The McKee-Farrar Total Hip Replacement

The first 403 McKee-Farrar total hip replacement arthroplasties performed in five general hospitals in Vancouver by twenty-three different surgeons have been reviewed after an average follow-up of 1.4 years (range three months to four years). Thirty-five were excluded for various reasons leaving 368 (242 unilateral and sixty-three bilateral) available for analysis. Total hip replacement was performed for idiopathic osteoarthritis in 241 hips, for post-traumatic arthritis in forty-two, for rheumatoid arthritis in thirty-nine, for congenital dysplasia in six, and for a variety of conditions in the remaining hips. Previous surgical procedures had been performed on seventy-four (20 per cent) hips in sixty-nine patients. The results of total hip replacement were evaluated in terms of relief of pain, range of motion, and ability to walk. For pain relief the results were: improved, 85 per cent; no change, 10 per cent; and worse, 5 per cent. For range of motion the results were: improved, 76 per cent; no change, 20 per cent; and worse, 4 per cent. For ability to walk the results were: improved, 69 per cent; no change, 25 per cent; and worse, 6 per cent. In this series 184 complications occurred after 115 replacement procedures. These complications included five deaths, thirty-two instances of periarticular ossification, thirty postoperative infections (eleven early and nineteen late), twenty-four instances of loosening of the prosthesis (nine aseptic and fifteen septic), twenty-seven cases of thromboembolic disease, ten non-unions of the greater trochanter, twenty-one other systemic complications, and other less frequent local complications such as dislocation, recurrent subluxation, and so forth. The highest incidence of complications was in the patients who had had previous surgical procedures on the hip in which the total hip replacement was performed. The complications were analyzed in detail. There were sixty-three total hip replacements that were rated failures (unsatisfactory to the patient, surgeon, or both). These failures occurred in fifty-seven hips, some of which had more than one total replacement that failed. The failures were classified as mechanical in thirty-six, biological in seventeen, and technical in ten. The causes of failure in each of these categories were reviewed. Sixty-four salvage procedures were performed on forty-seven hips. These procedures included relocation of a dislocated prosthesis in eight hips, drainage of a hematoma or infection in sixteen, revision and reinsertion of the prosthesis in fourteen, a Girdlestone arthroplasty in seventeen, and a variety of other procedures perfomed two times or less. Since completion of this study late infection and loosening have developed in some of the hips previously rated as having good results. Based on the findings in this study, it is concluded that the over-all results of total hip replacement are very impressive but that this procedure should not be done by the occasional hip surgeon but by those who have a thorough knowledge of surgery of the hip joint and who are equipped to deal with the complications.