Charnley total hip arthroplasty with use of improved techniques of cementing. The results after a minimum of fifteen years of follow-up.
Three hundred and fifty-seven consecutive Charnley total hip arthroplasties were performed in 320 patients with use of a so-called second-generation technique of cementing between July 1976 and June 1978. This technique includes use of a distal femoral intramedullary cement plug, hand-mixing of the cement, and use of a cement gun to deliver the cement into the femoral canal in a retrograde fashion. At the time of the latest follow-up evaluation, a minimum of fifteen years after the arthroplasty, 130 patients (142 hips) were still alive, 189 patients (214 hips) had died, and one patient (one hip) had been lost to follow-up. A radiograph was made for 116 (82 per cent) of the 142 hips in the 130 surviving patients. Of the 356 hips that had not been lost to follow-up, thirty-three (9 per cent) had had a revision and two (1 per cent), a Girdlestone resection arthroplasty during the follow-up period. Nineteen hips (5 per cent) were revised because of aseptic loosening of the femoral or acetabular component, or both (two hips); seven (2 per cent), because of loosening with infection; and seven (2 per cent), because of dislocation. The two resection arthroplasties were performed because of loosening with infection; both were done in patients who died before the time of the latest follow-up evaluation. Of the 142 hips in the 130 patients who were alive at a minimum of fifteen years, twenty-two (15 per cent) had been revised: fifteen (11 per cent), because of aseptic loosening; three (2 per cent), because of loosening with infection; and four (3 per cent), because of dislocation. Revision of the femoral component because of aseptic loosening (excluding components that were revised because of dislocation or infection) was performed in four (1 per cent) of the entire series of 356 hips and in three (2 per cent) of the 142 hips in the 130 patients who survived for at least fifteen years. Two of the 356 hips and two of the 142 hips had aseptic loosening of the acetabular as well as the femoral component at the time of the revision. Loosening of the femoral component, defined as aseptic loosening leading to revision or as definite or probable radiographic loosening, occurred in ten (3 per cent) of the 356 hips and in six (5 per cent) of the 116 hips for which radiographs were made at a minimum of fifteen years. The acetabular component was revised because of aseptic loosening in seventeen (5 per cent) of the entire series of 356 hips and in fourteen (10 per cent) of the 142 hips in the 130 patients who survived for at least fifteen years. The acetabular component loosened without infection in forty-one (12 per cent) of the 356 hips and in twenty-six (22 per cent) of the 116 hips for which radiographs were made at a minimum of fifteen years. In two of these patients, the femoral component was also revised. Thus, of the entire series of 356 hips, two had a revision of the femoral component alone because of aseptic loosening; fifteen, a revision of the acetabular component alone; and two, a revision of both components. Of the 142 hips in the 130 patients who survived for at least fifteen years, one was revised for loosening of the femoral component alone; twelve, for loosening of the acetabular component alone; and two, for loosening of both components. These findings demonstrate long-term durability of fixation of the femoral component but less reliable fixation of the acetabular component, even when the surgeon is experienced and improved techniques of cementing are used.