A P r o s p e c t i v e Study of 100 C o n s e c u t i v e HarrisGalante Porous Total Hip A r t h r o p l a s t i e s 2-5-Year Results P a u l F. L a c h i e w i c z ,

M D , W i l l i a m E. A n s p a c h

III, MD, and Ralph DeMasi,

MPH

Abstract: This is a prospective study of the authors" first 100 Harris-Galante porous total hip arthroplasties (TIIA) that were followed for 2-5 years. The mean age of the 83 patients was 43 years. Using the Itarris hip rating system, 80% of the hips were rated as excellent, 13% as good, 5% as fair, and 2% as poor at final evaluation. Eighty percent of the hips had no pain, 11% had slight or occasional pain, 8% had activityrelated pain, and 1% had moderate pain. Eighty-seven percent of the hips had no limp, 8% had a slight limp, and 5% had a moderate limp. One femoral component, placed as a conversion of a loose bipolar hemiarthroplasty, has been removed for loosening. Two other hips have been reoperated, one for lengthening the femoral neck and one for changing the acetabular liner. There were no problems with acetabular screw fixation and no component migrated. Only two hips had 1 mm nonprogressive radiolucent lines in all three zones. Femoral component subsidence of 3 or more m m was measured in 16 hips, but was progressive in only 1. Radiolueent and radiodense lines were frequently seen in the nonporous coated regions of the femoral stem. Loss of proximal medial femoral bone density was seen in 59% of hips, and calcar resorption was seen in 16% of hips. Although the clinical results of this uncemented implant system were good or excellent in 93% of hips, the high incidence of femoral component subsidence is worrisome. Key words: porous-coated total hip arthroplasty, titanium fiber metal uncemented total hip arthroplasty.

The short and relatively long-term results of cemented total hip arthroplasty (THA) in y o u n g or very active patients have been relatively disappointing. 5"8,24 The preliminary results of THA using cementless c o m p o n e n t s have been encouraging. 4,~~ 1. ~6,~8 However, there is controversy concerning the optimum component design for cementless arthroplasty. Components are fabricated from either titanium or chrome-cobalt alloy. Acetabular c o m p o nents h a v e various means of achieving initial stability, including screws, pegs, spikes, or threads. Femo-

ral stems are either straight or curved to m a t c h the proximal b o w of the femur. The type of porous coating ( m e s h or beads), and its distribution (proximal or fully coated) are variable. The femoral c o m p o n e n t m a y or m a y not have a collar. We began a prospective study of the Harris-Galante porous THA (Zimmer USA, Warsaw, IN) at the University of North Carolina Hospital in 1984 in those patients considered to be at high risk for cemented implant failure (ie, age less than 60 years, obesity, and high physical demands). The p u r p o s e of this study is to report the 2 - 5 - y e a r clinical and radiographic results of the first 100 cases.

From the Di~ion of Orthopaedics, UNC Schoolof Medicine, Chapel ltill, North Carolina.

Materials and Methods

Reprint requests: Paul F. Lachiewicz,MD, Divisionof Orthopaedics, UNC School of Medicine, 250 Bumett-Womack Building, 229-H, Chapel Hill, NC 27599-7055.

The Harris-Galante THA c o m p o n e n t s are forged titanium alloy with commercially pure titanium fi-

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The Journal of Arthroplasty Vol. 7 No. 4 December 1992

!

I !

f Fig. 1. The Harris-Galante porous THA components. The modular head and polyethylene liner are not shown.

