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Hip: Y.-H. Kim, J.-S. Kim, and S.-H. Yoon Long-term survivorship of the Charnley Elite Plus femoral component in young patients J Bone Joint Surg Br 2007; 89-B: 449-454 [Abstract] [Full text] [PDF]

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Young-Hoo Kim   (6 September 2007)

The Charnley Elite Plus - what is a success?

Ben J Ollivere, Clare Darrah, Neil Walton   (31 August 2007)

Authors' reply: 6 September 2007
Young-Hoo Kim, Professor and Director The Joint Replacement Center of Korea Send letter to journal: Re: Authors' reply: younghookim{at}ewha.ac.kr Young-Hoo Kim	Sir, We thank Mr Ollivere and his colleague for their interest in our paper. 1. We agree that it is not possible to obtain grade A cement technique in the femur with a femoral cortical perforation. One hip in our series had a small cortical perforation and we were able to obtain grade A cement technique in this case after plugging the perforating cortex with dough stage of bone cement. 2. The quality of the images are poor after reproduction. Radiographs shown in Figures 1a and 1b clearly demonstrate that stems in both hips are well fixed and there is no osteolysis or radiolucent line. 3. Femoral osteolysis in 25 hips was confined to the calcar femorale. Therefore, this finding did not compromise the stability of the femoral component. Acetabular osteolysis in 21 hips also was less than 1 cm2 in zone II of acetabulum and did not compromise the stability of the cup. 4. Two patients had femoral fracture but the stems were not loose. Two hips were loose and one hip with extensive osteolysis was loose. Therefore 3 of 194 hips (1.5%) were loose. We agree with Mr Ollivere that the survival rate should be 98.5% instead of 99.5%. This is a typographical error. We believe that our series had good outcomes at 11.2 years follow-up. Y-H. Kim, M.D, J-S. Kim, M.D, S-H. Yoon, M.D, The Joint Replacement Center of Korea, Ewha Womans University School of Medicine, Seoul, Korea.
The Charnley Elite Plus - what is a success? 31 August 2007
Ben J Ollivere, SpR Orthopaedics Norfolk & Norwich University Hospital, Clare Darrah, Neil Walton Send letter to journal: Re: The Charnley Elite Plus - what is a success? ben{at}ollivere.co.uk Ben J Ollivere, et al.	Sir, We read this paper with interest, particularly in light of several other reports1-4 of poor radiological outcomes. We were especially interested in the accuracy of the definitions used for radiological failure of the prosthesis. The paper quotes the Barrack classification5 for cement mantle grading, yet goes on to state that a stem with a lateral cortical perforation was graded ‘A’. A grade ‘A’ cement mantle as defined by Barrack requires "a so-called ‘white-out’ at the cement-bone interface"5 which is not possible with a cortical perforation. The radiographs given as examples in the paper of a well fixed and surviving stem also give us concern. In the right hip there is a prosthesis-cement radiolucent line in all zones on the AP and lateral views. There also appears to be a cement fracture in zone 2. The left stem has cement-prosthesis radiolucencies in zones 1 and 7 and hypertrophy in zone 3. It is impossible to compare with the post-operative films, and the quality of the images once reproduced is poor. The right stem would definitely be loose and the left probably loose according to Harris.6 We were confused as to how the calculation of radiographic success was made. Table II states that 46 hips were observed to have osteolysis. The radiographic survivorship rate for both components is quoted as 99.5%. The paper reports five patients (two fractures round a loose stem, two radiographically loose stems, one with significant osteolysis) where the intention to treat was revision. At best this makes a radiographic survival rate of 97.4%. The authors conclude good outcomes for the case series, however, the radiographs shown do not support this conclusion, and we have concerns over the statistical reporting. B. Ollivere, MRCS, Specialist Registrar, C. Darrah, RGN Dip Sci, Research Co-ordinator and Clinical Nurse Practitioner, N. Walton, FRCS, Consultant Orthopaedic Surgeon, Institute of Orthopaedics, Norfolk & Norwich University Hospital NHS Trust, Norfolk, UK. 1. Livingston SJ, Ivory JP. Five year survivorship study of the Charnley Elite Plus total hip replacement. J Bone Joint Surg [Br] 2003;85-B(Suppl 1):59-60. 2. Walton NP, Darrah C, Shepstone L, Donell ST, Phillips H. The Elite Plus arthroplasty: the need for radiological surveillance. J Bone Joint Surg [Br] 2005;87-B:458-62. 3. Rowsell M, Der Tavitian J, Birtwistle S, Power R. Survivorship of the Charnley Elite Plus cemented femoral stem. Int Orthop 2005;29:214-18. 4. Hauptfleisch J, Glyn-Jones S, Beard DJ, Gill HS, Murray DW. The premature failure of the Charnley Elite Plus stem. J Bone Joint Surg [Br] 2006;88-B:179-83. 5. Barrack RL, Mulroy RD Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty: a 12-year radiographic review. J Bone Joint Surg [Br] 1992;74-B:385-9. 6. Harris WH, McCarthy JC Jr, O’Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg [Am] 1982;64-A:1063-7.