The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. 1972.
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Hip Prosthesis↗
Biomedical subjects
J Charnley
Publications and source records attributed to J Charnley.
Radiographic morphology of the osteoarthritic hip.
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Adolescent↗
Faltin lecture: evolution of total hip replacement.
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Bone Cements↗
The future of total hip replacement.
Postoperative infection and the possibility of a stable, long-term cement-bone interface have been chosen as the two most important aspects of the future of total hip replacement. An attempt has been made to rekindle enthusiasm for extreme sterility in the operating room environment and to combine this with antibiotic prophylaxis. Examples of perfect cement-bone interfaces, judged on radiologic data after 12 1/2 years, are presented, together with radiographs of four examples of acrylic cement in the femur after 20 and 21 years of load bearing.
Acrylic Resins↗
Long-term results of low-friction arthroplasty.
Two long-term studies of total hip replacement, carried out at Wrightington Hospital, England, and already published in 1977 and illustrated in detail, have been presented in an abbreviated, and it is hoped, more readable form. The first of these studies averaged 13 years and the second 8.3 years, but the latter has been updated to a maximum period of 13 years by reference to hospital records of secondary operations. The failure rate of the first series was 1.5% and that of the updated second series now becomes 2.6%. Some suggestions are made to explain this difference.
Bone Cements↗
Subsidence of the femoral prosthesis in total hip replacement in relation to the design of the stem.
A method is described of measuring radiological subsidence of a femoral prosthesis in relation to the femur after total hip arthroplasty. The method depends on measuring the distance from the tip of the femoral prosthesis to a fixed point in the bone. Subsidence after the use of a conventional design of femoral stem is compared with that after the use of a stem with a dorsal flange (Cobra). A significant reduction in the incidence and amount of subsidence was found when using the dorsal flange. There was also a notable absence of transverse fractures involving the cement near the tip of the stem, which occurred in 26 per cent of the cases using a conventional prosthesis.
Biomechanical Phenomena↗
Low-friction arthroplasty for healed septic and tuberculous arthritis.
Forty hips, which had previously been the site of tuberculous or pyogenic arthritis and which had later developed a degenerative arthritis, were treated by low-friction arthroplasty some forty years after the original infection. The results suggest that, when healing of the primary infection has been followed by a long period of quiescence with acceptable function before the onset of degenerative change, the arthroplasty can be confidently expected to result in greatly improved function and that this improvement is long-lasting.
Adult↗
Total hip replacement following infection in the opposite hip.
Total hip replacements without ensuing infection were performed in 31 patients in the presence of infection in the contralateral hip. Infection in the opposite hip was proved bacteriologically in the follow-up in 19 cases averaged 5 years (2 years 3 months to 10 years). In another 12 hips in the same circumstances, without positive bacteriological evidence of active infection on the opposite side, healing occurred without infection.
Adult↗
Hydroxychloroquine in prophylaxis of pulmonary embolism following hip arthroplasty.
Two thousand one hundred and forty four patients received Plaquenil (hydroxychloroquine sulphate) prior to total hip arthroplasty; the drug was continued until the patient was fully mobile. Fatal emboli (confirmed by postmortem) occurred in 0.28% and non-fatal emboli (diagnosed clinically) occurred in 4.15%. This was a statistically significant improvement over the overall results of all previous prophylactic measures used in this unit. The results of Plaquenil are significantly better than the most effective agent previously used in this unit, namely, Dindevan (phenindione). There were no deaths and no serious gastrointestinal or genitourinary bleeding. Allergic rashes occurred in 18 patients (0.8%), temporary blurring of vision in 6 (0.3%), and minor gastrointestinal upsets, including nausea, vomiting and minor bleeding in 12 (0.6%).
Dextrans↗
The characteristics of acetabular cups worn in the human body.
In laboratory tests, the ultra-high molecular weight polyethylene used for the acetabular cups of Charnley hip prostheses has a very low wear rate against steel. In the body radiographic measurements indicate that the polyethylene wears more rapidly. In order to investigate this higher wear rate, the sockets of acetabular cups removed at post-mortem have been examined using optical and electron microscopy. It has been shown that a socket wears predominantly on its superior part and that this is a direct consequence of the orientation of the cup in the body and the direction of loading of the hip. In the worn region the femoral head in effect bores out a new socket for itself, a process which is visible with the naked eye after approximately eight years. Electron microscopy shows that the predominant wear mechanism is adhesion, but after about eight years the appearance of surface cracks suggests that surface fatigue is taking place in addition to this. Laboratory wear tests have shown that pure surface fatigue is not sufficient to account for the high clinical wear rate. Other deformation processes are suggested and discussed with regard to the higher clinical wear rate.
Acetabulum↗
Low-friction arthroplasty after fracture-dislocations of the hip.
Sixty-six patients are presented who have had a total hip replacement by the Charnley low-friction technique after injuries of the hip, the majority of which were fracture-dislocations. The clinical results of the arthroplasties in this relatively young group of patients are shown to be very good. The selection of young patients for total hip replacement arthroplasty is discussed.
Adult↗
Postoperative dislocation after Charnley low-friction arthroplasty.
