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Total Hip Arthroplasty at the Rothman Institute

  • Review Article
  • Published:
HSS Journal ®

Abstract

Background

Total hip arthroplasty (THA) is one of the most successful surgical interventions devised in modern times. Attempts to change the current THA procedure with unproven innovations bring the risk of increased failure rates while trying to improve the benefit of the surgery.

Questions/Purposes

This manuscript examines the evolution of THA at the Rothman Institute illustrating the key elements that lead the success of this procedure at this institution. These key elements include femoral stem design, use of highly crossed-linked polyethylene and use of pain and rehabilitation protocols. We attempted to describe the long-term results regarding safety, effectiveness, and durability of specific THA implant designs used at this institution drawing on reported evidence in the literature.

Methods

The authors performed a review of peer-reviewed articles related to the Rothman Institute’s experience with THA.

Results

Total hip arthroplasty is an efficient, safe, and durable procedure. It is a highly successful operation to restore function and improve pain. The survivorship of THA procedures at the Rothman Institute is higher than 99% at 10 years based on mechanical failure. The use of collarless, tapered wedge femoral stem, highly crossed-linked polyethylene, and improved pain rehabilitation protocols have contributed to this success.

Conclusions

There is a well-documented long-term survivorship after THA. Future innovation in THA should address new challenges with younger and more demanding patients, rather than change current methods that have a proven good survivorship. This innovation depends mainly upon improvements in the bearing surfaces and advances in pain control and rehabilitation.

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References

  1. Bitsch RG, Loidolt T, Heisel C, Ball S, Schmalzried TP (2008) Reduction of osteolysis with use of Marathon cross-linked polyethylene. A concise follow-up, at a minimum of five years, of a previous report. The Journal of Bone and Joint Surgery. American Volume 90:1487–1491.

    Article  PubMed  Google Scholar 

  2. Busch CA, Whitehouse MR, Shore BJ, MacDonald SJ, McCalden RW, Bourne RB. The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty. Clinical Orthopaedics and Related Research. 2010;468:2152–2159.

    Article  PubMed  Google Scholar 

  3. Calvert GT, Devane PA, Fielden J, Adams K, Horne JG. A double-blind, prospective, randomized controlled trial comparing highly cross-linked and conventional polyethylene in primary total hip arthroplasty. The Journal of Arthroplasty. 2009;24:505–510.

    Article  PubMed  Google Scholar 

  4. Casper DS, Kim GK, Restrepo C, Parvizi J, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component five- to nine-year results. The Journal of Arthroplasty. 2011;26:838–841.

    Article  PubMed  Google Scholar 

  5. Ciccotti MG, Rothman RH, Hozack WJ, Moriarty L. Clinical and roentgenographic evaluation of hydroxyapatite-augmented and nonaugmented porous total hip arthroplasty. The Journal of Arthroplasty. 1994;9:631–639.

    Article  PubMed  CAS  Google Scholar 

  6. Dumbleton JH, D'Antonio JA, Manley MT, Capello WN, Wang A. The basis for a second-generation highly cross-linked UHMWPE. Clinical Orthopaedics and Related Research. 2006;453:265–271.

    Article  PubMed  Google Scholar 

  7. Engh CA, Powers CC, Ho H, Beykirch-Padgett SE, Hopper RH, Jr., Engh CA, Jr. The effect of poly sterilization on wear, osteolysis and survivorship of a press-fit cup at 10-year followup. Clinical Orthopaedics and Related Research. 2011.

  8. Froimson MI, Garino J, Machenaud A, Vidalain JP. Minimum 10-year results of a tapered, titanium, hydroxyapatite-coated hip stem: an independent review. The Journal of Arthroplasty. 2007;22:1–7.

    Article  PubMed  Google Scholar 

  9. Hearn SL, Bicalho PS, Eng K, Booth RE, Jr., Hozack WJ, Rothman RH. Comparison of cemented and cementless total hip arthroplasty in patients with bilateral hip arthroplasties. The Journal of Arthroplasty. 1995;10:603–608.

