P.J. Livesley¹, V.M. Srivastiva¹, M. Needoff¹, H.G. Prince¹´² and A.M. Moulton¹´²

Category: Furlong Clinical Results

¹Mansfield District General Hospital and ²Harlow Wood Orthopaedic Hospital, Mansfield, UK

A prospective clinical trial has been conducted comparing the use of a hydroxyapatite-coated bipolar hemiarthroplasty and an uncemented bipolar prosthesis in the treatment of displaced subcapital fractures of the femur. The trial was conducted over 1 year, 82 patients suffering displaced subcapital fractures of the femur were included. The patients were followed up for 1 year postoperatively. The functional result was significantly superior in the hydroxyapatite-coated group. Characteristic changes were found on radiographs both proximally and distally, indicating that distal stem fixation with proximal stress shielding had occurred.

Valera I Pertegas M; Sancho Navaarro, R; Crusi I Sererols, X

Category: Furlong Clinical Results

Hospital de la Santa Creu I Sant Pau, Barcelona

Objective
The objective of this work is to evaluate the clinical and radiological results of the total hip replacement (THR) with hydroxyapatite coating (Furlong) from JRI after a five year clinical follow up.

Material and Methods
This is a prospective study of 98 consecutive THRs in 59 patients. The average follow up is 6.8 years (range 5-8 years). Three patients died from causes not related to the prosthesis and five patients were lost to follow up. The remaining hips were evaluated annually. In the radiological evaluation, special attention was paid to the biological response to the implant and technical defects in the implantation technique.

Results
The modified Harris Hip score rose from an average of 32 points pre-operatively to 83 points average at the last control. At the end of the study, 2 acetabular components (2%) were awaiting revision for loosening. The remainder were considered radiologically stable. None of the femoral components showed any lucent lines. A medullary reaction in the form of a pedestal at the tip of the stem, considered as a sign of distal fixation, was detected in 25 cases (24.5%), 19 cases (18.6%) showed a varus femoral component and 9 cases (8.8%) showed an acetabular component that was considered high. None of these technical deficiencies showed a radiological progression nor any statistical correlation with the final clinical measurements (p=0.8 and p=0.3 respectively).

Conclusions
1. The hydroxyapatite coated THR Furlong (JRI) gives a satisfactory bony fixation with excellent clinical and radiological results (2% failure of the cup, 0% failure of the stem);
2. Technical defects during implantation did not have any negative effect on the final results;
3. It is necessary to have a longer follow up to confirm these promising medium term results.
Translation of Article
Brian P. Jones
26th October 2001

Results presented at the Spanish National Orthopaedic Meeting (SECOT), Bilboa, 10 – 13 October 2001

G Kapetanos

Category: Furlong Clinical Results

We describe the clinical and radiological outcome of 100 consecutive JRI Furlong hydroxyapatite coated cementless hip replacements. The age of patients ranged from 22 to 77 years (mean 63 years). The mean follow- up is 3 years (1 to 5). All the operations were performed from the same surgeon with the same technique. The patients were examined every six months post-op. We assessed the Merle d’ Aubigné score was 3.4/1.1/1.8 and the post op 5.3/5.6/4.7. radiographs showed no radiolucence line around the components and radiological ingrowth was almost always observed. We did not notice any serious complications. Our findings suggest that HA – coated give a satisfactory prosthesis – bone interface which is preferable to other systems.

From the Journal of the Hellenic Assocaition of Orthopaedic Surgery and Traumatology, Vol 51, No 4, Athens 2000

Valera I Pertegas M; Sancho Navaarro, R; Crusi I Sererols, X

Category: Furlong Clinical Results

Hospital de la Santa Creu I Sant Pau, Barcelona

Objective
The objective of this work is to evaluate the clinical and radiological results of the total hip replacement (THR) with hydroxyapatite coating (Furlong) from JRI after a five year clinical follow up.

Material and Methods
This is a prospective study of 98 consecutive THRs in 59 patients. The average follow up is 6.8 years (range 5-8 years). Three patients died from causes not related to the prosthesis and five patients were lost to follow up. The remaining hips were evaluated annually. In the radiological evaluation, special attention was paid to the biological response to the implant and technical defects in the implantation technique.

Results
The modified Harris Hip score rose from an average of 32 points pre-operatively to 83 points average at the last control. At the end of the study, 2 acetabular components (2%) were awaiting revision for loosening. The remainder were considered radiologically stable. None of the femoral components showed any lucent lines. A medullary reaction in the form of a pedestal at the tip of the stem, considered as a sign of distal fixation, was detected in 25 cases (24.5%), 19 cases (18.6%) showed a varus femoral component and 9 cases (8.8%) showed an acetabular component that was considered high. None of these technical deficiencies showed a radiological progression nor any statistical correlation with the final clinical measurements (p=0.8 and p=0.3 respectively).