ber-metal mesh porous ingrowth surfaces (Fig. 1). The mesh has a pore volume of 50% and an average pore size of 300 p.m, characteristics that have been shown to be conducive to bone ingrowth. 15 The acetabular component is hemispherical with a full mesh covering. Fixation is achieved with multiple self-tapping cancellous screws, either 4.5 or 5.1 mm in diameter. The femoral component is a straight stem with a Morse taper articulation for a modular chromecobalt head. The stem has a flat medial collar and ingrowth pads limited to the anterior, posterior, and medial surfaces of the proximal third of the implant. Between December 1984 and September 1988, 104 Harris-Galante THAs were performed in 83 patients who were considered to be at high risk for cemented implant failure (ie, age less than 60 years, obesity, and high physical demands). Three patients (4 hips) were excluded from the study. One patient (with a good result) died from an unrelated cause at 18 months, one was completely lost during the follow-up period after 6 weeks, and one patient (2 hips) with excellent results had moved out of state and had only telephone follow-up evaluation. The remaining 100 hips in 80 patients were followed prospectively

for 2-5 years with a mean follow-up period of 37 months. There were 52 women and 28 men with a mean age of 43 years (range, 18-68 years) and a mean weight of 72 kg (range, 47-112 kg). Forty-one of the 80 patients were considered obese, as defined by weight greater than 119% ideal body weight, using the 1983 Metropolitan Life Insurance Company tables. 23 Only seven patients were older than 60 years. These seven patients (mean age, 63 years) were either obese or had very high activity demands, such as active farmers. The preoperative diagnosis was primary or posttraumatic osteoarthritis in 37 hips, rheumatoid arthritis and juvenile rheumatoid arthritis in 31 hips, and avascular necrosis in 24 hips. There were eight hips with various other diagnoses, including conversions of two uncemented hemiarthroplasties, and two cup arthroplasties. There were no revisions of failed cemented implants included in this series. There was no selection bias involved for the patients entered into this study. The activity level of the 22 patients (31 hips) with rheumatoid arthritis varied. Before surgery, six patients were employed, four were homemakers, eight were home on full-time disability, and four were home and nonambulatory. After surgery, ten patients (14 hips) were employed, four (8 hips) remained active homemakers, and eight (9 hips) remained at home, not employed but ambulatory. All procedures were supervised or performed by the senior author (P.F.L.) in a conventional operating room without laminar air flow. Ninety-six arthroplasties were performed through a posterior approach. Four hips had a trans-trochanteric approach: one to aid removal of an Austin-Moore hemiarthroplasty and three to permit trochanteric advancement in hips with varus deformities. Eight patients had bilateral procedures during the same hospitalization. Six of these were performed under the same anesthesia. The femur and acetabulum were reamed on line, that is, the size of the prosthesis implanted matched the size of the reamer. However, with acetabular implantation the final reamer was used sparingly and only at the rim of the acetabulum. All acetabular components were then press fit. Additional fixation was obtained with three to six screws (mean, 3.9 screws), which were placed superiorly or posteriorly, in addition to a polar hole screw. An attempt was made to achieve femoral component collar-calcar contact in all cases using the appropriate instrumentation. Intraoperatwe collar-calcar contact was considered to be achieved ifa scalpel blade could not be passed between the implant collar and the medial femoral neck. Prophylactic cerclage wiring of the femoral neck and torque wrench-micrometer

Harris-Galante Porous THAs

evaluation of the implant were not utilized in these cases. Patients with unilateral procedures were advised non-weight bearing for 12 weeks after surgery. those with bilateral procedures during the same hospitalization ambulated with two Lofstrand crutches with a four-point gait for 12 weeks. Thromboembolism prophylaxis consisted of aspirin (650 mg twice daily) and monitoring using pre and postoperative Doppler or Duplex vein scans and ventilation-perfusion lung scans. 21 Patients were examined, and postoperative radiographs were obtained at 6 weeks, 3 months, 6 months, 1 year, and yearly thereafter. The results of the arthroplasties were evaluated using both the Hospital for Special Surgery (HSS) hip scoring system and the modified ttarris hip score. 14"2~ The two scoring systems were used in order to compare these results in the future to those from other orthopaedic institutions. These scoring systeins measure different parameters, thus there are differences in the pre and postoperative scores. With the HSS hip scoring system, 32 or more points is considered an excellent result, 2 4 - 3 1 a good result, 1 6 - 2 3 a fair result, and less than 16 a poor result. Any hip that has had removal of the components is also considered a poor result. With the ttarris hip score, a score of 90 or more points is considered an excellent result, 8 0 - 8 9 a good result, 7 0 - 7 9 a fair result, and less than 70 a poor result. All patients were evaluated with an anteroposterior radiograph of the pelvis, centered over the pubis, and an anteroposterior and frog lateral of the hip, which included the entire prosthesis. The radiographs were analyzed for component position and migration, femoral fill, radiolucent and radiodense lines, and heterotopic bone formation using the following parameters. The acetabular c o m p o n e n t position o n the anteroposterior pelvic radiograph was defined by (I) the cup angle, (2) the vertical distance between the lower edge of the component and the bottom of the teardrop, and (3) tile horizontal distance between the medial edge of the component and Kohler's line. 4 The acetabulum c o m p o n e n t position was also assessed utilizing the method of Ranawat et al. 2~ Migration was defined as a change

