Ten-year survival of the MS-30 matt-surfaced cemented stem

Abstract

The Morscher-Spotorno (MS-30) femoral stem is a stainless-steel, straight, three-dimensionally tapered, collarless implant for cemented fixation in total hip replacement. We report the results at ten years of a consecutive series of 124 total hip replacements in 121 patients with the matt-surfaced MS-30 stem and an alumina ceramic head of 28-mm diameter. All the stems were fixed with Palacos bone cement with gentamicin using a modern cementing technique. They were combined with an uncemented, press-fit cup. The mean period of observation was 10.2 years (8.3 to 12.1) and no patient was lost to follow-up. Twenty-seven patients (22%) died with the implant in situ. Nine could only be interviewed by telephone. We included 85 patients with 88 hips in the clinical and radiological follow-up examinations. None of the stems or cups had been revised. The Harris hip score was excellent or good in 97% (85 hips) and moderate in 3% (three hips). Radiologically, six hips (6.8%) had osteolysis adjacent to the stem, mostly in Gruen zone 7. Twenty (22.7%) showed one or more radiolucent lines. Twenty-two stems (25%) had subsided by 2 mm to 5 mm. In these cases two showed osteolysis (9.1%) with subsidence and four without (6.1%). Radiolucent lines were seen in seven with migration (31.8%) and in 13 without (19.7%). No infections and no acetabular osteolysis were observed. The clinical results were excellent with survivorship after ten years of 100% and only a slightly statistically non-significant higher rate of osteolysis and radiolucency in cases of subsidence.

The influence of proximal stem geometry and surface finish on the fixation of a double-tapered cemented femoral stem

“…These results are generally consistent with the clinical success of a flanged, collarless, double-tapered cemented stem in both highly polished and matte surface finishes (Berli et al, 2005;Morscher et al, 2005;Morscher and Wirz, 2002). Collectively, these laboratory results and clinical observations suggest that dorsal flanges are more important to the fixation of cemented doubletapered femoral components than surface finish.…”

“…Clinical observations suggest that, contrary to findings for nonflanged stems, for double-tapered stems with proximal flanges, surface finish does not appear to affect clinical outcome (Berli et al, 2005;Morscher et al, 2005). In a multi-center study of a double-tapered stem with flanges, either highly polished or with a matte finish, the risk of aseptic loosening at 6-10 years was less than 1%, regardless of surface finish .…”

“…The matte-finished Marburg, implanted between 1984 and 1987 in 220 hips, had a 95.4% survival rate at 13 years; whereas, the grit-blasted version, implanted between 1991and 1994 in 343 hips, had a 76.7% survival rate at 8 years. The stem with the longest survival, while relatively more polished than the other, was in fact matte, the same finish that was detrimental to the clinical performance of the Exeter, but had no reported clinical effect in terms of revisions or radiographic outcome for the MS-30 after 10 years (Berli et al, 2005;Howie et al, 1998;Ling, 1992;Middleton et al, 1998;Morscher et al, 2005;Morscher and Wirz, 2002). It stands to reason that the MS-30 and the Marburg flanges played a role in fixation leading to enhanced outcome; however, till date, no other study has examined the interactions between surface finish and flanges on fixation.…”

“…In a multi-center study of a double-tapered stem with flanges, either highly polished or with a matte finish, the risk of aseptic loosening at 6-10 years was less than 1%, regardless of surface finish . Further, investigators reported 100% survival rate at 10 years for the same matte stem design (Berli et al, 2005). Considering the disparity in outcome for flanged and non-flanged tapered stems, it stands to reason that flanges are of clinical significance.…”

The effect of a collar and surface finish on cemented femoral stems: a prospective randomised trial of four stem designs

“…Both designs show excellent long-term clinical survival [17]. Individual series show excellent clinical results with collared polished [1], collared matt [18], collarless polished [19] and collarless matt [20] stems, which indicates that the two features we assessed in this study are only two of many that could affect long-term survival. Other studies concentrated on the effect of surface finish and presence of a collar.…”