Conclusions
1. The hydroxyapatite coated THR Furlong (JRI) gives a satisfactory bony fixation with excellent clinical and radiological results (2% failure of the cup, 0% failure of the stem);
2. Technical defects during implantation did not have any negative effect on the final results;
3. It is necessary to have a longer follow up to confirm these promising medium term results.
Translation of Article
Brian P. Jones
26th October 2001

Results presented at the Spanish National Orthopaedic Meeting (SECOT), Bilboa, 10 – 13 October 2001

D. J. Simpson, B. J. L. Kendrick, M. Hughes, S. Glyn-Jones, H. S. Gill, G. F. Rushforth, D. W. Murray

Category: Furlong Clinical Results

From The Nuffield Orthopaedic Centre, Oxford, United Kingdom

We have evaluated the difference in the migration patterns over two years of two cementless stems in a randomised, controlled trial using radiostereophotogrammetric analysis (RSA). The implants studied were the Furlong HAC stem, which has good long-term results and the Furlong Active stem, which is a modified version of the former designed to minimise stress concentrations between the implant and bone, and thus to improve fixation.

A total of 23 Furlong HAC and 20 Furlong Active stems were implanted in 43 patients. RSA examinations were carried out immediately post-operatively and at six, 12 and 24 months post-operatively.

The subsidence during the first year in the Furlong HAC stem, was approximately one third that of the Furlong Active stem, the measured mean subsidence of the femoral head at six months being 0.27 mm (95% confidence interval (CI) 0.03 to 0.51) and 0.99 mm (95% CI 0.38 to 1.60), respectively (p = 0.03). One Active stem continued to subside during the second year. All hips, regardless of the type of stem were clinically successful as judged by the Oxford hip score and a derived pain score without any distinction between the two types of stem.

The initial stability of the Furlong Active stem was not as good as the established stem which might compromise osseo-integration to the detriment of long-term success. The changes in the geometry of the stem, to minimise stress have affected the attainment of initial stability.

R Rees, S Sobratree, K O’Dwyer (Worcester)

Category: Furlong Clinical Results

We evaluated the results of this prosthesis in a series of 88 patients. The patients were reviewed clinically using a clinical evaluation system, the Harris Hip score and radiographic analysis.

25 patients had died and 12 were lost to follow up. Average length of follow up 2.1 years. The mean Clinical Rating Score was 70 (Harris Hip Score 80.6). 86% had no pain and 90% were satisfied. Two prostheses were revised. The prosthesis behaved as a bipolar in 45%. This prosthesis functions well in the active elderly patient with a displaced intracapsular fracture.

Presented at BOA 2001

A. Robertson, D. Lavalette, S. Morgan, P. D. Angus

Category: Furlong Clinical Results

Dewsbury & District Hospital, Dewsbury, England

We present the clinical and radiographic outcome of 68 consecutive primary total hip replacements performed in 54 patients under the age of 55 years using a hydroxyapatite-coated femoral component and threaded cup with a modular ceramic head (JRI-Furlong). We reviewed 62 (91%) hips at a median follow-up of 8.8 years (5 to 13.8) after implantation; six (9%) were lost to follow-up. At review there had been four (6%) revisions but only one for aseptic loosening (acetabulum). Radiographic review of the remaining hips did not identify any evidence of femoral or acetabular loosening. The median Harris and Merle d’Aubigné and Postel hip scores were 95.9 (42.7 to 100) and 17 (3 to 18) respectively. The JRI-Furlong hip gives promising functional and radiographic results in young patients in the medium term.

J Bone Joint Surg (Br) 2005:87-B:12-15

P.J. Warren¹, D. O’Doherty², G Scott³ and C.G. Greenough²

Category: Furlong Clinical Results

¹ Wexham Park Hospital, Slough, UK
² Royal Free Hospital, London, UK
³ Heatherwood Hospital, Ascot, UK

The results of 148 total hip replacements using the Furlong cemented prosthesis are reported. Average follow up was 52 months, with a minimum of 36 months. Operations were performed by all grades of surgeon. Defining survival as retention of the prosthesis the 5-year survivorship was 97%. Significant heterotopic ossification occurred in 12 patients, but this did not affect the clinical outcome. It is concluded that the early results of this inexpensive prosthesis are satisfactory and there is no reason to reconsider its use.

A Cossey, S A Edwards, H J Clarke and M Grover (Portsmouth)

Category: Furlong Clinical Results

A retrospective study was made of 203 Furlong total hip prostheses implanted in one hundred and fifty two patients between 1983 and 1993 in a single Orthopaedic unit. All patients were clinically and radiologically assessed in the research clinic.

The mean age at surgery was 67.9. The average duration in situ was 9.19 years (range 5-16 years). The average Merle d’Aubigné-Postel, Harris hip, and Patients satisfaction scores were 5.25, 88.78 (range 52-98), and 4.3 respectively.

Eleven of the two hundred and three prosthesis failed, at a mean of 4.6 years. Reasons for failure included aseptic loosening in eight cases (3.9%), recurrent dislocations in two and one periprosthetic fracture. In fourteen prosthesis with progressive radiological lucencies eight developed clinical symptoms warranting revision surgery.

