THE
MCKEE-FARRAR
HIP
A LONG-TERM
A.
C.
AUGUST,
From
C.
STUDY
H.
ALDAM,
the Norfolk
and
1965 and 1973 a total of 808 McKee-Farrar performed in the Norfolk and Norwich Hospital. reviewed at average follow-up of 13.9 years.
P.
were good or excellent
results
in 49%
B.
Norwich
Between
were
There
ARTHROPLASTY
PYNSENT
Hospital
metal-on-metal
total
cemented
Of these, 230 surviving
of the arthroplasties
as judged
by the Harris
78% of these having little or no pain. A comprehensive radiographic analysis survivorship study of 81 % of the total number of prostheses is presented.
The
introduction
of polymethylmethacrylate
1958 enabled
prosthetic
the skeleton 1961 : McKee
in the short and and Watson-Farrar
performance of mented (Charnley
implants
metal-on-plastic and Cupic
cement
to be securely medium term 1966). The
1973;
designs Cupic
in
fixed
to
(Charnley long term
is well docu1979; Olsson,
Jernberger and Trygg#{246} 1981 Salvati et al. 1981 Aimby and Hierton 1982, Stauffer 1982) but there are few such studies of metal-on-metal prostheses (Dobbs 1980; ;
Tillberg The in 1960,
1982). McKee-Farrar had evolved
(McKee
1970;
and
Chen
1973).
first by
The
used 1965
cobalt-
chrome-molybdenum (vitallium) cup had studs both for fixation to the cement and also to ensure a minimum depth
of
cement.
A flanged
rim
helped
to
cement in the acetabulum as the cup was vitallium femoral component had a collar stem, being modelled on the Thompson (Thompson 1952). Radiolucent cement digitally cement designed frictional
AC.
FRCS,
St Bartholomew’s
Institute
England. Correspondence ,-.
1986
British
Senior
Hospital.
England. C.H. Aldam, FRCS, Norfolk and Norwich NR1 3SR, England. PB. Pynsent, PhD,
National
the
Registrar Smithfield. London
Orthopaedic
West
Orthopaedic Hospital,
Registrar Brunswick
Road,
ECIA
Norwich,
7BE. Norfolk
Scientist
for Medical
Research,
should
be sent
Editorial
Society
0301-620X,’86/41 18 $2.00
520
retain
inserted. The and a curved prosthesis was inserted
into a vented femoral medullary canal and a restrictor was not used. The components were to allow polar bearing in order to minimise the moment of the joint, which had been high in
August.
to Mr of
arthroplasties
was
have
been
hip score with
undertaken
and
a
the original equatorial bearing design (Walker and Gold 1971). The functional, radiographic and survivorship results of a series of McKee-Farrar total hip arthroplas-
ties
inserted
between
at
the
the
years
of
Norfolk
and
Norwich
1965
1973
are
and
Hospital
presented.
;
total hip arthroplasty, to its standard design
McKee
hip
arthroplasties
Mill AC.
Bone
Hill,
London
Joint
IAA,
of
Surgery
the
approach
hips
were
without
inserted
using
trochanteric
an
anterolateral
osteotomy
(McKee
and
Watson-Farrar 1966). Antibiotics and anticoagulants were not used routinely. The patients were evaluated using the Harris hip score system (Harris 1969). From a total of 100 points, 44 were allocated for pain, 47 for function, 5 for range of movement
and
the drawbacks elderly, and condition separately
son
4 for absence
ofall consider
of the assessed
ofdeformity.
We
recognise
hip scoring systems, especially this score as only a guide
arthroplasty. using visual
Pain and analogue
in the to the
mobility were scales (Huskis-
1974). All
patients
were
reviewed
authors. A proforma was anteroposterior radiograph During
the
plasties
were
and pelvis
by
the
a standard was taken.
We
performed
analysed
arthroplasties under review. have
I 75 patients years (range
period
examined
died and a further but would probably have
nine-year
and
completed of the
review 808 arthroin patients who had 259 in patients who were untraceable have died by the time of the review.
We
August. and
NW7
METHOD
All
: 255
under were
from
notes
and
that
had
been
revised
been
able
to review
radiographs
during 230
64 of the
the
unrevised
with an average length of follow-up 10 to 22 years). This represents a 28% THE
JOURNAL
OF
BONE
AND
JOINT
period in of 13.9 follow-
hips
SURGERY
THE
MCKEE-FARRAR
140-n
HIP
(Fig.
