Aims

BoneMaster is a thin electrochemically applied hydroxyapatite (HA) coating for orthopaedic implants that is quickly resorbed during osseointegration. Early stabilization is a surrogacy marker of good survival of femoral stems. The hypothesis of this study was that a BoneMaster coating yields a fast early and lasting fixation of stems.

Introduction. Slipped upper femoral epiphysis (SUFE) predominantly affects males in early adolescence. Severe slips occur with an estimated incidence of 1 per 100,000 children. Controversy exists over optimal treatment of severe slips with debate between in-situ fixation versus corrective surgery. We report on our management of a large series of such patients using a sub-capital cuneiform osteotomy. Patients/Methods. Between 2001–2011, 57 patients (35M: 22F) with an average age of 13.1 years were referred to our tertiary referral institution with a severe slip. This was defined as an epiphyseal-metaphyseal displacement greater than half the width of the femoral neck on a Billing lateral radiograph. The affected limb was rested in slings and springs prior to corrective surgery which was performed via an anterior Smith-Petersen approach. More recently our series has included pre-operative MRI to look for avascular necrosis of the epiphysis. Data was analysed to compare complication rate with time to surgery and surgeon's experience. Results. 50 patients (88%) were complication free at a mean follow up of 7 years and their average Oxford Hip Score was 44 (range: 37–48) and median visual analogue pain score was 0 (out of 10). 6 patients (10.5%) developed AVN requiring further surgery and one patient developed chondrolysis (1.8%) but declined further intervention. Complication rate was closely related to time to surgery with 100% AVN rate for surgery within 1 weeks of symptoms onset or 5–7% thereafter. A learning curve was identified with fewer complications seen as the series progressed. Discussion/Conclusion. This is a technically demanding operation with variable outcomes reported in the literature. We have demonstrated good results but feel it should be reserved for specialist centres exposed to higher volumes of these rare cases

We report a multicentre prospective consecutive study assessing the long-term outcome of the proximally hydroxyapatite (HA)-coated ABG II monobloc femoral component in a series of 1148 hips in 1053 patients with a mean age at surgery of 64.77 years (22 to 80) at a mean follow-up of 10.84 years (10 to 15.25). At latest follow-up, the mean total Harris hip score was 94.7 points (sd; 6.87; 49 to 100), and the mean Merle d’Aubigné–Postel score was 17.6 points (sd 1.12; 7 to 18). The mean total Engh radiological score score was 21.54 (sd 5.77; 3.5 to 27), with 95.81% of ‘confirmed ingrowth’, according to Engh’s classification. With aseptic loosening or pain as endpoints, three AGB II stems (0.26%) failed, giving a 99.7% survival rate (se 0.002; 95% confidence interval (CI) 0.994 to 1) at 14 years’ follow-up. The survival of patients ≤ 50 years of age (99.0% (se 0.011; 95% CI 0.969 to 1)) did not differ significantly from those of patients aged > 50 years (99.8% (se 0.002; 95% CI 0.994 to 1)). This study confirmed the excellent long-term results currently achieved with the ABG II proximally HA-coated monobloc stem.

Cite this article: Bone Joint J 2013;95-B:1610–16.

The aim of this prospective randomised study was to compare the clinical and radiological results of a cemented all-polyethylene Ultima acetabular component with those of a cementless porous-coated acetabular component (PFC) following total hip replacement (THR). A total of 287 patients received either a polyethylene acetabular component (group A) or a cobalt–chromium porous-coated component (group B) with an identical cemented femoral component and 28 mm cobalt-chromium head, thus making it the largest study of its type. Patients were evaluated radiologically and clinically using the Harris hip score (HHS). Group A comprised 183 patients (73 male, 110 female) with a mean age of 71.3 years (55 to 89). Group B comprised 104 patients (48 male, 56 female) with a mean age of 69.8 years (56 to 89). A total of 16 patients (13 in Group A, three in Group B) did not have post-operative data for analysis. The mean follow-up in group A was 7.52 years (0.4 to 15.0) and in Group B 7.87 years (0.5 to 14.0).

At final follow-up the mean HHS was similar between groups A and B (74.5 (25 to 100) and 78.0 (37 to 100), respectively; p = 0.068). The total number of revisions for any cause was 28, 17 of which were in group A and 11 in group B. The ten-year survivorship was 86.8% (95% confidence interval (CI) 78.4 to 92.1) and 89.2% (95% CI 78.3 to 94.8) for groups A and B, respectively (log-rank p-value = 0.938). A total of 20 cemented and two cementless acetabular components had evidence of acetabular radiolucencies or acetabular component migration at last follow-up (p = 0.001).

These results indicate that patients with a cemented all-polyethylene and cementless porous-coated polyethylene lined acetabular component have similar long-term clinical outcomes.