Survivorship of 2000 Tapered Titanium Porous Plasma-sprayed Femoral Components

Abstract

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.

Long-term (20- to 25-year) Results of an Uncemented Tapered Titanium Femoral Component and Factors Affecting Survivorship

“…Osteolysis was progressive only in 2% of the hips evaluated radiographically, and remote osteolysis was not detected. Similar radiological findings were reported at a 20-year followup with use of other titanium stems such as the Corail stem [54], the MalloryHead prosthesis [35], and the Taperloc femoral component [38]. This finding is in contrast to other mainly cobaltchrome alloy cementless stems, ranging up to 37% osteolysis of [ 1.5 cm [5].…”

“…As reported previously [50], late periprosthetic femoral fracture after minor trauma (eg, falls from ground level) was an important mode of failure in this series resulting in increasing rates of revision in the second and third decades after surgery. Periprosthetic femoral fractures have been reported as an important reason for failure in the long term with use of other uncemented [35] and cemented stem designs [12]. In the present study, we attribute the increasing failure rate for periprosthetic fracture to both a rising incidence of falls and age-related osteoporosis.…”

“…Uncemented tapered titanium femoral components are widely used and have performed well in primary THA. Excellent long-term survivorship has been reported with minimum radiographic evidence of stress shielding and osteolysis [35,38,54]. However, despite their widespread use, there is only limited evidence on their survival and radiographic outcome beyond the 20-year followup [13,35,38,39,54].…”

“…Excellent long-term survivorship has been reported with minimum radiographic evidence of stress shielding and osteolysis [35,38,54]. However, despite their widespread use, there is only limited evidence on their survival and radiographic outcome beyond the 20-year followup [13,35,38,39,54]. Our study, therefore, sought to evaluate longterm results with one design of uncemented stem in the hands of a large group of surgeons at one center, focusing specifically on (1) survivorship using femoral revision as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening.…”

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

“…A multitude of published studies report overall survivorship of several standard-length tapered femoral components ranging from 94% to 100% at up to 20 years' followup [10-12, 17-20, 25, 27-29, 33 [43]. Cementless femoral fixation with tapered-geometry designs has evolved over the past several decades with a recent surge of interest in shorter stems.…”