The Journal of Bone and Joint Surgery 82:487 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Charnley Total Hip Arthroplasty with Cement
Minimum Twenty-five-Year Follow-up*
John J. Callaghan, M.D. ,
Jay C. Albright, M.D.,
Devon D. Goetz, M.D. ,
Jason P. Olejniczak, B.A. and
Richard C. Johnston, M.D.
Investigation performed at Iowa Methodist Medical Center,
Des Moines, and the University of Iowa College of Medicine, Iowa
City, Iowa
*One or more of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article. In addition,
benefits have been or will be directed to a research fund, foundation,
educational institution, or other nonprofit organization with which
one or more of the authors is associated. Funds were received in total
or partial support of the research or clinical study presented in
this article. The funding source was National Institutes of Health
Grant AR43314.
Department of Orthopaedics, University of Iowa College of Medicine,
Iowa City, Iowa 52242. E-mail address for J. J. Callaghan: john-callaghan{at}uiowa.edu
Des Moines Orthopaedic Associates, 6001 Westown Parkway, West
Des Moines, Iowa 50266.
Background: This report presents the results
of the senior author's initial twenty-five-year experience with
the use of Charnley total hip arthroplasty with cement. The purpose
of this paper was to evaluate the long-term results of total hip
arthroplasty.
Methods: Between July 1970 and April 1972, the
senior author (R. C. J.) performed 330 Charnley total hip replacements
with cement using a hand-packing cement technique in 262 patients.
Fifty-one patients (sixty-two hips) who were alive at least twenty-five
years postoperatively were evaluated from a clinical standpoint
with use of a standard-terminology questionnaire. The average age
of this group at the time of surgery was fifty-six years (range,
thirty-five to seventy-one years) compared with sixty-five years
(range, twenty-one to eighty-nine years) for the entire group. All
patients were evaluated for radiographic changes at the time of their
most recent follow-up. Of the fifty-one patients (sixty-two hips)
who were alive at least twenty-five years postoperatively, thirty-one
(thirty-six hips) had a follow-up radiograph made at a minimum of
twenty-five years after the surgery. The average duration of radiographic
follow-up for the fifty-one patients was 22.7 years (range, two
to twenty-seven years).
Results: Of the sixty-two hips in the fifty-one
patients who were alive at least twenty-five years postoperatively,
fourteen (23 percent) had been revised. Three (5 percent) had the
revision because of loosening with infection; eleven (18 percent),
because of aseptic loosening; and none, because of dislocation.
The prevalence of revision due to aseptic loosening of the acetabular
component in all 316 hips (excluding those that were lost to follow-up
or that were revised for infection or dislocation) was 6 percent
(eighteen hips), whereas the prevalence in the fifty-nine hips (excluding
the three revised for infection) in the patients who were alive
at least twenty-five years after the arthroplasty was 15 percent
(nine hips). The prevalence of revision because of aseptic loosening
of the femoral component in all 316 hips was 3 percent (nine hips), and
the prevalence in the fifty-nine hips in the living patients was
7 percent (four hips). In the group of living patients, osteolysis
occurred in Gruen zone 1 or 7 in thirty-three hips and in Gruen
zones 2 through 6 in two hips. Ballooning acetabular osteolysis
occurred in five hips.
Of the 327 hips for which the outcome was known after a minimum
of twenty-five years, 295 (90 percent) had retained the original
implants until the patient died or until the most recent follow-up
examination. Of the sixty-two hips in patients who lived for at
least twenty-five years after the surgery, forty-eight (77 percent)
had retained the original prosthesis.
Conclusions: Our follow-up study at twenty-five
years following Charnley total hip arthroplasty with cement demonstrates
the durability of the results of the procedure. These results should
provide a means for comparison with the results of newer cementing
techniques as well as those associated with newer cemented and cementless
hip designs.
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