Presented at BOA 2001

M.A. Hafez, A.P. Wright, J. Smith, P. Venugopal, P.D. Angus

Category: Furlong Clinical Results

Dewsbury Health Care Trust, West Yorkshire, United Kingdom

Introduction: There are more than 60 different hip prostheses currently available for total hip replacement (THR). Cemented prostheses make up about 90 to 95% of current total UK market. The cost of THR prosthesis varies widely with some prostheses cost 5 times more than others. Furlong Stainless steel cemented is a low-cost prosthesis that has been used in few hospitals in UK and Europe. There is no published data to report its survival and performance.

Aim: To evaluate the outcome of a low-cost THR prosthesis (Furlong stainless steel) that has been in use in our hospital since 1993.

Patients and Methods: we retrospectively reviewed 142 THR performed between 1993 and 2001. The average age was 72 and osteoarthritis was the primary pathology in 92%. Operations were performed by different grades of surgeons. 25 patients were dead at the time of the study.

Results: 4 cases underwent revision (2.8%) with survival rate of 97.2%.6 cases of dislocation, 17 cases of heterotopic calcifications, 5 cases of DVT and one neurological injury. 88% reported no pain and 79.6% were satisfied.

Conclusions: The results of this study compare favourably with Furlong Titanium cemented prosthesis and other popular THR prostheses (e.g. Charnley). It is rational to continue using this prosthesis, which appears to be cost effective

Paper presented at EFORT 2003, Helsinki, Finland, June 4 – 10 2003.

J.F. Osborn

Category: Furlong Clinical Results

The First Histological Evaluation of Human Autopsy Material

Following a 7-week implantation period, a cementless IRI Furlong hydroxyapatite ceramic-coated total hip endoprosthesis made of TiA16V4 was examined by light and scanning electron microscopy. The undecalcified thin ground sections revealed that the intact hydroxyapatite ceramic coating (Osprovit) was almost invariably covered by newly formed bone, which revealed the maturity and mineral content of young lamellar bone. The obligatory gap between prosthesis and femur due to the trauma of insertion is obviously bridged by bilateral osteogenesis, i.e. by primary bone formation initiated from both the surface of the endosteal bone and the hydroxyapatite ceramic. This new bone shows a substantial intergrowth with the ceramic so that on no part of the interface is there any fibrous tissue. Bonding osteogenesis occurs both in the spongy as in the cortical bed – in contrast to the conventional form-fit – and establishes the basis for linear force transfer between the implant and bone. This fact, realised for the first time with the aid of a hydroxyapatite ceramic coating, inevitably requires a fundamental revision of the biomechanical concept of prosthesis anchorage to bone.

Andrew F.M. McKee, M.D. George, R. Hussein, J.AN. Shepperd

Category: Furlong Clinical Results

Conquest Hospital, Hastings, England

Aims: To assess the medium term results of this design of hydroxyapatite coated press fit cup.

Methods: This series represents the first 179 consecutive hips performed using the CSF press fit cup (JRI, London UK) at our institution by or under the direct supervision of one surgeon (JANS). We did not routinely augment the cup with screws. All hips were followed up prospectively in dedicated hip research clinics and assessed clinically and radiologically.

Results: Of 179 hips in 153 patients, 21 had bilateral procedures under one anaesthetic, 5 had staged bilateral replacement. The mean age at operation was 69 years (range 39-90 years). The mean follow up was 7 years and one month (range 6-10 years). One patient was lost to follow up. Six patients had revision surgery (infection 2, late acetabular fracture following trauma 1, recurrent dislocation 2, aseptic loosening 1). 31 patients have subsequently died but none had evidence of component failure at their last follow up. The latest Merle D’ Aubigné & Postel hip scores are 5.8 for pain, 5.5 for movement and 4.8 for function. No patient has evidence of radiological failure at latest follow up.

Conclusions: The medium term results of this type of acetabular cup are good and we continue to use this prosthesis. We have not encountered a problem with ‘backside wear’ and osteolysis at the site of the screw holes and have only one case of aseptic loosening. These findings are in contrast to much higher rates of mechanical failure described by some authors with press fit hydroxyapatite coated cups and indicate that cup design or technical error may be at fault rather than the hydroxyapatite coating itself.

Poster presented at EFORT 2003, Helsinki, Finland, June 4 – 10 2003.

R. Furlong

Category: Furlong Clinical Results

Long term fixation of both components of a total hip prosthesis has been a never-ending problem facing replacing surgeons.

Even the less frequent use of methyl-methacrylate cement does not seem to have reduced the tendency of femoral components to loosen after perhaps a decade or even less of use. The case is argued that the present methods of attempting long term fixation both of socket and stem are doomed to ultimate failure be they never so sophisticate nor cunning. The reason is that a locus of pathology is created in the immediate vicinity of the intruder; “gate post”; in the case of the stem. Pathology engenders change and instability, clinically demonstrated by loosening.

A new method of fixation is described. It has been used in over 8,000 instances spread over seven years without failure. The problem of joining “living to dead material” is accepted and solved in a novel way. The dead material i.e. the metal prosthesis is coated with another dead material i.e. calcium hydroxyapatite ceramic, but this latter material has the capacity of being animated. Once animated, hydroxyapatite ceramic becomes “osteotropic”, not to say osteogenic.