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in the vertical or horizontal position of 3 m m or more, or a change in tile cup angle of more than 5 ~ Femoral component fill was measured at the midlesser trochanter as described by Dorr, and at a distance proximal to the tip equal to 10% of the length of the stem. 9 Femoral c o m p o n e n t subsidence was defined as a change in position of 3 m m or more with respect to the tip of the greater trochanter and the mid-lesser trochanter o n comparable radiographs. Radiolucent lines and radiodense lines (condensation) were measured and localized using the zones defined by DeLee and Chamley for the acetabular component 7 and Gruen et al. for the femoral component. 13 Collar-calcar contact was confirmed on the postoperative anteroposterior radiograph of the pelvis, and on subsequent similar radiographs. Calcar rounding was defined as rounding of the cut edge of the proximal medial femur without longitudinal loss. Calcar resorption was defined as longitudinal loss of the proximal medial femoral neck. Heterotopic ossification was classified according to the method of Brooker et al. 3

Results Clinical Results The m e a n preoperative Harris hip score was 39 (range, 5 - 7 6 ) . The m e a n Harris hip total score at both 2 years and final follow-up evaluation was 94 (range, 6 0 - 1 0 0 ) . Using the Harris hip score, 80% of hips were rated as excellent, 13% as good, 5% as fair, and 2% as poor at the last follow-up examination. Using tlae I-ISS hip rating system, 87% of hips were rated as excellent, 12% as good, 1% as fair, and none as poor. There was little difference between the postoperative result described by either the Harris or HSS hip scoring systems (Table 1). However, patients with rheumatoid arthritis had lower functional scores than those w i t h o t h e r diagnoses (P = .001). Pain Using the Harris hip system, at the 1 year followup evaluation, 80% of hips had no pain, 17% had slight and occasional thigh or groin pain, 2% had

Table I. Total Score Comparison Excellent

Preoperative 1 year 2 years Final follow-up score

Good

Fair

Poor

ttarris

HSS

Harris

ttSS

Harris

HSS

Harris

ttSS

0 75 83 80

0 83 84 87

0 20 9 13

9 17 14 12

l 5 3 5

55 0 1 1

99 0 4 2

36 0 1 0

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The Journal of Arthroplasty Vol. 7 No. 4 December 1992

activity-related pain requiring mild analgesics, and 1% had moderate pain requiring activity modification and stronger analgesics. At the most recent follow-up evaluation, 80% of hips had absolutely no pain, 11% had slight and occasional thigh, hip, or groin pain, 8% had activity-related pain that required mild analgesics (aspirin or a nonsteroidal medication), and 1% had moderate pain that reduced ambulation and required occasional strong analgesics. The incidence of thigh or groin pain did not correlate with femoral fill or the presence or absence of collar-calcar contact.

Limp At the final follow-up evaluation, 87% of hips exhibited no limp, 8% had a slight limp, and 5% had a moderate limp.

Support At the final follow-up evaluation, 89% of hips used no support, 5% used a cane for long walks, 3% used a cane full=time, and 3% used two supports.

