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Total hip arthroplasty: review of long-term results in 185 cases
Insights
This review of Muller total hip arthroplasties found 70% excellent outcomes at 5-9 years. However, 15% poor results and 28% femoral loosening highlight areas for improvement in hip replacement surgery.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Total hip arthroplasty (THA) is a common procedure for hip joint diseases.
- The Muller total hip prosthesis has been used historically, necessitating long-term outcome evaluation.
Purpose of the Study:
- To evaluate the clinical and radiographic outcomes of Muller total hip arthroplasties.
- To identify complications and factors influencing long-term success rates.
Main Methods:
- Retrospective review of 185 consecutive Muller total hip arthroplasties.
- Clinical and radiographic examinations with a minimum 5-year follow-up.
- Exclusion of patients lost to follow-up or with unrelated exclusions.
Main Results:
- 126 hips in 104 patients were analyzed.
- Excellent outcomes in 70%, good in 10%, fair in 5%, and poor in 15%.
- Complications included deep infection (1), dislocations (5), subluxations (6), acetabular loosening/malposition (4), and trochanteric osteotomy failures (4/9).
- Radiographic evidence of femoral component loosening in 28%, with 8% requiring revision.
- Poor cement filling and varus stem positioning were associated with loosening.
Conclusions:
- Muller total hip arthroplasty demonstrated a high rate of excellent outcomes but also significant rates of loosening and instability.
- Technical factors such as cement technique and femoral stem positioning are critical for long-term prosthesis survival.
Abstract:
Review of 185 consecutive Muller total hip arthroplasties five to nine years after operation showed that 14 patients had died and that three deaths were directly related to the surgery. Of these, 37 patients (54 hips) could not be located and were excluded. Another patient, nonambulatory for an unrelated cause, was also excluded. A total of 126 hips in 104 patients were available for clinical and roentgenographic examinations with a minimal follow-up of five years. The final result was excellent in 70%, good in 10%, fair in 5%, and poor in 15%. One deep infection required removal of the prosthesis. There was no sciatic nerve injury. Five hips dislocated postoperatively and six others had recurrent subluxation. Replacement of the acetabular component was required in four hips, three because of loosening and the other for malposition in association with paraparesis. Trochanteric osteotomy was done in nine hips and four failed to unite. There was roentgenographic evidence of femoral component loosening in 28% of the hips and 8% required replacement. Poor cement filling and varus positioning of the femoral stem contributed to loosening.