Long term survival analysis of cementless Spotorno femoral stem in young patients

Abstract

ObjectiveThe aim of this study was to analyze the survivorship and clinical outcome of Cementless Spotorno (CLS) stem in young patients.MethodsA total of 99 consecutive hip arthroplasties using CLS stem were performed on 84 patients younger than 50 years of age between 1993 and 2001. 63 patients were available for final follow-up (mean age: 39 ± 7.8 (range: 22–50)). Patients' Harris Hip Scores (HHS) and survivorship estimates were calculated. Radiographs were analyzed for acetabular implant status, canal fill index (CFI), stem alignment, osteolysis, and stress shielding.ResultsMean follow-up time was 18 years (13–3), and mean HHS was 88.7 (58–100). Patients with femoral neck fracture had a more favorable functional outcome (p = 0.027), while those with stems in varus had lower scores (p = 0.017). 31 stems (49%) were undersized and 30 hips (47%) had perifemoral osteolysis. Acetabular impairment was strongly associated with osteolysis in Gruen zones 1 and 7 (p < 0.01). Seventeen of the osteolytic lesions occurred in Gruen zone 1, 4 lesions in zone 2, 9 in zone 6 and 22 in zone 7. Forty nine stems were well aligned, 10 were in varus and 5 in valgus. Six patients presented with grade 1 stress shielding, 42 with grade 2, 9 with grade 3 and 7 with grade 4. Pedestal formation was evident in 13 cases. Kaplan-Meier survivorship estimates at 18 years with revision for any reason as the end point and with septic revisions excluded were 91.2% (95% CI: 83.7%–98.7%) and 95.1% (95% CI: 89.5%–100%), respectively. There was no difference between survival estimates of patients with different etiologies.ConclusionCLS stems in young patients have high survival estimates in the long term with good-excellent results. Spotorno stems perform equally well in all etiologies with no difference in terms of survivorship.Level of EvidenceLevel IV Therapeutic study.

Straight stem and threaded cup total hip arthroplasty systems in patients under 60 years of age: outdated or still a benchmark? A report on a cohort of 75 patients after 28.8-30.2 years of follow-up

“…The results of this study group are comparable to to previous published cohorts as shown by Delauny, giving survival rates of 99% for aseptic loosening after a timespan of 7 to 8 years [1]. Other stems with excellent long term results in younger patients such as CLS Spotorno (72.8 any reason after 23.8 years) [10,12,11], Bicontact (93.57% at 12 years) [6,5] and Corail (95% at 12 years) [8,9] show good results up to 24 years of follow-up, but none of the mentioned cohorts give results for a period up to the end of the third decade as we do. Published data does sometimes not focus on the long-term problems such as wear of early polyethylene liners, therefore the reason for aseptic loosenings stays unclear in most cases.…”

“…Some studies describe longterm results up to 20 years [4]. Other well established stem systems are reported to have excellent long term results such as Bicontact [5,6], Taperloc [7], Corail [8,9], CLS [10][11][12] as well as threaded cups such as T-TAP ST [13].…”

Straight stem and threaded cup in patients under 60 years of age: 28.8–30.2 years of follow-up

“…Within the Czech arthroplasty register, 2677 evaluated stems showed a survival rate of 99.81% after 1 to 11 years [30]. Other stems with excellent long-term results in younger patients such as CLS Spotorno (72.8 any reason after 23.8 years) [10][11][12], Bicontact (93.57% at 12 years) [5,6], and Corail (95% at 12 years) [8,9] show good results up to 24 years of follow-up, but none of the mentioned cohorts give results for a period up to the end of the third decade as we do. Published data does sometimes not focus on the long-term problems such as wear of early polyethylene liners; therefore, the reason for aseptic loosenings stays unclear in most cases.…”

“…Some studies describe long-term results up to 20 years [ 4 ]. Other well-established stem systems are reported to have excellent long-term results such as Bicontact [ 5 , 6 ], Taperloc [ 7 ], Corail [ 8 , 9 ], and CLS [ 10 – 12 ] as well as threaded cups such as T-TAP ST [ 13 ].…”

Long-Term results of total Hip Arthroplasty performed using a cementless expansive Acetabular Cup and Spotorno Femoral Stem

“…5 , 6 In a recent study, the cementless Spotorno ® femoral stem, even in young patients, has been reported to have a survival rate of 91.2% after 18 years, when all causes are considered, and the rate reaches 95.1% when infection is excluded. 7 With the femoral stem of the CLS system having such a high survival rate, we wanted to determine the survival rate of the expansive acetabular component and the total prosthesis.…”