Complications Intraoperative. In 27% of hips, despite the proper use of the rasp-trial and t h e c a l c a r reamer, the prosthetic collar was unable to be impacted sufficiently to obtain intimate collar-calcar contact. In six hips, a calcar or posteromedial neck crack or fracture occurred during preparation of the femur or impaction of the implant. In five of these hips, there was previous hardware that was removed at the time of surgery. These six hips were treated with cerclage wire fixation. Postoperative. Four patients had an asymptomatic deep vein thrombosis as determined by a change in the venous Doppler or Duplex examination. Two patients, w h o had bilateral arthroplasties, had nonfatal symptomatic pulmonary embolism; and seven patients had an asymptomatic pulmonary embolism as determined by a high probability change in the ventilation-perfusion lung scan. There was no statistically significant difference in the incidence of thromboembolism between patients with cemented components and those with cementless components, at T h e r e were no superficial or deep infections. There were two transient peroneal nerve palsies, one urinary tract infection, and one prolonged ileus. Two hips had episodes of posterior dislocation during the study period. One hip had five separate episodes over 4 years, and recently u n d e r w e n t reoperation. The second hip had two separate episodes of posterior dislocation.

Reoperation. Three hips have had additional surgery. One hip, in a w o m a n with rheumatoid arthritis, had five episodes of posterior dislocation over 4 years, and had placement of an extended lip polyethylene acetabular liner with posterior capsule repair at 4.5 years after surgery. There have been no subsequent dislocations. The second hip requiring reoperation was in a young w o m a n with osteonecrosis with episodes of subluxation and thigh pain. At 2.5 years after surgery the hip was explored, but the femoral component was found to be rigidly fixed. The neck length was changed from m e d i u m to long. At five years after surgery, she has occasional episodes of thigh pain, and a good Harris hip score. One femoral component that had progressive subsidence was recently revised (at 6.5 years after surgery) to a cemented calcar replacement component. This HarrisGalante porous femoral c o m p o n e n t was placed as a conversion of a loose bipolar hemiarthroplasty with severe calcar bone loss.

Radiographic Results Acetabulum There was no evidence of acetabular c o m p o n e n t migration or shift. Two hips had 1 m m nonprogressive radiolucent lines in all three zones. Four hips had thin radiodense lines in all three zones at the final follow-up examination. The distribution ofradiolucent and radiodense lines is s h o w n in Figure 2. There were no radiolucent lines around any of the screws and there were no broken screws. No component showed evidence of delamination of the fiber mesh. One acetabular c o m p o n e n t was noted at 3 years to have a fracture of one of six metal tines used to hold the polyethylene liner. There has been no change on the 4-year follow-up radiograph.

Femur Femoral component subsidence of 3 or more m m was noted in 16 hips. Ten hips had measured subsidence of between 3 and 5 m m o n the anteroposterior

12% 8%

RADIOLUCENT LINES

22% =l i I

RADIODENSE

10%

LINES

Fig. 2. The frequency (% of hips) and distribution (DeLee and Chamley zones) of radiolucent and radiodense lines around the acetabular component.

Harris-Galante Porous THAs

radiograph. Six hips had measured subsidence greater than 5 ram. One hip had 6 mm, three hips had 7 mm, one had 8 mm, and one had 26 m m of subsidence. All but one femoral component appeared to have stabilized by the final follow-up examination. The one hip with 26 m m of subsidence, which has not stabilized, was a conversion of a loose bipolar prosthesis with severe calcar bone loss. The Harris-Galante porous femoral c o m p o n e n t was a poor choice of implant in this patient, ttips with subsided components had lower mean pain scores (38 points) than hips without subsidence (43 points), a statistically significant difference at the 2-year follow-up evaluation (P = .05). However, there was no significant difference at other periods of followup evaluation. The mean measured femoral fill at the calcar isthmus on the anteroposterior radiograph was 70% (range, 5 1 - 1 0 0 % ) . The m e a n femoral fill of the distal stem was 94% (range, 7 8 - 1 0 0 % ) on the anteroposterior radiograph, but only 60% (range, 3 9 - 7 9 % ) on the lateral radiograph. There was no correlation between femoral fill and subsidence, nor was there a relationship between intraoperative collar-to-calcar contact and subsidence of the femoral component. The overall distribution and frequency of radiolucent and radiodense lines around the femoral component are shown in Figures 3 and 4. Although a radiodense line usually accompanies a radiolucent line, radiodense lines directly adjacent to the compo-

