Systematic Review of Literature of Cemented Femoral Components: What Is the Durability at Minimum 20 Years Followup?

Abstract

Background Cemented femoral total hip arthroplasty may be one of the most successful surgical interventions of all time. However, although results are very encouraging over the early to mid-term followup, relatively few studies have analyzed the durability of these implants beyond 20 years followup. To evaluate the performance of contemporary implants, it is important to understand how previous implants perform at 20 or more years of followup; one way to do this is to aggregate the available data in the form of a systematic review. Questions/purposes (1) How durable is cemented femoral fixation in the long term (minimum 20-year followup) with respect to aseptic loosening? (2) Is the durability of cemented femoral fixation dependent on age of the patient? (3) Are the long-term results of the cemented femoral fixation dependent on any identifiable characteristics of the prosthesis such as surface finish? Methods A systematic review was performed to identify long-term studies of cemented femoral components. After application of inclusion and exclusion criteria to 1228 articles found with a search in PubMed and EMBASE, 17 studies with a minimum of 20-year followup on cemented femoral components were thoroughly analyzed in an attempt to answer the questions of this review. The quality of the studies reviewed was assessed with the Methodological Index for Nonrandomized Studies (MINORS) instrument. All studies were case series and cohort sizes ranged from 110 to 2000 hips for patients older than 50 years of age and 41 to 93 hips for patients younger than 50 years at the time of surgery. Results Among the six case series performed in patients older than 50 years of age, survivorship for aseptic loosening of the femoral component ranged from 86% to 98% at 20 years followup. There were no obvious differences for younger patients when analyzing the five studies in patients younger than age 50 years in which survivorship free from aseptic loosening for these studies ranged from 77% at 20 years in one study and 68% to 94% at 25 years in the other studies. Although data pooling could not be performed because of heterogeneity of the studies included here, it appeared that stems with a rougher surface finish did not perform as well as polished stems; survivorship of stems with rougher surface finishes varied between 86% and 87%, whereas those with smoother finishes ranged between 93.5% and 98% at 20 years. Conclusions Excellent long-term fixation in both older and younger patients can be obtained with cemented,

Comparative analysis of osseointegration in various types of acetabular implant materials

“…Different implant and surface designs have shown varying long term osteointegration and failure rates. [16][17][18][19][20][21][22][23][24][25][26][27] Assessment of osseointegration is an accepted criterion for the evaluation of modern acetabular implant stability. 28 Long-term success of orthopedic implants is largely dependent on the degree of osseointegration with the surrounding bone.…”

Biomechanical behaviour of a French femoral component with thin cement mantle

“…In a review of cement fixation systems for total hip arthroplasty (THA), polished surface stems were associated with better outcomes than rough surface stems with a follow up period of more than 20 years. 1 This suggests that a taper slip design with a polished finish stem enables cement creep and are less prone to mechanical failure than rough surface stems. 2 - 4 Reported outcomes are generally more favourable for cement thicknesses of at least 2 mm, and this thickness is now widely accepted as optimum for the cement mantle.…”

Міцність Кістково-Металевого Блока Для Різних Типів Поверхонь Імплантатів За Умов Нормального Стану Кісткової Тканини Та При Моделюванні Остеопорозу В Експерименті На Щурах

“…На сучасному розвитку ендопротезування кульшового суглоба пацієнтам молодого та зрілого віку не рекомендована цементна фіксація ацетабулярного компонента ендопротеза через велику кількість випадків його асептичної нестабільності та пов'язаними з нею ревізійними втручаннями в терміни понад 10 років після ендопротезування за такого типу фіксації [7][8][9][10][11][12][13][14][15][16].…”