Placed in a situation that simulates a fresh fracture, union by first intention, primary bone healing, takes place with surprising speed. Local conditions are contrived so as to encourage and accelerate bony union, this is achieved by the design of the prosthesis. Once the “fracture” is united the fixation problem is solved and since uncomplicated fractures, once healed, do not break down it is only reasonable to expect that a prosthesis coalesced into bone in this manner will remain fixed and functional.

The method whereby the inevitable differential motion between stem and bone is accepted and neutralized will be explained.

It is suggested that development along the line outlined may be the only way to escape from the problem of “aseptic loosening”.

R Raman, RP Kamath, PD Angus

Category: Furlong Clinical Results

Dewsbury

We report the clinical/radiological outcome of revision of cemented hip arthroplasties using HAC coated femoral and acetabular components. 66 revision hip arthroplasties were performed JRI Furlong HAC coated femoral and acetabular components. Mean follow up was 10 yrs. Mean Harris and Oxford scores were 82 and 48.4. Mean linear polyethylene wear was 0.05mm per year. The mean subsidence was 1.6mm. 3 hips were re- revised. EQ5D description and health scores were 0.69 and 79 (p > 0.05).

Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 93% [95% CI2.3]
Paper presented at BOA 2004, Manchester, England, September 18th 2004

R. Raman, R. P. Kamath, A. Parikh, and P. D. Angus

Category: Furlong Clinical Results

From Dewsbury & District Hospital

Abstract

We report the clinical and radiological outcome of 86 revisions of cemented hip arthroplasties using JRI-Furlong hydroxyapatite-ceramic-coated acetabular and femoral components. The acetabular component was revised in 62 hips and the femoral component in all hips. The mean follow-up was 12.6 years and no patient was lost to follow-up.

The mean age of the patients was 71.2 years. The mean Harris hip and Oxford scores were 82 (59 to 96) and 23.4 (14 to 40), respectively. The mean Charnley modification of the Merle d’Aubigné and Postel score was 5 (3 to 6) for pain, 4.9 (3 to 6) for movement and 4.4 (3 to 6) for mobility. Migration of the acetabular component was seen in two hips and the mean acetabular inclination was 42.6°. The mean linear polyethylene wear was 0.05 mm/year. The mean subsidence of the femoral component was 1.9 mm and stress shielding was seen in 23 (28%) with bony ingrowth in 76 (94%). Heterotopic ossification was seen in 12 hips (15%). There were three re-revisions, two for deep sepsis and one for recurrent dislocation and there were no re-revisions for aseptic loosening. The mean EuroQol EQ-5D description scores and health thermometer scores were 0.69 (0.51 to 0.89) and 79 (54 to 95), respectively. With an end-point of definite or probable loosening, the probability of survival at 12 years was 93.9% and 95.6% for the acetabular and femoral components, respectively. Overall survival at 12 years, with removal or further revision of either component for any reason as the end-point, was 92.3%.

Our study supports the continued use of this arthroplasty and documents the durability of hydroxyapatite-ceramic-coated components.

Journal of Bone and Joint Surgery, August 2005
J Bone Joint Surg (Br) 2005;87-B:1061-7

A. A. Shetty, R. Slack, A. Tindall, K. D. James, C. Rand

Category: Furlong Clinical Results

From Medway Maritime Hospital

Abstract

We describe the survival of 134 consecutive JRI Furlong hydroxyapatite-coated uncemented total hip replacements. The mean follow-up was for 14.2 years (13 to 15).

Patients were assessed clinically, using the Merle d’Aubigné and Postel score. Radiographs were evaluated using Gruen zones for the stem and DeLee and Charnley zones for the cup. Signs of subsidence, radiolucent lines, endosteal bone formation (spot welds) and pedestal formation were used to assess fixation and stability of the stem according to Engh’s criteria. Cup angle, migration and radiolucency were used to assess loosening of the cup. The criteria for failure were revision, or impending revision because of pain or loosening. Survival analysis was performed using a life table and the Kaplan-Meier curve.

The mean total Merle d’Aubigné and Postel score was 7.4 pre-operatively and 15.9 at follow-up. During the study period 22 patients died and six were lost to follow-up. None of the cups was revised. One stem was revised for a periprosthetic fracture following a fall but none was revised for loosening, giving a 99% survival at 13 years. Our findings suggest that the long-term results of these hydroxyapatite-coated prostheses are more than satisfactory.

Journal of Bone and Joint Surgery, August 2005
J Bone Joint Surg (Br) 2005;87-B:1050-4.

S. S. Rajaratnam, C. Jack, A. Tavakkolizadeh, M. D. George, R. J. Fletcher, M. Hankins, J. A. N. Shepperd

Category: Furlong Clinical Results

Results from The Conquest Hospital, St Leonards-on-Sea

Abstract

Between 1986 and 1991 we implanted 331 consecutive Furlong hydroxyapatite-coated femoral components of a total hip replacement in 291 patients. A cemented acetabular prosthesis was used in 217 hips and a hydroxyapatite-coated component in 114. We describe the long-term clinical and radiological survival of the femoral component at a mean follow-up of 17.5 years (15 to 21). Only two patients (0.68%) were lost to follow-up. With revision of the femoral component for any reason as the endpoint, the survival at a mean of 17 years was 97.4% (95% confidence interval 94.1 to 99.5), and with revision for aseptic loosening as the endpoint it was 100%. The survival at a maximum of 21 years with revision of the femoral component for any reason as the endpoint was 97.4% (95% confidence interval 81.0 or 99.5). These results compare favourably with the best long-term results of cemented or uncemented femoral components used in total hip replacement.

