High Revision Rates of a Cementless Beta-Titanium Alloy Stem with Contamination-Free Roughened Surface in Primary Total Hip Arthroplasty

Abstract

<jats:p>Optimal osseointegration of cementless total hip arthroplasty is essential for high stability and long-term survival. The purpose of this follow-up study was to evaluate the clinical and radiological outcome, the complications, and survival rates of a beta-titanium alloy stem with a specific grit-blasted-free surface. In 192 patients (mean age of 64.4 years), 202 consecutive primary total hip arthroplasties were performed using a cementless Hipstar® stem (Stryker, Duisburg, DE). The Harris Hip Score (HHS) was assessed pre-operatively and post-operatively. Radiolucent lines were evaluated and the implant survival rate was calculated using Kaplan-Meier analysis. The mean follow-up was 7.71 years (range of 5.0–14.0 years). Overall, 15 revisions were performed. Early aseptic stem loosening was observed in six cases (2.97%). Radiolucent-lines adjacent to the stem were detected in 73 cases (83.02%), especially (70.46%) in the Gruen zones 1, 7, 8, and 14. The mean postoperative HHS was 92.65 points (range 42–100). The cumulative survival probability of the stem was 94.4% (95% CI 90.3 to 98.5%). Considering aseptic failure as an endpoint, the cumulative survival rate of the stem was 95.3% (95% CI 0.914 to 0.992) at six years of follow-up. Overall, an inferior mid-term implant survival was observed in comparison to well-established cementless stem designs.</jats:p>

Comparison of radiographic changes in rectangular curved short stem with thin versus thick porous coating for cementless total hip arthroplasty: a retrospective study with a propensity score matching

“…However, since standard stems with good long-term results also present various radiographic changes [ 38 ], it remains unclear how such imaging findings in rectangular curved short stems change over a long period of time, impacting the clinical results. There have been reports that radiographic changes may be linked to early revision [ 19 , 20 ]; thus, although the short-term clinical results showed no difference in the present study, these radiographic changes would be of clinical concern.…”

“…Radiolucent lines (reactive lines) that appear and advance over a wide area around the cementless stem with movements in the stem may be a sign of loosening [ 19 , 20 , 34 ]. However, radiolucent lines that are about 1–2 mm in width near the Zweymüller type stem, which is a rectangular straight standard-length stem, have no impact on the clinical result and are not a sign of loosening for a distally fixed stem [ 11 ].…”

“…Radiographical changes may develop relatively quickly following surgery. They are often related to stem fixation and may be associated with clinical outcomes, such as the need for early revision [ 19 , 20 ].

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Metallic artifact suppression with MAVRIC-SL in magnetic resonance imaging for assessing chronic pain after hip or knee arthroplasty

“…All components of the knee prostheses were evaluated using the radiographic evaluation and scoring system developed by the Knee Society ( 12 ) . The hip prostheses were evaluated by DeLee and Charnley zone ( 13 ) , for the acetabular component, and by Gruen zone ( 14 ) , for the femoral component.…”