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nent, without an intervening radiolucent zone, were frequently observed. Femoral radiolucent lines and radiodense lines (condensation) were observed in three general patterns. Hips in group 1 had no radiolucent or radiodense lines or thin radiodense lines only in theanteroposterior zone 1 or 4. Hips in group 2 exhibited lines more extensively about the smooth or nonporous-coated portions of the stem on both the anteroposterior and lateral radiographs. Hips in group 3 had a radiolucent line or radiodense line adjacent to one or more of the fiber-mesh pads. Those components with measured subsidence were classified as group 4. The distribution of hips in these four groups, and the m e a n pain score is shown in Table 2. Only three femoral components had radiolucent lines in all seven zones. With the exception of group 5, the patterns were not predictive of clinical score. There was a higher incidence of radiodense lines (condensation) than radiolucent lines. In m a n y femurs, the radiodense line was immediately adjac e n t to the porous or n o n p o r o u s surface without an interposed radiolucent line. Femoral remodeling, as defined as the loss of density of the proximal medial femur, was seen in 59 hips. Rounding of the calcar was noted in 60 hips, and 16 hips had longitudinal loss of the medial neck (calcar resorption) of 2 m m or more. There was no statistically significant correlation between calcar resorption or loss of density of the proximal medial femur and the measured femoral fill at the calcar

41

ANTERIOR 38 I0

43 ;5

n

12

13

28 F~STERIOR

A

B

Fig. 3. (A) The frequency (%) and distribution (zones I-7) of radiolucent lines around the femoral component on the anteroposterior radiograph at the most recent follow-up evaluation. (B) The frequency (%) and distribution (zones 8-14) of radiolucent lines around the femoral component on the lateral radiograph at the most recent follow-up evaluation.

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The Journal of Arthroplasty Vol. 7 No. 4 December 1992

84

48i611112 f 281 322 A

61

ANTERIOR 48

14

IO

9

.

tl ~.

69

IZ 21. POSTERIOR

15 "28

B

Fig. 4. (A) The frequency ( % ) and distribution (zones 1-7) of radiodense lines (condensation) around the femoral component on the anteroposterior radiograph at most recent follow-up evaluation. (B) The frequency (%) and location (zones 8 - 1 4 ) of radiodense lines around the femoral component on the lateral radiograph at the most recent follow-up evaluation.

isthmus. However, no hip with intraoperative collarcalcar contact exhibited calcar resorption of 2 mm or more (P = .0001). Distal cortical hypertrophy in zones 3 and 5 was seen in,18 hips. Cortical erosion (osteolysis) was seen in four hips in zone 3, and two patients (2 hips) had associatedthigh pain. No significant correlation could be found between femoral remodeling in its various forms and the clinical outcome.

Heterotopic Ossification Fi•-seven percent of hips had no heterotopic bone formation. Twenty-nine hips had grade 1, eleven had grade 2, and three had grade 3 heterotopic ossification. No hip had grade 4 heterotopic bone formation.

Discussion The 2-5-year clinical results of the Harris-Galante porous THA have shown good or excellent results in 93% of our first 100 arthroplasties performed. The Harris hip scores are comparable to those published by other authors using both the Harris-Galante porous prosthesis and other cementless designs. Rosenberg reported good or excellent results in 98% of 68 hips using the Harris-Galante prosthesis at the 3-4year follow-up period. 26 Similarly, Callaghan reported 94% good or excellent results at 2 years with the porous-coated anatomic implant (a chrome-co-

bait prosthesis).4 Bargar reported an average Harris rating of 94 at 3 years with custom cementless titanium prostheses. ~ However, Maloney and Harris described the results of a retrospective study comparing hybrid cemented femoral components with uncemented THAs. 2~The hips with the cementless HarrisGalante porous femoral component had lower hip scores and a higher rate of reoperation. The incidence of femoral component subsidence was higher than that reported in other series of cementless femoral components. 4.~8,26 This may be due to the strict method of measurement, different length of the follow-up period, or it may reflect the senior