Journal of Bone and Joint Surgery, January 2008
J Bone Joint Surg [Br] 2008; 90-B : 27-30.

P. Maquet, L. Zhang, F. DE Lamotte

Category: Furlong Clinical Results

Remodelling of bone, regularly observed after the implantation of a hydroxyapatite coated Furlong hip prosthesis, stimulated the authors to analyse the stress distribution and relative magnitude in photoelastic models, of 1. the upper half of an intact femur; 2. of a femur equipped with a prosthesis free of glue to simulate the implantation of a cementless non coated prosthesis; and 3. of a femur in which a prosthesis was glued to simulate the implantation of a hydroxyapatite coated prosthesis. The results match precisely the remodelling thus observed in the X-rays.

P Chandran, M Azzabi, DJC Burton, M Andrews, JG Bradley

Category: Furlong Clinical Results

Data from Scarborough Hospital

Abstract We report the mid-term results of hemiarthroplasty with the Furlong hydroxyapatite coated bipolar prosthesis for displaced (Garden type III and IV) intracapsular hip fracture in 480 patients operated between 1989 and 2000. Three hundred sixty eight (77%) patients were lost to follow-up due to death, dementia or movement away from the area. In the patients followed up there was an 8% reoperation rate for infection, aseptic loosening, periprosthetic fracture and acetabular erosion. One hundred and twelve patients with a mean follow-up of 4 years (3-14) were studied. Eighty eight percent had no or slight pain, 77% could mobilise outdoors and 89% needed either no aid or a single walking stick to mobilise. Radiographic assessment revealed a stable implant with visible osseointegration in 91%. We conclude that hemiarthroplasty with the hydroxyapatite coated bipolar Furlong® LOL prosthesis for displaced intracapsular fracture of the neck of the femur gives good mid term results in elderly patients for return to mobility, use of mobility aids and freedom from pain. It avoids the need for cement and provides satisfactory incorporation into the host bone. The use of a modular head makes revision to total hip replacement easier.

Acta Orthop. Belg., 2006, 72, 428-433.

Alexander Ryborz, University of Cologne, Medical Director: Professor P. G. Schneider MD

Category: Furlong Clinical Results

In order to determine the medium-term results for the hydroxyapatite ceramic-coated Furlong® total hip prosthesis, the first 119 patients to be implanted with this prosthesis during a primary total hip replacement at the Klinik fur Orthopädie und Sporttraumatologie in Cologne-Braunsfeld were invited to the follow-up study. The 91 patients who attended had received 101 total hip replacements with the hydroxyapatite ceramic-coated Furlong® total hip prosthesis in the period from August 1989 to April 1992. The follow-up study was carried out 3.9 to 6.6 years after arthroplasty (average 4.8 years). The average age of the patients at implantation was 58.2 years. The youngest patient was 29 and the oldest was 71.

The clinical results achieved by the hydroxyapatite ceramic-coated Furlong® total hip prostheses were excellent an average of 4.8 years after implantation. There was only one case of aseptic socket loosening. No shaft loosening was found. Xeroradiographs showed perfect osteointegration of the prostheses, as is the aim in hip replacement surgery.

R Raman, D David, V Eswaramoorthy, M Tiru, P Angus

Category: Furlong Clinical Results

Results from Dewsbury District Hospital

Abstract

We reviewed 586 consecutive cementless primary THA using the JRI-Furlong HAC coated femoral and acetabular components in 542 patients, with a minimum 12-year follow-up to 18 years. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 97.2%. The results of this study support the continued use of a fully-coated prosthesis and documents the durability of the HAC – coated components. In our clinical experience, the Furlong prosthesis revealed encouraging radiographic stability over a long-term period with excellent clinical results.

Data presented at BOA 2007, Manchester, 26 – 28 September 2007.

C. J. Mann, E. J. Taylor. S. McNally. J. A. N. Shepperd

Category: Furlong Clinical Results

From The Conquest Hospital, Hastings, UK

Reports of the results of screw-cup arthroplasties have been disappointing with high revision rates. We reviewed our experience of 173 HA coated screw cups which have been implanted in 150 patients. The average follow up was 6.5 years (range 5- 9 years). The follow up rate was 93%. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year and annually thereafter. The patients were assessed using the Merle D’ Aubigné (MOP) clinical scoring scale and by radiographic review. 2 patients had revision surgery for recurrent dislocation (1.2%). 2 patients were revised for aseptic loosening (1.2%). 1 patient underwent revision surgery due to deep prosthetic infection (0.6%), and 2 patients were revised for polyethylene wear without loosening (1.2%), which gave a total revision rate of 4.0%. The average post operative MOP scores were 5.7 for pain, 5.5 for range of movement and 5.4 for function. Radiological review revealed 1 patient with extensive granuloma formation and 2 patients with evidence of migration although no cups were revised for migration alone. We believe that the lower revision rate in this series is due to the double advantage of an HA coated cup (which leads to low revision rates for aseptic loosening), and the use of a ceramic head (which produces low polyethylene wear rates). We believe our results convey strong evidence for the advantage offered by HA coating for use with a screw-cup or other prosthesis.

