Papers by Author: James M. Buchanan

Abstract: The goal of hip arthroplasty is to restore the patient to an active and pain free life for ever. Unfortunately, prosthetic implants fail because of loosening, wear or infection. This study sets out to ascertain whether or not Hydroxyapatite hip arthroplasty (HA) will produce long-lasting function of at least ten years in unselected patients of all ages and all diagnoses. Cemented implants used in hip arthroplasty often loosen after ten or more years of use. This is partly mechanical but also associated with debris disease arising from plastic wear products. Cementing techniques have been improved and the Swedish Hip Register [1] demonstrates that the revision rates have been reduced with improved cementing techniques. Revision surgery after cemented arthroplasty is difficult and may be complicated by fracture of the host bone Bioactive materials are being used to secure joint implants [2,3] and this paper presents the results of a consecutive series of hip arthroplasties carried out over a total period of over 19 years using the Furlong Hydroxyapatite Ceramic Coated hip prosthesis.[4, 5]

Abstract: This paper describes the clinical application of alumina ceramic and, more recently, Zirconia Toughened Alumina (ZTA), to the bearing surfaces of hip implants with a maximum follow up of fifteen years. Patients are assessed pre- and post-operatively using the Harris Hip Score. [1] X-rays are taken annually and, where appropriate, post mortem histological examination is carried out. Results are discussed. Some failures of alumina ceramic components have been seen and measures to prevent such incidents are described.

Abstract: Wear debris contributes to the development of granulomatous debris disease and loosening. It is accepted that hydroxyapatite ceramic (HA) will bond a prosthesis to bone.[1,2] Osteolysis has not been seen for several years after implantation but cases are now emerging [3]. Is HA still working Should we use hard on hard bearings Should we abandon polythene liners With a modular hip system, patients with polythene acetabular liners have been compared with those with ceramic liners. Polythene liners wear out and patients with a life expectancy of more than ten years should have ceramic/ceramic bearings.

Abstract: Uncemented hip arthroplasty is gaining interest. However, it is alleged that uncemented hip implants fail in osteoporotic bone because of early loosening and a higher incidence of periprosthetic fractures. Will Hydroxyapatite Ceramic Coated Hips (HAC) bond on to the osteoporotic bone and continue to function well in this vulnerable group of patients Post-menopausal women are prone to develop osteoporosis. They are seen too frequently with wrist, hip and spinal crush fractures following minor low impact injuries. These ladies also contribute to the cohort of patents requiring hip arthroplasty for all the usual diagnoses including sub capital fractures. This is a study of HAC hip arthroplasty in female patients over the age of sixty which includes women with osteoporosis.

Abstract: To reduce osteolysis and loosening, alumina bearings in hip arthroplasty have been used in Sunderland since 1991. This consecutive series demonstrates the results which have been most rewarding. However, ceramic implant fractures have been encountered but these probably represent less than meticulous operative technique. The results are published and the complications discussed together with advice to reduce the incidence of implant failure.

Abstract: Traditionally implants for hip arthroplasty are secured with bone cement. Problems have been encountered with cement fixation with loosening and osteolysis attributed to the reaction to particulate cement material and also polyethylene debris from wear. Cementing techniques have been improved and the Swedish Hip Register [1] demonstrates that the revision rates have been reduced with improved cementing techniques. However, uncemented hip arthroplasty is now having a revival. In particular, bioactive materials are being used and this paper presents the results of a consecutive series of hip arthroplasties carried out over a total period of just 16 years. All the patients are included, including primary and revision hip arthroplasty. Patients are assessed using the Harris Hip Score [2]. 13% of the hips scored less than 80 on the Harris Hip Score but only 9.4% scored poor pain scores. These represent the results of poor hip arthroplasty, of which an even smaller percentage are related to failed HA hip arthroplasty.