Table 2. Femoral Component Radiolucent and Radiodense Line Patterns and Harris Hip Rating Pain Scores (Final Follow-up)

Group 1: No lines or lines in zones 1 or 4 Group 2: Lines along the smooth portions of the stem Group 3: Lines adjacent to the ingrowth pads Group 4: Subsided components

Hips

Mean Pain Score (points)

19

43.8

27

41.9

38

43.1

16

40.9

Harris-Galante Porous THAs

author's learning curve for this implant, with less t h a n aggressive reaming and c o m p o n e n t fill in the early cases. Pain scores were, however, only slightly lower in subsided hips and significantly lower only at the 2 year follow-up interval. All but one of the c o m p o n e n t s appeared to stabilize b y the final followup examination, and this c o m p o n e n t was revised at 6.5 years after surgery. With the exception of subsidence of the femoral c o m p o n e n t , there was no radiographic finding that was predictive of the clinical result. In contrast to the results reported by Mills et al. for the Harris-Galante porous prosthesis, 22 there was no significant difference b e t w e e n the scores of those hips with an inert a p p e a r a n c e a n d other radiographic patterns, nor was there a significant difference noted b e t w e e n those hips with collar-calcar contact and those femoral c o m p o n e n t s seated proud. In this series, collar-calar contact seemed to prevent significant longitudinal calcar loss, suggesting that the collar m a y be functional in permitting some proximal loading. The etiology of calcar resorption after implantation of this p o r o u s - c o a t e d femoral c o m p o n e n t is u n k n o w n , but m a y be due to thermal injury from the p o w e r saw osteotomy, stress shielding, particulate debris or a c o m b i n a t i o n of these factors. However, it is doubtful that this calcar resorption is due to particulate polyethylene or metal debris because it usually occurred in the first 6 - 1 2 m o n t h s after surgery, and appeared to stabilize. Particulate debris m a y have a role in the d e v e l o p m e n t of osteolysis, which was seen in four hips. The collar and limitation of ingrowth surfaces to the proximal portion of the femoral c o m p o n e n t did not, however, protect the proximal f e m u r from b o n e atrophy. Qualitatively, 59 hips showed proximal medial osteopenia. Acetabular c o m p o n e n t stability was excellent and similar to that reported by Rosenberg and Harris using the same acetabular component. 1~'26 Callaghan reported a 2% 4 and Blum reported a 35% 4 incidence of acetabular migration with the porouscoated a n a t o m i c component. Fixation with multiple cancellous screws has been s h o w n to achieve a high degree of initial stability, a m a j o r prerequisite to b o n y ingrowth.19 There were no complications related to the use of screws for initial acetabular c o m p o n e n t fixation. In s u m m a r y , the Harris-Galante porous THA provided good or excellent clinical results in 93% of h i p s - - i n a group of relatively y o u n g and active patients during a 2 - 5 - y e a r follow-up period. However, the high incidence of femoral c o m p o n e n t subsidence is a w o r r i s o m e radiographic sign, and warrants further study before this cementless femoral c o m p o n e n t can be r e c o m m e n d e d for widespread use.