Results presented at the Combined New Zealand and Australian Orthopaedic Associations Scientific Meeting, 7 – 12 October 2001, Queenstown, New Zealand

A Tindall, KD James, R Slack, C James, AA. Shetty

Category: Furlong Clinical Results

Results from Medway Maritime Hospital, Gillingham

Abstract

We evaluated the survival of 112 consecutive JRI hydroxyapatite ceramic–coated threaded acetabular components (JRI Ltd, London, UK). Follow-up was for a minimum of 13 years (range, 13-15 years). Patients were assessed clinically and radiographically using the Merle d’Aubigne´ and Postel scoring systems and the De Lee and Charnley zones. Cup angle, migration, and signs of radiolucency were used to assess loosening. The criteria for failure were revision or impending revision due to pain and septic or aseptic loosening. The mean results of the Merle d’Aubigne´ and Postel score for pain, motion, and ability to walk were 2.2/2.7/2.2 preoperatively and 5.6/4.3/5.1 postoperatively. There was 100% endosteal bone formation in De Lee and Charnley zones 1 and 3 and 87% in zone 2. No reactive lines were seen in any zone in any cup. There were no cases of migration, change in cup angle, or revision for loosening. Our survival was 99% at 13 years (95% confidence interval, 96-100).

The journal of Arthroplasty 2007 Vol. 22, No 8

S Datir, P Angus, Dewsbury

Category: Furlong Clinical Results

The Dewsbury District General Hospital

Abstract

The aim of this study was to review the long term clinical results and the polythene wear rate of uncemented total hip arthroplasty performed using the Furlong H-A.C. coated threaded acetabular cup. In this retrospective cross-sectional survivorship study we reviewed the results of 144 uncemented total hip arthroplasties in 118 patients (Male: Female-65: 53, Mean age: 52.8 years(range 21-78 years) performed between 1988 and 2000, with a minimum of 5 year follow up. The mean duration of follow-up for the group was 10.2 years (range: 5-17.5, median: 9.7). Data was collected on demographics, complications, revision surgery, clinical scores. Radiographic mesurement of wear was performed using dual circle technique. Kaplan-Meier survival analysis was performed to evaluate 10-year survival. Four patients were lost to follow-up and 11 patients (12 hips) had died due to unrelated causes. Two femoral stems were revised, one due to intaoperative fracture and one due to stem fracture. Two acetabular shells were revised due to aseptic loosening. One patient underwent two-staged revision of both components due to deep infection. Nine hips (6.2%) underwent polyethylene liner exchange for asymptomatic polythene wear at mean interval of 13 years after the primary procedure. Mean Engh’s score for fixation and stability of the stem was 9.7 out of 10 and 14.5 out of 17 respectively. There was no evidence of osteolysis around the femoral or acetabular components in spite of relatively high polythene wear rate (0.24mm/year). Ten-year survival for the acetabular and femoral component with radiological evidence of aseptic loosening as an end point was 99.15 (CI: 98.3-99.9) and 99.28 (CI: 98.5-99.9). Our study demonstrates excellent survival of threaded HAC coated acetabular sockets at 10 year interval in a young population in spite of relatively higher polythene wear rate.

Data displayed at the British Orthopaedic Association Annual Congress, Liverpool, September 16th – 19th, 2008.

Angus Robertson, S. Morgan, D. Lavalelte, P. Angus

Category: Furlong Clinical Results

Dewsbury Health Care Trust, West Yorkshire, United Kingdom

Aims: To assess the results of hip arthroplasty performed in patients under the age of 55 using an hydroxyapatite coated (HAC) femoral component with a modular ceramic head and threaded HAC cup (JRI – Furlong) with minimum 5 year follow up.

Methods: Sixty-seven consecutive primary hip replacements (54 patients) performed from 1988-1997 were recalled for clinical and radiographic review. Deaths, complications, revisions and losses to follow up were noted. Radiographs were assessed for evidence of loosening and heterotopic ossification and function was recorded using the Harris (HHS) and Merle d’Aubigné (MdA) hip scores and an analogue pain score (0 – 100mm).

Results: 61 (91 %) hips were available for review at a median of 8.8 (5.0 – 13.8) years post implantation. Full clinical and radiographic review was performed on 53 (79%) hips, 8 (12%) were contacted to ascertain whether revision had occurred and 6 (9%) were lost to follow up (3 deaths, 3 untraceable). At the time of review there had been 3 (4.9%) revisions (3 Femoral, 1 Acetabulum). In the remaining hips radiographic review demonstrated no evidence of femoral or acetabular loosening. Minor complications were noted in 12 (18%) patients. Median functional scores were HHS 95.9 (42.7-100.0), MdA 17 (3-18) and analogue pain 6 (0 – 90).

