Institute of Bone and Joint Surgery

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Fracture of the hydroxyapatite-ceramic-coated JRI-Furlong femoral component: body mass index and implications for selection of the implant.

J Bone Joint Surg Br. 2007 Jun;89(6):742-5

Authors: Harvie P, Haroon M, Henderson N, El-Guindi M

We describe three cases of fracture of the titanium JRI-Furlong hydroxyapatite-ceramic (HAC)-coated femoral component. We have examined previous case reports of failure of this stem and conclude that fracture may occur in two places, namely at the neck-shoulder junction and at the conical-distal cylindrical junction. These breakages are the result of fatigue in a metallurgically-proven normal femoral component. All the cases of failure of the femoral component have occurred in patients with a body mass index of more than 25 in whom a small component, either size 9 or 10, had been used. In patients with a body mass index above normal size 9 components should be avoided and the femoral canal should be reamed sufficiently to accept a large femoral component to ensure that there is adequate metaphyseal fixation.

PMID: 17613497 [PubMed - indexed for MEDLINE]

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Long-term follow-up (11 years plus) results of JRI (Furlong) total hip arthroplasty in young patients: cause for concern regarding acetabular cup?

Int Orthop. 2006 Oct;30(5):375-80

Authors: Sharma DK, Brooks S

We describe the clinical and radiological long-term outcomes of 77 primary total hip replacements in 69 patients using the fully hydroxyapatite-coated JRI (Furlong) total hip replacement. The total cases followed up were 77 hips, performed at a mean duration of 11 years and 2 months. Twelve hips could not be followed up for various reasons, which are discussed in the results section. The mean Harris hip score was 89. Seventeen acetabular cups were revised for aseptic loosening. Only one femoral stem was revised, for fracture. By Engh's criteria there were a further two unstable cups with no symptoms, and all femoral stems were stable. Kaplan-Meier survivorship analysis revealed a survival of 98.8% for the femoral stem, 78.7% for the acetabular cup, and a combined survival of 77.8% for both components. Our findings suggest that the JRI (Furlong) hip gives a durable femoral stem implant fixation, whereas the prosthesis-bone interface achieved with the acetabular component is questionable.

PMID: 16761147 [PubMed - indexed for MEDLINE]

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Revision of cemented hip arthroplasty using a hydroxyapatite-ceramic-coated femoral component.

J Bone Joint Surg Br. 2005 Aug;87(8):1061-7

Authors: Raman R, Kamath RP, Parikh A, Angus PD

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 degrees. 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.

PMID: 16049239 [PubMed - indexed for MEDLINE]

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Hydroxyapatite-ceramic-coated femoral stems in revision hip surgery.

J Bone Joint Surg Br. 2005 Aug;87(8):1055-60

Authors: Trikha SP, Singh S, Raynham OW, Lewis JC, Mitchell PA, Edge AJ

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.

PMID: 16049238 [PubMed - indexed for MEDLINE]

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Results of a hydroxyapatite-coated (Furlong) total hip replacement: a 13- to 15-year follow-up.

J Bone Joint Surg Br. 2005 Aug;87(8):1050-4

Authors: Shetty AA, Slack R, Tindall A, James KD, Rand C

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.

PMID: 16049237 [PubMed - indexed for MEDLINE]

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The hydroxyapatite-coated JRI-furlong hip. Outcome in patients under the age of 55 years.

J Bone Joint Surg Br. 2005 Jan;87(1):12-5

Authors: Robertson A, Lavalette D, Morgan S, Angus PD

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.

PMID: 15686230 [PubMed - indexed for MEDLINE]

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Hydroxyapatite ceramic-coated femoral stems in young patients. A prospective ten-year study.

