0
Scientific Article   |    
Charnley Total Hip Arthroplasty with Use of Improved Cementing Techniques A Minimum Twenty-Year Follow-up Study
Aimee S. Klapach, MD; John J. Callaghan, MD; Devon D. Goetz, MD; Jason P. Olejniczak, BA; Richard C. Johnston, MD
View Disclosures and Other Information
Investigation performed at the University of Iowa College of Medicine, Iowa City, and Des Moines Methodist Hospital, Des Moines, Iowa

Aimee S. Klapach, MD
John J. Callaghan, MD
Jason P. Olejniczak, BA
Richard C. Johnston, MD
University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1088. E-mail address for J.J. Callaghan: john-callaghan@uiowa.edu.

Devon D. Goetz, MD
Des Moines Orthopaedic Surgeons, 6001 Westown Parkway, West Des Moines, IA 50266-7702

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from National Institutes of Health Grant AR43314. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from commercial entities (Zimmer and DuPuy). Also, commercial entities (Zimmer and DuPuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which one or more of the authors are affiliated or associated.

J Bone Joint Surg Am, 2001 Dec 01;83(12):1840-1848
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: In total hip arthroplasty, techniques for cementing the femoral component have changed over time. The purpose of the present study was to determine whether a cementing technique that includes use of a distal cement plug and retrograde filling of the femoral canal affects the fixation of the femoral component at a minimum of twenty years after the operation.

Methods: Between 1976 and 1978, the senior one of us (R.C.J.) performed 357 total hip arthroplasties with use of a Charnley flatback polished femoral stem and a contemporary cementing technique (insertion of a distal cement plug and retrograde filling of the femoral canal with cement) in 320 patients. The results after a minimum follow-up of twenty years were compared with those after 330 total hip arthroplasties performed, between 1970 and 1972, with the same femoral stem by the same surgeon with use of a hand-packing technique of cementing in 262 patients. The clinical and radiographic evaluation as well as the duration of follow-up were identical in the two groups.

Results: In the group managed with the contemporary cementing technique, six (1.8%) of the 336 hips that had not been lost to follow-up or revised because of infection or dislocation were revised because of aseptic loosening of the femoral component. Of the ninety-one hips in the eighty-two patients who were alive at a minimum of twenty years, five (5%) had a revision because of aseptic loosening of the femoral component. Only one hip was revised during the fifteen-to-twenty-year follow-up interval. (The revision was performed because of a fracture of the femoral component.) The rate of failure when radiographic signs of loosening were included was 4.8% (sixteen of 336 femoral components that had not been revised because of infection or dislocation) for the group managed with the contemporary cementing technique compared with 6.3% (twenty of 319 hips) in the group managed with the hand-packing technique; the difference was not significant (p = 0.40). Adequate filling of the femoral canal with cement was found to be associated with improved survival of the femoral component (p = 0.03).

Conclusions: While no significant difference between the two cementing techniques could be identified, the ability to deliver adequate cement around the femoral component was more predictable with the contemporary cementing technique. In addition, the prevalence of loosening of the femoral component was low with use of either technique, a tribute to the Charnley flatback polished femoral component design.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Hip
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    04/16/2014
    Ohio - OhioHealth Research and Innovation Institute (OHRI)
    01/08/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    05/03/2012
    California - UCLA/OH Department of Orthopaedic Surgery