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The continued value of clinical and radiological surveillance: the Charnley Elite Plus hip replacement system at 12
B Ollivere1, C Darrah, R C Brankin
1Institute of Orthopaedics Norfolk, Norwich University Hospital, Norwich, UK. ben@ollivere.co.uk
Insights
This 12-year follow-up of Elite Plus total hip replacements found 8.1% required revision, primarily for aseptic loosening. Radiological loosening predicted later failure, highlighting the need for regular implant surveillance.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Clinical Epidemiology
Background:
- The Elite Plus total hip replacement (THR) is a widely used implant.
- Previous studies reported outcomes at a mean of 6.4 years.
- Long-term performance data is crucial for evaluating implant survivorship.
Purpose of the Study:
- To report the 12-year clinical and radiological outcomes of the Elite Plus THR.
- To assess the survivorship and identify predictors of failure for this total hip replacement.
- To evaluate the association between radiological findings and clinical outcomes.
Main Methods:
- A cohort of 217 patients (234 THRs) with Elite Plus total hip replacements were followed for 12 years.
- Patients underwent radiological assessment and clinical evaluation using the Oxford hip score.
- Survivorship analysis was performed to determine implant survival rates, with revision for aseptic loosening as an endpoint.
Main Results:
- At 12 years, 19 (8.1%) THRs required revision, predominantly for aseptic loosening.
- Implant survivorship was 88.0% at 12 years.
- Radiological loosening of the femoral component was significantly associated with poorer Oxford hip scores and predicted later failure (p = 0.03).
Conclusions:
- The Elite Plus THR demonstrated an 88.0% survival rate at 12 years, with aseptic loosening being the main cause for revision.
- Radiological loosening is a significant predictor of total hip replacement failure and poorer clinical outcomes.
- Regular medium-term radiological and clinical surveillance is recommended for early detection of implant performance issues.
Abstract:
We report the follow-up at 12 years of the use of the Elite Plus total hip replacement (THR). We have previously reported the results at a mean of 6.4 years. Of the 217 patients (234 THRs), 83 had died and nine had been lost to follow-up. The patients were reviewed radiologically and clinically using the Oxford hip score. Of the 234 THRs, 19 (8.1%) had required a revision by the final follow-up in all but one for aseptic loosening. Survivorship analysis for revision showed a survival of 93.9% (95% confidence interval (CI) 89.2 to 96.5) at ten years, and of 88.0% (95% CI 81.8 to 92.3) at 12 years. At the final follow-up survival analysis showed that 37% (95% CI 37.3 to 44.7) of the prostheses had either failed radiologically or had been revised. Patients with a radiologically loose femoral component had a significantly poorer Oxford hip score than those with a well-fixed component (p = 0.03). Radiological loosening at 6.4 years was predictive of failure at 12 years. Medium-term radiographs and clinical scores should be included in the surveillance of THR to give an early indication of the performance of specific implants.