Minimal 10-year results of a tapered cementless femoral component in total hip arthroplasty

Park

Clinical Orthopaedics &Amp; Related Research

et al. 2014

Background Long-term results of standard total hip arthroplasty (THA) in young patients were not optimal. There are a number of reported disadvantages to longer cementless stems in THA including thigh pain and proximal stress shielding. However, it is unknown whether a short, metaphyseal-fitting anatomic stem without diaphyseal fixation, which represents a possible alternative, will maintain fixation over the longer term. Question/purposes We therefore evaluated long-term (1) clinical results using validated scoring instruments; (2) osseointegration and bone remodeling; (3) complications; and (4) rates of revision and osteolysis in patients younger than 65 years who underwent THA with a short, metaphyseal-fitting anatomic cementless stem.Methods We reviewed 500 patients (630 hips) younger than 65 years (mean age at surgery, 52.7 years) who underwent THA with the Immediate Postoperative Stability stem (IPS; DePuy, Leeds, UK) by one surgeon (Y-HK) from January 1995 to March 2002. Demographic data, Harris hip score, WOMAC score, UCLA activity score, and radiographic data were recorded. All patients underwent dual-energy x-ray absorptiometry scanning of the acetabulum and proximal femur at 2 weeks after the operation and at final followup to determine stress shielding. Thigh pain was specifically investigated and scored by patients on a visual analog scale. Other complications were recorded. We determined component survival rates at 15 years using revision and aseptic loosening as end points. Minimum followup was 11 years (mean, 15.8 years; range, 11-18 years). Results The clinical and functional results improved significantly for the Harris hip score, WOMAC, and UCLA activity scores (p \ 0.001). At latest followup, mean Harris hip, WOMAC, and UCLA activity scores were 94 (range, 71-100), 15 (range, 5-29), and 7.9 (range, 6-9) points, respectively. All hips had osseous integration of the acetabular and femoral components. No patients had thigh pain. Four hips (0.6%) had deep infection and four (0.6%) had a recurrent dislocation. No patients had Grade 3 stress shielding. Fifteen-year survival rates were 98.7% (95% confidence interval [CI], 0.95-1.00) for the acetabular component and 99.4% (95% CI, 0.97-1.00) for the femoral component with revision as the end point and 100% (95% CI, 0.98-1.00) for both components with aseptic loosening as the end point. Conclusions The short, metaphyseal-fitting anatomic cementless femoral stem provided stable fixation without relying on diaphyseal fixation in younger patients, suggesting metaphyseal fitting alone is sufficient in young

Section: Discussionsupporting

confidence: 94%

Long-term Results and Bone Remodeling After THA With a Short, Metaphyseal-fitting Anatomic Cementless Stem

Park

Clinical Orthopaedics &Amp; Related Research

et al. 2014

Clinical Orthopaedics &Amp; Related Research

“…However, longer-term followup questions the durability of these designs, with failure rates of 11% at 11.2 years and 6% at 15 years [34,38]. Tapered stems of various designs have enjoyed a high degree of success (Tables 1, 2) [44,46,47]. They are appropriate in both Dorr Type A [12] bone typical of young patients [13,14,20] and Dorr Type C [12] bone typically seen in older patients [3,31,60].…”

Section: Introductionmentioning

confidence: 99%

“…While somewhat prone to proximal fracture at the time of insertion, they have demonstrated high survivorship (100% at 7.5 years) if treated with a proximal cerclage cable or wire [2]. These tapered titanium stems also seem to respect the proximal femur with minimal proximal stress shielding [16,39,40,[44][45][46][47].…”

Section: Introductionmentioning

confidence: 99%

Survivorship of 2000 Tapered Titanium Porous Plasma-sprayed Femoral Components

Lombardi

Berend

Mallory

et al. 2009

Self Cite

111

Tapered titanium porous plasma-sprayed components have performed well in primary THA. To confirm the literature at longer followup we retrospectively reviewed all 1639 patients who underwent 2000 THAs in which a specific porous femoral component was used. One hundred fourteen patients (134 hips) were lost to followup leaving a cohort of 1525 patients (1866 THAs). The component is a tapered titanium plasma spray-coated design that remained relatively unchanged since its first implantation except for circumferential proximal porous coating added in 1986 and an offset option added in 1999. Minimum followup was 24 months (average, 119 months; range, 24 to 275 months). To date there have been 39 femoral revisions for an implant survival of 98%. Using the Kaplan-Meier method, cumulative survival with any stem revision as the end point was 98.6% at 5 years, 98.4% at 10 years, 97.1% at 15 years, and 95.5% at 20 years. Using aseptic revision for failure of ingrowth as the endpoint, stem survival was 99.1%. Kaplan-Meier cumulative survival with aseptic revision for failure of ingrowth as the endpoint was 99.4% at 5 years, 99.3% at 10, 15 and 20 years. Harris hip pain and total scores improved. This titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of component revision for any reason or aseptic failure of ingrowth.

“…Recently, encouraging long-term results have been reported for cementless tapered titanium stems and cementless cylindrical cobalt-chrome stems (Zweymüller [12], CLS [18], Mallory-Head [19], Tri-Lock [24], Anatomic Medullary Locking (AML) prosthesis [10], Taperloc stem [21], Anatomic hip stem [1], Ultralok [11], Spotorno stem [2], Omnifit [16], etc.). However, no long-term follow-up studies have been conducted on cementless total hip replacements with a tapered fully porous-coated cobaltchrome stem.…”

Section: Introductionmentioning

confidence: 99%

Fifteen- to 20-year results of uncemented tapered fully porous-coated cobalt-chrome stems

Yoon

Rowe

International Orthopaedics (SICO

et al. 2007

In this paper, we evaluated the long-term results of uncemented total hip arthroplasties using tapered fully porous-coated cobalt-chrome stems (Autophor 900S). The average follow-up was 206 months in 127 hips (113 patients). The articulations of the joints were ceramic-on-polyethylene in 43 hips and ceramic-onceramic in 84. The survival rate of the stems at 17 years was 94.5%. A stable stem with bony ingrowth was identified in all 120 hips, excluding femoral revision cases (seven hips). The causes of the seven femoral revisions were aseptic loosening in four, infection in two, and stem fracture in one. No surgical intervention was performed for osteolysis or stress shielding. The Autophor 900S tapered fully porous-coated cobalt-chrome femoral stem revealed encouraging radiographic longterm stability.