2), and
equal
a male
numbers
average the time
120-
521
ARTHROPLASTY
right
age of the ofoperation
then equal. Our matched for age
100-
to female
of
Previous pre-operative
whole was
of 1 : I 1 There .
left
sample of this and sex.
.
were
replacements.
series of 808 61 .5 years and
hip surgery diagnosis
The
arthroplasties the sex ratio
population
at was
is thus
well
was uncommon (4.4%) and the was osteoarthritis in 87.5%
80-
(Table
60-
The early complications in this group of patients have been reported previously (McKee and Chen 1973; Dandy and Theodorou 1975). in
I). The
ratio
and
operation
was
40-
Table
I.
Pre-operative
230 unrevised
20-
0-
II
I
1
21-30
d II IFI
1
31-40
41-50
Fig.
Number of arthroplasty.
up which
(1979).
patients
is similar
Bilateral
of the patients measurements, cal
in
61-70
Operation
at
Age
51-60
each
to the
long-term
replacements
data, into
the
review
had
(3 1 .4%). The were entered
at
71-80
been
time
including a computer
in 55
average a range review
was
72.7
years
arthroplasty patients was (Fig. 1). The
with
a range
radiographic for statisti-
operation, the 60.3 years, with average age at
of
6.5
CDH
2.0
Post-traumatic
2.0
Other
2.0
RESULTS
Clinical
findings
Hip score. The hip arthroplasties and
the time of the age ofthe reviewed of 24 to 78 years
in
of
analysis. At
arthritis
of Charnley
performed
diagnosis
87.5
Rheumatoid
(yrs.)
group
by a consultant
arthroplasties
Osteoarthritis
I age
performed
72% of cases.
poor
Harris were
as shown
76.4 points
hip scores for the 230 divided into excellent,
in Table
(range
Table II. unrevised
38 to 95 years
100-
80
II. The
6 to 100 points), Harris hip arthroplasties
mean
hip
and 48.9% score
unrevised good, fair score
were
was
good
in 230
Score
Grade
Percentage
91 to 100
Excellent
27.6
81 to
90
Good
21.3
71 to
80
Fair
22.2
Under
71
Poor
28.9
60 or 40
11 1_
II
2:
30-39
40-49
50-59
Age Number
68-B,
of patients
NO.
4,
60-69
at Review Fig.
VOL.
excellent,
painless
70-79
>80
(yrs.)
2
in each age group
AUGUST
[1
1986
at the time of review.
while
or only
78%
occasionally
of
the
painful
arthroplasties
(Fig.
equivalent to Charnley’s Grades 5 and 1972). Over halfofthe patients (52.5%) could than a mile and 26.8% could walk between
were
3). This
is
6 (Charnley walk further half a mile
and a mile. Only 36% regularly used a walking aid, though 10% needed the equivalent of two sticks and 19.5% were unable to walk out-doors. These figures are partly a reflection of the high average age of 72 years. The mean score for function was 64% (range 4% to 100%).
AC.
522 Subjective own with
assessment.
We
have
C.H.
AUGUST,
compared
the
ALDAM,
P.B.
PYNSENT
patient’s
assessment o1 pain and mobility before operation that at review. Visual analogue scales 100 mm long used, the absence of pain scoring 0 points whilst
were
intolerable pain scored 100. Full mobility scored 0 points and total immobility scored 100. The mean scores before operation were 78 for pain and 74 for mobility : these had improved to 7 and 27 respectively at review. When asked their opinion of their operations, 90% of the patients were satisfied, dissatisfied.
5.5%
were
indifferent
and
SI
4.5%
140K Fig.
___
::
___
___
___
4
Diagram of the anteroposterior pelvic radiograph. SI, line across the inferior margin of the sacro-iliac joints: K, Kohler’s line: V. line perpendicular to SI at the sacro-iliac joint used as a baseline to measure acetabular migration ; a, angle of insertion of the acetabular
___
component.
80-
60-
I I
I
::
-j
I I I I I I I I
44
Number of
patients
of
related
to the Harris
pain
score
at the time
revies.
Cortical tip
of the
made
on
7 only,
while
7). Loosening
hip score component associated
hypertrophy
6%
had
in all zones
calcar was
seen
was
shown to correlate very loosening (p