Conclusions: The JRI Furlong hip gives good functional and radiographic results in young patients in the medium term

Poster presented at EFORT 2003, Helsinki, Finland, June 4 – 10 2003.

S. P. Trikha, S. Singh, O. W. Raynham, J. C. Lewis, P. A. Mitchell, A. J. Edge

Category: Furlong Clinical Results

From Worthing & Southlands NHS Trust

Abstract

We describe the clinical and radiological results of 120 consecutive revision hip replacements in 107 patients, using the JRI Furlong hydroxyapatite-ceramic-coated femoral component. The mean age of the patients at operation was 71 years (36 to 92) and the mean length of follow-up 8.0 years (5.0 to 12.4). We included patients on whom previous revision hip surgery had taken place. The patients were independently reviewed and scored using the Harris hip score, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Charnley modification of the Merle d’Aubigné and Postel score. Radiographs were assessed by three reviewers for the formation of new bone, osteolysis, osseointegration and radiolucent lines in each Gruen zone.

The mean Harris hip score was 85.8 (42 to 100) at the latest post-operative review. The mean WOMAC and Merle d’Aubigné and Postel scores were 34.5 and 14.8, respectively. The mean visual analogue score for pain (possible range 0 to 10) was 1.2 overall, but 0.5 specifically for mid-thigh pain. There were no revisions of the femoral component for aseptic loosening. There were four re-revisions, three for infection and one for recurrent dislocation. Radiological review of all the femoral components, including the four re-revisions showed stable bony ingrowth and no new radiolucent lines in any zone. Using revision or impending revision for aseptic loosening as an end-point, the cumulative survival of the femoral component at ten years was 100% (95% confidence interval 94 to 100). We present excellent medium- to long-term clinical, radiological and survivorship results with the fully hydroxyapatite-ceramic-coated femoral component in revision hip surgery.

Journal of Bone and Joint Surgery, August 2005
J Bone Joint Surg (Br) 2005;87-B:1055-60

Angus Robertson, S. Morgan, D. Lavalelte, P. Angus

Category: Furlong Clinical Results

Dewsbury Health Care Trust, West Yorkshire, United Kingdom

Aims: To assess the results of hip arthroplasty performed in patients under the age of 55 using an hydroxyapatite coated (HAC) femoral component with a modular ceramic head and threaded HAC cup (JRI – Furlong) with minimum 5 year follow up.

Methods: Sixty-seven consecutive primary hip replacements (54 patients) performed from 1988-1997 were recalled for clinical and radiographic review. Deaths, complications, revisions and losses to follow up were noted. Radiographs were assessed for evidence of loosening and heterotopic ossification and function was recorded using the Harris (HHS) and Merle d’Aubigné (MdA) hip scores and an analogue pain score (0 – 100mm).

Results: 61 (91 %) hips were available for review at a median of 8.8 (5.0 – 13.8) years post implantation. Full clinical and radiographic review was performed on 53 (79%) hips, 8 (12%) were contacted to ascertain whether revision had occurred and 6 (9%) were lost to follow up (3 deaths, 3 untraceable). At the time of review there had been 3 (4.9%) revisions (3 Femoral, 1 Acetabulum). In the remaining hips radiographic review demonstrated no evidence of femoral or acetabular loosening. Minor complications were noted in 12 (18%) patients. Median functional scores were HHS 95.9 (42.7-100.0), MdA 17 (3-18) and analogue pain 6 (0 – 90).

Conclusions: The JRI Furlong hip gives good functional and radiographic results in young patients in the medium term

Poster presented at EFORT 2003, Helsinki, Finland, June 4 – 10 2003.

S. P. Trikha, S. Singh, O. W. Raynham, J. C. Lewis, P. A. Mitchell, A. J. Edge

Category: Furlong Clinical Results

From Worthing & Southlands NHS Trust

Abstract

We describe the clinical and radiological results of 120 consecutive revision hip replacements in 107 patients, using the JRI Furlong hydroxyapatite-ceramic-coated femoral component. The mean age of the patients at operation was 71 years (36 to 92) and the mean length of follow-up 8.0 years (5.0 to 12.4). We included patients on whom previous revision hip surgery had taken place. The patients were independently reviewed and scored using the Harris hip score, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Charnley modification of the Merle d’Aubigné and Postel score. Radiographs were assessed by three reviewers for the formation of new bone, osteolysis, osseointegration and radiolucent lines in each Gruen zone.

The mean Harris hip score was 85.8 (42 to 100) at the latest post-operative review. The mean WOMAC and Merle d’Aubigné and Postel scores were 34.5 and 14.8, respectively. The mean visual analogue score for pain (possible range 0 to 10) was 1.2 overall, but 0.5 specifically for mid-thigh pain. There were no revisions of the femoral component for aseptic loosening. There were four re-revisions, three for infection and one for recurrent dislocation. Radiological review of all the femoral components, including the four re-revisions showed stable bony ingrowth and no new radiolucent lines in any zone. Using revision or impending revision for aseptic loosening as an end-point, the cumulative survival of the femoral component at ten years was 100% (95% confidence interval 94 to 100). We present excellent medium- to long-term clinical, radiological and survivorship results with the fully hydroxyapatite-ceramic-coated femoral component in revision hip surgery.