    Article  PubMed  CAS  Google Scholar 

  10. Hozack W, Gardiner R, Hearn S, Eng K, Rothman R. Taperloc femoral component. A 2–6-year study of the first 100 consecutive cases. The Journal of Arthroplasty. 1994;9:489–493.

    Article  PubMed  CAS  Google Scholar 

  11. Hozack WJ, Rothman RH, Booth RE, Jr., Balderston RA. Cemented versus cementless total hip arthroplasty. A comparative study of equivalent patient populations. Clinical Orthopaedics and Related Research. 1993:161–165.

  12. Hozack WJ, Rothman RH, Booth RE, Jr., Balderston RA, Cohn JC, Pickens GT. Survivorship analysis of 1,041 Charnley total hip arthroplasties. The Journal of Arthroplasty. 1990;5:41–47.

    Article  PubMed  CAS  Google Scholar 

  13. Hozack WJ, Rothman RH, Eng K, Mesa J. Primary cementless hip arthroplasty with a titanium plasma sprayed prosthesis. Clinical Orthopaedics and Related Research. 1996:217–225.

  14. Keisu KS, Orozco F, McCallum JD, 3 rd, Bissett G, Hozack WJ, Sharkey PF, Rothman RH. Cementless femoral fixation in the rheumatoid patient undergoing total hip arthroplasty: minimum 5-year results. The Journal of Arthroplasty. 2001;16:415–421.

    Article  PubMed  CAS  Google Scholar 

  15. Keisu KS, Orozco F, Sharkey PF, Hozack WJ, Rothman RH, McGuigan FX. Primary cementless total hip arthroplasty in octogenarians. Two to eleven-year follow-up. The Journal of Bone and Joint Surgery. American Volume. 2001;83-A:359–363.

    PubMed  CAS  Google Scholar 

  16. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. The Journal of Bone and Joint Surgery. American Volume. 2007;89:780–785.

    Article  PubMed  Google Scholar 

  17. Lenfant C. Shattuck lecture—clinical research to clinical practice—lost in translation? The New England Journal of Medicine. 2003;349:868–874.

    Article  PubMed  Google Scholar 

  18. Lettich T, Tierney MG, Parvizi J, Sharkey PF, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component: two- to seven-year results. The Journal of Arthroplasty. 2007;22:43–46.

    Article  PubMed  Google Scholar 

  19. McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. The Journal of Bone and Joint Surgery. American Volume. 2008;90:1290–1296.

    Article  PubMed  Google Scholar 

  20. National Institute of Health. Consensus Statement Total Hip Replacement. 1994;12(5). http://consensus.nih.gov/cons/098/098_intro.htm. Accessed 8th August 2011.

  21. National Joint Registry for England and Wales. 6th Annual Report. 2009. http://www.njrcentre.org.uk/NjrCentre/Portals/0/Sixth%20annual%20NJR%20report.pdf. Accessed 8th August 2011

  22. Orishimo KF, Claus AM, Sychterz CJ, Engh CA. Relationship between polyethylene wear and osteolysis in hips with a second-generation porous-coated cementless cup after seven years of follow-up. The Journal of Bone and Joint Surgery. American Volume. 2003;85-A:1095–1099.

    PubMed  Google Scholar 

  23. Ottenbacher KJ, Smith PM, Illig SB, Linn RT, Ostir GV, Granger CV. Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. JAMA : the Journal of the American Medical Association. 2004;292:1687–1695.

    Article  CAS  Google Scholar 

  24. Parvizi J, Keisu KS, Hozack WJ, Sharkey PF, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem. The Journal of Arthroplasty. 2004;19:151–156.

    Article  PubMed  Google Scholar 

  25. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. The Journal of Bone and Joint Surgery. American Volume. 2011;93:1075–1084.

