Hip Osteoarthritis, Post-traumatic Osteoarthritis
Conditions
Keywords
ceramic-on-ceramic, total hip arthroplasty, acetabular fracture, post-traumatic hip osteoarthritis
Brief summary
A retrospective consecutive population of patients treated with cementless total hip arthroplasty with ceramic-on-ceramic bearing surfaces due to post-traumatic osteoarthritis due to acetabular fractures will be selected. The aim of this retrospective study is to evaluate the long-term clinical and radiographic results of this implant in such a specific cohort. The secondary aim of the sudy is to provide the complication rate and the failure rate of the cohort. A descriptive analysis of the failures will be provided as well.
Detailed description
Total hip arthroplasty (THA) is the recommended treatment to restore functionality and control pain in post-traumatic hip osteoarthritis due to acetabular fractures. However, THA in post-traumatic osteoarthritis following acetabular fractures is a complex procedure and it is burdened with occasional failures. Modest long-term outcomes have been reported, generally lower than conventional THAs performed due to osteonecrosis or primary osteoarthritis: 10-year clinical results are usually good but not excellent (average Harris Hip score: 88), 10-year revision rate is between 15% and 26%. In review study about the complications of post-traumatic THAs, 30% of ossifications, 4.4% of dislocations, 5.6% of infections, and 2.1% of neurovascular lesions were reported: all the percentages were higher than in primary conventional THAs. The most critical issues are related to the young age of the patients, to the anatomical changes affecting the periarticular tissues, to the presence of hardware and to the greater exposure to septic complications. All these factors may prevent the surgeon to achieve a good cup positioning and a satisfying outcome. However a correct surgical technique, associated with meticulous pre-operative planning and the use of low-wear implants can improve the clinical result and the long term survival rates. However, the literature about mid-to-long-term studies about post-traumatic THAs is scarce (currently 5 with an average follow-up of at least 5 years). Furthermore, these studies often include outdated implants, positioned with invasive surgical techniques and with removal of all previous hardware. Therefore, a long-term study (minimum 10-year follow-up) involving more recent implants, with modern articular couplings demonstrating low wear (such as ceramic-on-ceramic), and performed with minimally invasive technique and pre-operative CT-guided planning, would be desirable. The aim of this study is to describe the survival rates and the long-term clinical and radiological outcome (minimum 10-year follow-up) of cementless THAs, with ceramic-on-ceramic couplings, performed with minimally-invasive technique and CT guided pre-operative planning, in post-traumatic osteoarthritis due to acetabular fractures
Interventions
DEVICEceramic-on-ceramic total hip arthroplasty
ceramic-on-ceramic, cementless total hip arthroplasty for post-traumatic hip osteoarthritis.
Sponsors
Istituto Ortopedico Rizzoli
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* symptomatic, post-traumatic hip osteoarthritis due to acetabular fracture * consecutive population with a minimum follow-up of 10 years * cementless total hip arthroplasty with ceramic-on-ceramic bearing surfaces * pre-operative planning using CT * complete clinical and radiographic assessment
Exclusion criteria
* other type of hip osteoarthritis * other type of implants * inadequate pre-operative planning (eg: no CT) * incomplete assessment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Survival Rates of the Hip Implants | 10 years-18 years | Kaplan Meier curve with 95% confidence intervals |
| Clinical Outcomes of the Hip Implants | 10 years-18 years | HHS score (Harris Hip Score). Total scale: 0-100. Best performance: 100 |
| Percentage of Patients With Adequate Radiographic Cup Osseointegration | 10 years-18 years | Percentage of patients with a good osseointegration defined by the criteria described by Moore et al. Measurement technique: qualitative visual assessment of 5 binary parameters (yes/no): radial trabeculae, stress shielding, superolateral buttress, inferomedial buttress, absence of radiolucent lines. Adequate osseointegration: at least 3 parameters are present. Total scale: 0%-100%. Best performance (every patient has adequate osseointegration at 10 years): 100 |
Countries
Italy
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| THA Post Acetabular Fractures Ceramic-on-ceramic THA for Post-traumatic Hip Osteoarthritis After Acetabular Fracture with a minimum follow-up of 10 years | 68 |
| Total | 68 |
Baseline characteristics
| Characteristic | THA Post Acetabular Fractures |
|---|---|
| Age, Continuous | 47.6 years STANDARD_DEVIATION 11.6 |
| percentages of patients treated operatively | 50 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 68 Participants |
| Region of Enrollment Italy | 68 participants |
| Sex: Female, Male Female | 8 Participants |
| Sex: Female, Male Male | 60 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 68 |
| other Total, other adverse events | 2 / 60 |
| serious Total, serious adverse events | 8 / 68 |
Outcome results
Primary
Clinical Outcomes of the Hip Implants
HHS score (Harris Hip Score). Total scale: 0-100. Best performance: 100
Time frame: 10 years-18 years
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| THA Post Acetabular Fractures | Clinical Outcomes of the Hip Implants | 88.4 score on a scale | Standard Deviation 11.6 |
Primary
Clinical Outcomes of the Hip Implants
WOMAC score (Western Ontario and McMaster Universities Osteoarthritis Index). Total scale: 0-96. Best performance: 96
Time frame: 10 years -18 years
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| THA Post Acetabular Fractures | Clinical Outcomes of the Hip Implants | 84.3 score on a scale | Standard Deviation 9.6 |
Primary
Percentage of Patients With Adequate Radiographic Cup Osseointegration
Percentage of patients with a good osseointegration defined by the criteria described by Moore et al. Measurement technique: qualitative visual assessment of 5 binary parameters (yes/no): radial trabeculae, stress shielding, superolateral buttress, inferomedial buttress, absence of radiolucent lines. Adequate osseointegration: at least 3 parameters are present. Total scale: 0%-100%. Best performance (every patient has adequate osseointegration at 10 years): 100
Time frame: 10 years-18 years
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| THA Post Acetabular Fractures | Percentage of Patients With Adequate Radiographic Cup Osseointegration | 68 Participants |
Primary
Survival Rates of the Hip Implants
Kaplan Meier curve with 95% confidence intervals
Time frame: 10 years-18 years
| Arm | Measure | Value (MEAN) |
|---|---|---|
| THA Post Acetabular Fractures | Survival Rates of the Hip Implants | 96.3 percentage of non-revised implants |