Journal of Bone and Joint Surgery, August 2005
J Bone Joint Surg (Br) 2005;87-B:1055-60

N. N. Shah, A. J. Edge, D. W. Clark

Category: Furlong Clinical Results

From Worthing and Southlands Hospitals NHS Trust, Shoreham-by-Sea, England

Abstract

In 2004 we described the ten-year prospective results of 38 total hip replacements using the Furlong hydroxyapatite-ceramic-coated femoral component in 35 patients < 50 years old. We have now reviewed the surviving 35 arthroplasties in 33 patients at a mean of 16 years (10.3 to 19.9). The mean age of the surviving patients at the time of operation was 41.3 years (26.0 to 49.0). Of these, eight have undergone revision of their acetabular component for aseptic loosening. None of the femoral components has had revision for aseptic loosening giving a survival rate of 100% at 16 years (95% confidence interval 89% to 100%). The Furlong hydroxyapatite-ceramic-coated femoral component gives excellent long-term survival in young and active patients.

The Journal of Bone and Joint Surgery
J Bone Joint Surg [Br]
2009;91-B:865-9.
VOL. 91-B, No. 7, JULY 2009

I. Escriba, R. Sancho, X. Crusi, M. Valera

Category: Furlong Clinical Results

Orthopaedic and Traumatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Aims: The bone – conductive properties of hydroxyapatite (HA) coatings are attractive in revision surgery with bone loss. The purpose of this study is to analyse the clinical and radiological results of 55 cases of revision hip arthroplasty using hydroxyapatite femoral stems.

Methods: Between May 1995 and October 2000 we performed 55 patients total hip replacements in 50 patients (5 bilateral) using hydroxyapatite (HA) – coated femoral stem. The average age of the patients at the time of the index revision was 67 years (range 44-84). Clinical evaluation was by a Merle d’Aubigné Score (preoperative 6.54 points). Radiological evaluation used the AAOS system for preoperative films and scaring system after Engh for the postoperative films. Bone grafts was required in 35 cases.

Results: Postoperative Merle d’Aubigné score was 17.25 points. Complications: 3 dislocations, one transitory nerve palsy and 14 associated intraoperative fractures. All grafts consolidated. None of the femoral stem components required revision because of aseptic loosening. No radiologically progressive lucency or signs indicating a loose implant were visible in any cases. There were no cases of femoral stem migration.

Conclusions: We conclude that the hydroxyapatite femoral stem is suitable for implantation at revision hip arthroplasty and can give good results in the short to medium term, because the clinical and radiological results are excellent, with a early consolidate fractures.

Paper presented at EFORT 2003, Helsinki, Finland, June 4 – 10 2003.

S. Singh, S. P . Trikha, A.J. Edge

Category: Furlong Clinical Results

Worthing & Southlands NHS Trust, Worthing, England

We describe the clinical and radiological results of 38 total hip replacements (THR) using the JRI Furlong hydroxyapatite-ceramic (H-A.C.)-coated femoral component in patients younger than 50 years. The mena age at the time of operation was 42 years (22 to 49) and the mean length of follow-up was ten years (63 to 170 months). All patients receiving a Furlong H-A.C. THR were entered into the study regardless of the primary pathology including patients who had undergone previous hip surgery.

The mean Harris hip score improved from 44 before operation to 92 at the last post-operative review. After 12 years the cumulative survival for the stem as 100% (95% confidence interval at 89 to 100). No femoral component was revised. Our results show that the Furlong H-A.C. implant gives excellent long-term results in young patients with high demands.

J Bone Joint Surg (Br) 2004;86-B:1118-23

I. Escriba, R. Sancho, X. Crusi, M. Valera

Category: Furlong Clinical Results

Orthopaedic and Traumatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Aims: The bone – conductive properties of hydroxyapatite (HA) coatings are attractive in revision surgery with bone loss. The purpose of this study is to analyse the clinical and radiological results of 55 cases of revision hip arthroplasty using hydroxyapatite femoral stems.

Methods: Between May 1995 and October 2000 we performed 55 patients total hip replacements in 50 patients (5 bilateral) using hydroxyapatite (HA) – coated femoral stem. The average age of the patients at the time of the index revision was 67 years (range 44-84). Clinical evaluation was by a Merle d’Aubigné Score (preoperative 6.54 points). Radiological evaluation used the AAOS system for preoperative films and scaring system after Engh for the postoperative films. Bone grafts was required in 35 cases.

Results: Postoperative Merle d’Aubigné score was 17.25 points. Complications: 3 dislocations, one transitory nerve palsy and 14 associated intraoperative fractures. All grafts consolidated. None of the femoral stem components required revision because of aseptic loosening. No radiologically progressive lucency or signs indicating a loose implant were visible in any cases. There were no cases of femoral stem migration.

Conclusions: We conclude that the hydroxyapatite femoral stem is suitable for implantation at revision hip arthroplasty and can give good results in the short to medium term, because the clinical and radiological results are excellent, with a early consolidate fractures.

Paper presented at EFORT 2003, Helsinki, Finland, June 4 – 10 2003.