title: The Corail stem as a reverse hybrid - survivorship and x-ray analysis at 10 years.
abstract: BACKGROUND
  The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA have been sparsely described.We report our experience of reverse hybrid THA, using the Elite plus polyethylene cemented cup together with the Corail fully hydroxyapatite-coated uncemented stem and a 28-mm alumina ceramic head.
  
  
  METHODS
  132 consecutive reverse hybrid hip arthroplasties were performed from January 2000 to December 2003 in 126 patients with a mean age of 54.3 years (28-65). All patients were routinely reviewed at 3 months, 1, 5, 7 and 10 years postoperatively. At each follow-up patients were seen either by a consultant orthopaedic surgeon or a senior trainee. Anteroposterior pelvic and lateral x-rays of the hip were taken at each visit. To estimate the survival of the THAs we used the Kaplan-Meier method with 95% confidence interval (CI). Logistic regression analysis was performed to determine which factors affected the presence of radiolucency around the femoral stem.
  
  
  RESULTS
  The mean follow-up was 11.1 years (9.0-14.2). 1 patient was lost to follow-up, and 7 patients were deceased at the time of 10-year follow up. At 10 years 7 patients have had further surgery. 5 for infection, 1 periprosthetic femoral fracture and 1 heterotopic bone formation. All stems were classified as well fixed. 2 cups were defined as loose at 10 years. 1 patient is scheduled for revision the other refused revision. The clinical outcome and radiological findings were assessed in 123 hips. The mean Harris Hip Score was 94 (35-100) at 10 years and the mean WOMAC score was 89 (30.2-100).
  
  
  CONCLUSIONS
  We report good results with respect to clinical outcome and survival of the reverse hybrid concept in patients younger than 65. A successful outcome depends on meticulous preoperative planning, use of modern cementing techniques in the acetabulum and experience in implanting an uncemented stem.
authors.affiliation: Orthopaedic Department, Elverum Hospital, Innlandet Hospital Trust, Elverum - Norway.
authors.forename: Helge
authors.initials: H
authors.lastname: Wangen
authors.affiliation: University of Oslo, Oslo - Norway.|Department of Orthopaedics, Oslo University Hospital, Oslo - Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Nordsletten
authors.affiliation: Orthopaedic Department, Clinic Siloah, Berne - Switzerland.
authors.forename: Jens G
authors.initials: JG
authors.lastname: Boldt
authors.affiliation: The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen - Norway.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Fenstad
authors.affiliation: Primary Joint Unit, Musgrave Park Hospital, Belfast - UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Beverland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D001843:Bone Cements; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D000073859:Survivorship; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements