Which Primary Total Hip Replacement - Kate Owers 15/1/2004

Which primary THR?

Murray, Carr and Bulstrode    JBJS Br July 1995 77B p520-27

-           essentially compared all the available THR implants in UK at that time

-           62 implants , 19 companies, 50% introduced in last 5 yrs

-           10-fold price difference

-           only 30% had any results in peer reviewed journals- only 8 had 5 yr survival data

-           some designs have good 5 year, but poor 10 year data

-           once get to good 10 yr data, will probably behave like Charnley

-           5000 revision THRs per year – cost++ and worse outcome

-           v. few randomised trials comparing implants – none for cemented vs. uncemented

Only 3 implants had >10 yr data

-           Muller 10 year data

o         straight stem better than curved

-           Stanmore 15 year data (now 22 yr data)

o         small straight or curved stem, 25mm head, UHMWPE cup

-           Charnley 20 year data – 85-90% survival (now 25 yr data)

o         gold standard against which all other designs should be compared

o         cheap

o         originally monoblock – stainless steel, 22.25mm head and UHMWPE cup

but modifications in design and cementing techniques since 1960s

-           cannot compare studies if different outcome scores used – not just ‘revision’ or radiological loosening

-           paper suggests various end-points more realistic eg. level of pain, not just revision

-           Swedish study looks at ‘revision’, many surgeons and techniques

-           results NOT just down to implant design and behaviour in lab

Cemented THRs

The outcome of Charnley THR with cement after minimum 20 year follow-up

Schulte, Callaghan, Kelley and Johnston    JBJS 75A 1993 961-75

-           330 THRs, 262 patients 1970-72

-           one surgeon

-           > 20 yrs 98 THRs (83 pts) still alive, 5 lost to f/u

-           85% retained original prosthesis

-           overall 90% retained original prosthesis at f/u or until death

-           however, loose on Xray or at revision - 22% cups , 7% stems

-           85% no pain, 14% mild pain, 1% moderate pain

Charnley THR with cement: minimum 25 year follow-up

Callaghan, Albright, Goetz, Olejniczak and Johnston    JBJS   2000 82A   p487-97

-           same cohort

-           >25 years 62 THRs (51 pts) still alive

-           77% retained original prosthesis (revision - 5% infection, 18% aseptic loosening)

-           overall 90% retained original prosthesis at f/u or until death

The Stanmore THR – a 22 year follow-up

Gerritsman-Bleeker, Deutman, Mulder and Steinberg   JBJS 82B 2000   p97-102

-           146 THRs, 135 patients, 1975-6

-           2 surgeons

-           no new cases femoral loosening after 1 ^st 10 yrs

-           >22 years 19/21 pts (90%) retained original prosthesis

-           overall survival 85% (stem 91%, cup 88%)

-           poly wear obvious in 40% cups but asymptomatic

The Stanmore compared with Charnley THR – prospective study 413 THRs

Marston, Cobb and Bentley   JBJS 78B 1996 p178-183

-           mean 6.5 years f/u

-           1982-87 randomised 213 Stanmore + 200 Charnley

-           16 (4%) revised – no sig. difference - except trainees vs. consultants

-           7 (2%) loose on Xray

-           1 deep infection

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