J Bone Joint Surg Br. 2004 Nov;86(8):1118-23

Authors: Singh S, Trikha SP, Edge AJ

We describe the clinical and radiological results of 38 total hip replacements (THR) using the JRI Furlong hydroxyapatite-ceramic (HAC)-coated femoral component in patients younger than 50 years. The mean 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 HAC 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 surivival for the stem was 100% (95% confidence interval 89 to 100). No femoral component was revised. Our results show that the Furlong HAC implant gives excellent long-term results in young patients with high demands.

PMID: 15568523 [PubMed - indexed for MEDLINE]

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Fatigue failure of the femoral component of a cementless total hip arthroplasty.

J Arthroplasty. 2004 Aug;19(5):658-60

Authors: Morgan-Hough CV, Tavakkolizadeh A, Purkayastha S

This case report describes a fracture of the neck of a femoral component of a Furlong (JRI Limited, London) hydroxyapatite-coated cementless total hip arthroplasty.

PMID: 15284991 [PubMed - indexed for MEDLINE]

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Pain in the well-fixed, aseptic titanium hip replacement. The role of corrosion.

J Bone Joint Surg Br. 2004 Jan;86(1):27-30

Authors: Hallam P, Haddad F, Cobb J

We have investigated nine patients with cemented Furlong (JRI, London, UK) titanium hip replacements who presented with early pain despite a well-fixed, aseptic prosthesis. All were followed up clinically and radiologically at regular intervals. Pain was located in the thigh and was worse at night. Radiographs showed cortical hypertrophy of the femur around the tip of the stem. Eight of the nine patients subsequently required single-stage revision using an uncemented prosthesis, which relieved the pain. At revision, the pH of the tip of the stem was found to be highly acidic with macroscopic evidence of corrosion consisting of multiple layers of titanium oxides when studied by X-ray dispersive analysis. Cemented titanium implants have a potential for crevice corrosion leading to cortical hypertrophy and intractable pain.

PMID: 14765860 [PubMed - indexed for MEDLINE]

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The femoral cement mantle in three total hip replacements.

Int Orthop. 2004 Feb;28(1):40-3

Authors: Mellor SJ, Ripley LG, Ricketts DM

We measured the size and volume of the femoral broaches and stems supplied with three commercial total hip replacement (THR) systems (JRI Furlong, Biomet Stanmore, and Howmedica Exeter). Using an in vitro method, we created cement mantles that could be directly measured. The broaches supplied with the Biomet Stanmore and the Howmedica Exeter systems allowed the creation of significantly thicker cement mantles than the JRI broaches and stems (Stanmore mean thickness = 1.7 mm, defects at 3% of measurement sites; Exeter mean thickness = 2.0 mm, no defects; JRI mantles mean thickness = 0.9 mm, cement defects at 29% of measurement sites). We conclude that, in vivo, the broaches supplied with the Stanmore and Exeter systems are significantly larger than the corresponding stems, and will excavate a cavity large enough to accommodate the appropriate femoral stem surrounded by an intact cement mantle.

PMID: 14534830 [PubMed - indexed for MEDLINE]

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The results at nine to twelve years of the use of a hydroxyapatite-coated femoral stem.

J Bone Joint Surg Br. 2000 Apr;82(3):378-82

Authors: McNally SA, Shepperd JA, Mann CV, Walczak JP

We describe the clinical and radiological outcome of 100 consecutive total hip replacements in 86 patients using the JRI Furlong hydroxyapatite-coated femoral component. The follow-up was 100% at a mean of ten years (9.0 to 12.0). All 54 living patients (62 hips) were examined annually. Their mean Merle d'Aubigné score was 5.8/5.6/4.6. A total of 32 patients had died. Their notes at the last annual assessment recorded a similar outcome to that of the living patients. Radiographs showed no radiolucent lines around any femoral component and there were no signs of impending failure. One patient required excision arthroplasty, but the femoral component had been bonded satisfactorily. There have been no other revisions of femoral components. Our findings suggest that the hydroxyapatite coating gives a satisfactory prosthesis-bone interface which is preferable to any other system.

PMID: 10813173 [PubMed - indexed for MEDLINE]