyethylene wear . Conclusions : This second-generation cementless , anatomically design ed femoral component provided excellent clinical and radiographic results with a 100 % survival rate at ten years . The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty There is no published literature to support mid to long term results of hip resurfacing ( HR ) arthroplasty in patients over the age of 70 years . The purpose of our study was to evaluate the function HR in this age group ( 70 or older at the time of surgery ) at medium to long term follow-up . Between July 1997 and November 2002 , the Oswestry Outcome Centre independently and prospect ively collected data on 5000 Birmingham Hip Resurfacings ( BHRs ) . 106 had been implanted in elderly patients who were 70 years of age or older . The post-operative Harris and Merle D'Aubigné and Postel ( MDP ) hip scores and causes for revision were used to ascertain function and implant survival . Hip scores for the older BHR patients were compared with those from younger patients . The average age at surgery of the elderly BHR cohort was 73.2 years ( range , 70.0 to 87.9 years ) with a mean follow-up of 7.1 years ( range , 0.5 to 10.9 years ) . Four patients had a femoral neck fracture and required conversion to a conventional total hip replacement . There were no patients lost to follow-up and no dislocations in this series . The median Harris hip score ( HHS ) was significantly better in the younger BHR group compared with the elderly BHR group , ( 96 vs. 94 p=0.008 ) . There was no significant difference in recovery rates after surgery . There was a significantly higher rate of revision in women than men among the elderly patients ( male= 1 of 65 ( 1.5 % ) ; women = 3 of 19 ( 15.8 % ) , p=0.03 ) . At latest follow-up the elderly patients continued to function well when compared with the younger BHR patients . There was a high mid to long term success rate after HR in patients who were 70 years of age or older , without the failure burden possibly anticipated . Elderly patients had a poorer functional outcome , but a difference in HHS of two points may be of only minor clinical significance
Conclusion Total hip arthroplasty in patients younger than 55 years provides reliable outcomes at up to 10 years .
Background Total hip arthroplasty ( THA ) is increasingly performed in younger patients despite the lack of comprehensive assessment of long-term outcomes .
We systematic ally review ed the contemporary literature to assess the 1 ) indications , 2 ) implant selection and long-term survivorship , 3 ) complication and reoperation rates and 4 ) radiographic and functional outcomes of primary THA in patients younger than 55 years .