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References 1. Bargar WL: Shape the implant to the patient. Clin Orthop 249:73, 1989 2. Blum HJ, Noble PC, Tullos HS: Migration and rotation of cementless acetabular cups: incidence, etiology and clinical significance. Presented at the 57th Annual Meeting of the American Academy of Orthopaedic Surgeons, New Orleans, LA, 1990 3. Brooker AF, Bowerman JW, Robinson RA, Riley LH: Ectopic ossification following total hip replacement. J Bone Joint Surg 51A:737, 1973 4. Callaghan J J, Dysart SH, Savory CG: The uncemented porous-coated anatomic total hip prosthesis: two-year results of a prospective consecutive series. J Bone Joint Surg 70A:337, 1988 5. Chandler HP, Reineck FT, Wixson RL, McCarthy JC: Total hip replacement in patients younger than thirty years old: a five year follow-up study. J Bone Joint Surg 63A:1426, 1981 6. Chamley J: Low friction arthroplasty of the hip. Springer-Verlag, New York, 1979 7. DeLee JG, Charnley J: Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 121:20, 1976 8. Dorr LD, Takei GK, Conaty JP: Total hip arthroplasties in patients less than forty-five years. J Bone Joint Surg 65A:474, 1983 9. Dorr LD: Total hip replacement using the APR system. Techniques in Orthopaedics 1:22, 1986 10. Engh CA, Bobyn JD, Glassman AH: Porous coated hip replacement. J Bone Joint Surg 69B:45, 1987 11. Engh CA, Massin P: Cementless total hip arthroplasty using the anatomic medullary locking stem: results using a survivorship analysis. Clin Orthop 249:141, 1989 12. Galante J, Rostoker W, Lueck R, Ray RD: Sintered fiber metal composites as a basis for attachment of implants to bone. J Bone Joint Surg 53A:101, 1971 13. Gruen TA, McNiece GM, Amstutz HC: Modes of failure of cemented stem-type femoral component: a radiographic analysis of loosening. Clin Orthop 141:17, 1979 14. Harris WH: Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg 51A:737, 1969 15. Harris WH: Advanced concepts in total hip replacement. Slack, Inc., New York, 1985 16. Harris WH: Current status of noncemented hip implants, p. 251. InThe hip. CV Mosby, St. Louis, 1986 17. Harris WH, Krushell RJ, Galante JO: Results of cementless revisions of total hip arthroplasty using the Harris-Galante prosthesis. Clin Orthop 235:120, 1988 18. Hedley AK, Gruen RAW, Borden LS et al: Two-year follow-up of the PCA noncemented total hip replacement. p. 225. In The hip. CV Mosby, St. Louis, 1986

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19. Lachiewicz PF, Suh PB, Gilbert J: In vitro initial fLxation of porous-coated acetabular total hip components: a biomechanical comparative study. J. Arthroplasty 3:201, 1989 20. Maloney WJ, Harris WH: Comparison of a hybrid with an uncemented total hip replacement. J Bone Joint Surg 72A:1349, 1990 21. McCardel BR, Lachiewicz PF, Jones K: Aspirin prophylaxis and surveillance of pulmonary embolism and deep vein thrombosis in total hip arthroplasty. J Arthroplasty 5:181, 1990 22. Mills M, Goldberg VM, Figgie HE: Radiographic evaluation of uncemented femoral components with a predictor of early hip function. Presented at the 57th Annual Meeting of the American Academy of Orthopaedic Surgeons, New Orleans, LA, 1990

23. Stem SH, Insall JN: Total knee arthroplasty in obese patients. J Bone Joint Surg 72A: 1400, 1990 24. Ranawat CS, Atkinson RE, Salvati EA, Wilson Jr PD: Conventional total hip arthroplasty for degenerative joint disease in patients between the ages of forty and sixty years. J Bone Joint Surg 66A:745, 1984 25. Ranawat CS, Dorr LD, Inglis AE: Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg 62A:1059, 1980 26. Rosenberg A: Cementless total hip arthroplasty: femoral remodeling and clinical experience. Orthopaedics 12:1223, 1989 27. Wilson PD, Amstutz HC, Czernsecki A et al: Total hip replacement with fixation by acrylic cement. J Bone Joint Surg 54A:207, 1972

A prospective study of 100 consecutive Harris-Galante porous total hip arthroplasties. 2-5-year results.

This is a prospective study of the authors' first 100 Harris-Galante porous total hip arthroplasties (THA) that were followed for 2-5 years. The mean ...
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