The dislocation rate after the Charnley arthroplasty with the 22 mm diameter femoral head was 0.8% in 3,820 arthroplasties performed before 1971. Over this era the annual rate ranged from 0.5% to 1.4% without any apparent explanation. Following the routine use of a low position for the socket in the acetabulum and the Long Posterior Wall design of socket, the dislocation rate fell to 0.4% over 4,706 arthroplasties and the annual dislocation rate over 4 years ranged between 0.5% and 0.2%.
Acetabulum↗
The results of Charnley arthroplasty of hip performed for protrusio acetabuli.
The results of total hip replacement in protrusio acetabuli using the Charnley technique have been very satisfactory. The immediate and late complications have been in no way different from those in ordinary cases of osteoarthritis and rheumatoid arthritis as performed in this hospital. There was no difference in the successful results whether a bone graft or cement alone had been used, and nothing to suggest that wire mesh need be used even in the severe cases. The diagnosis of idiopathic protrusio is 4 times more frequent than that of secondary protrusio. There was an incidence of 10 females for every male suffering from protrusio acetabuli. About half of the patients required bilateral low friction arthroplasties.
Acetabulum↗
An evaluation of a method of trochanteric fixation using three wires in the Charnley low friction arthroplasty.
The crossed wire technique of trochanteric reattachment, with ambulation from the second day after the arthroplasty, resulted in 2.3% of complete detachments, and 2.7% of fibrous union at one year (total failure rate of 5%). Of 75 trochanters which had a fibrous union at 3 months, 2 later became completely detached, 27 remained as a fibrous union and 46 progressed to complete or partial bony union by one year. The incidence of defective trochanteric union was 2.3 times more frequent in arthroplasties performed by residents in training than it was in those performed by senior staff, (10.8% and 4.6% respectively at 3 months and 5.6% and 2.4% respectively at 12 months). The incidence of defective trochanteric union in bilateral arthroplasties was double the rate in unilateral operations, (14% and 7% respectively). Eighty-six and one half per cent of the arthroplasties which developed defective union of the trochanter showed follow-up radiographic evidence of defective fixation, though 13.5% were apparently satisfactory on discharge. Roughly 79% (79.2%) of the cases which developed defective union of the trochanter developed broken wires within one year of the arthroplasty. Relief from pain by total joint arthroplasty was not significantly influenced by defective trochanteric union (mean postoperative grade for pain 5.8).
Aged↗
Conversion of fused hips to low friction arthroplasty.
Fifty-four hips converted to low friction arthroplasty between 1965 and 1975 have been reviewed one to eleven years after operation. In many cases malposition had led to degenerative changes in the opposite hip, the lumbar spine or the knee, often with severe loss of function due to pain. It was found that total replacement could give useful relief of pain and improved function, though the range of movement obtained was not as good as in primary replacement. An outstanding feature was the correction of inequality of leg length. In general, the results were much better in cases of ankylosis acquired in adult life than in cases of spontaneous fusion after sepsis in childhood. The most important complication was a single case of sciatic palsy.
Adult↗
Treatment of pulmonary embolism in total hip replacement.
From 1962-73 7,959 total hip replacements were performed by a standardized technique at Wrightington Hospital with 628 (7.89%) non-fatal emboli. Of 603 available for study the effect of different forms of anticoagulant therapy were compared with no therapy. The various antithromboembolic regimens in 295 cases had recurrent emboli in 13 per cent, while without anticoagulant therapy in 308 there were only 3.2 per cent recurrent pulmonary emboli.
Anticoagulants↗
Changes in the calcar femoris in relation to cement technology in total hip replacement.
Radiological changes in the calcar femoris after total hip replacement, in 97 hips where an extreme valgus position of the prosthesis had been achieved, were compared with 119 hips where the alignment of the prosthesis ranged from varus to only a moderate degree of valgus. In the series with extreme valgus there was a minimum of 1 cm of cement between the calcar femoris and the prosthesis, whereas in the other series the thickness of cement averaged 4.5 mm. In the series with thick cement destructive changes in the calcar were reduced by a factor of 10 and there were no examples of incipient subsidence of the femoral prosthesis. This comparison was based on a follow-up of only 2 years.
Acrylic Resins↗
Pulmonary embolism and its prophylaxis following the Charnley total hip replacement.
The incidence of pulmonary emboli after a standardized technique of total hip replacement in a series of 7,959 hip arthroplasties operated on between 1962 and 1973 was 1.04% fatal and 7.89% non-fatal. 1,174 had no prophylaxis against embolism with a fatality rate of 2.3% and non-fatal embolism in 15.2%. Phenindione, intravenous heparin and dextran all reduced the complication rate to about 1% fatal and 8% non-fatal but none was statistically better than another. Statistically, plaquenil (hydroxychloroquine sulphate), was as good as any of the other methods used and had few complications. Analysis of the blood groups, pre and post-operative hemoglobin levels, major and revision surgery showed little relationship to the incidence of embolism. The most frequent time of onset of embolism (75%) occurred in the second and third postoperative weeks with only 10% in the first week.
Blood Transfusion↗