    Article  PubMed  Google Scholar 

  26. Parvizi J, Wickstrom E, Zeiger AR, Adams CS, Shapiro IM, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH, Hickok NJ. Frank Stinchfield Award. Titanium surface with biologic activity against infection. Clinical Orthopaedics and Related Research. 2004:33–38.

  27. Pieringer H, Auersperg V, Griessler W, Bohler N. Long-term results with the cementless Alloclassic brand hip arthroplasty system. The Journal of Arthroplasty. 2003;18:321–328.

    Article  PubMed  Google Scholar 

  28. Pospischill M, Knahr K. Cementless total hip arthroplasty using a threaded cup and a rectangular tapered stem. Follow-up for ten to 17 years. The Journal of Bone and Joint Surgery. British Volume. 2005;87:1210–1215.

    Article  PubMed  CAS  Google Scholar 

  29. Purtill JJ, Eng K, Rothman RH, Hozack WJ. Heterotopic ossification. Incidence in cemented versus cementless total hip arthroplasty. The Journal of Arthroplasty. 1996;11:58–63.

    Article  PubMed  CAS  Google Scholar 

  30. Restrepo C, Mortazavi SM, Brothers J, Parvizi J, Rothman RH. Hip dislocation: are hip precautions necessary in anterior approaches? Clinical Orthopaedics and Related Research. 2011;469:417–422.

    Article  PubMed  Google Scholar 

  31. Rothman RH. Accelerated Rehabilitation for Total Hip Arthroplasty. In: The Hip Society. Washington, D.C.: 2005.

  32. Rothman RHS, P.F.; Hozack, W.J.; Martell, J. Wear performance of conventional (Arcom) and highly cross-linked acetabular liners in bilateral total hip arthroplasty. The Journal of Arthroplasty. 2004;19:261.

  33. Sakalkale DP, Eng K, Hozack WJ, Rothman RH. Minimum 10-year results of a tapered cementless hip replacement. Clinical Orthopaedics and Related Research. 1999:138–144.

  34. Teloken MA, Bissett G, Hozack WJ, Sharkey PF, Rothman RH. Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement. The Journal of Bone and Joint Surgery. American Volume. 2002;84-A:2140–2144.

    PubMed  Google Scholar 

  35. Wang A, Yau SS, Essner A, Herrera L, Manley M, Dumbleton J. A highly crosslinked UHMWPE for CR and PS total knee arthroplasties. The Journal of Arthroplasty. 2008;23:559–566.

    Article  PubMed  Google Scholar 

  36. Zicat B, Engh CA, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. The Journal of Bone and Joint Surgery. American Volume. 1995;77:432–439.

    PubMed  CAS  Google Scholar 

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Disclosures

(MSA) certifies that he has or may receive payments or benefits from a commercial entity (Zimmer) related to this work. (RHR) certifies that he has or may receive payments or benefits from a commercial entity (Stryker, Riverside) related to this work. One or more of the authors (MSA) has received research funding (DePuy). CAH certifies that he has no conflict of interest.

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Authors and Affiliations

  1. Rotham Institute, Thomas Jefferson University, 925 Chestnut St., 5th Floor, Philadelphia, PA, 19107, USA

    Matthew S. Austin MD, Carlos A. Higuera MD & Richard H. Rothman MD, PhD

Authors
  1. Matthew S. Austin MD
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  2. Carlos A. Higuera MD
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  3. Richard H. Rothman MD, PhD
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Corresponding author

Correspondence to Carlos A. Higuera MD.

Additional information

Level of Evidence: Level IV: Theraputic Study. Systematic Review of Level IV Studies

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Austin, M.S., Higuera, C.A. & Rothman, R.H. Total Hip Arthroplasty at the Rothman Institute. HSS Jrnl 8, 146–150 (2012). https://doi.org/10.1007/s11420-012-9268-x

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  • DOI: https://doi.org/10.1007/s11420-012-9268-x

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