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

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Abstract

Purpose

The optimal design for a cemented femoral stem remains a matter of debate. Over time, the shape, surface finish and collar have all been modified in various ways. A clear consensus has not yet emerged regarding the relative merits of even the most basic design features of the stem. We undertook a prospective randomised trial comparing surface finish and the effect of a collar on cemented femoral component subsidence, survivorship and clinical function.

Methods

One hundred and sixty three primary total hip replacement patients were recruited prospectively and randomised to one of four groups to receive a cemented femoral stem with either a matt or polished finish, and with or without a collar.

Results

At two years, although there was a trend for increased subsidence in the matt collarless group, this was not statistically significant (p = 0.18). At a mean of 10.1 years follow-up, WOMAC scores for the surviving implants were good, (Range of means 89–93) without significant differences. Using revision or radiographic loosening as the endpoint, survivorship of the entire cohort was 93 % at 11 yrs, (CI 87–97 %). There were no significant differences in survivorship between the two groups with polished stems or the two groups with matt stems. A comparison of the two collarless stems demonstrated a statistically significant difference in survivorship between polished (100 %) and matt (88 %) finishes (p = 0.02).

Conclusions

In the presence of a collar, surface finish did not significantly affect survivorship or function. Between the two collarless groups a polished surface conferred an improved survivorship.

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Acknowledgments

The authors thank William Twyman for his assistance with digitising and analysis of radiographs.

Conflicts of Interest and Funding

Johnson and Johnson (now Depuy, IN, USA) provided funding for the implants used in the study and for a research nurse over a 2-year period. None of the authors have any other financial disclosures relevant to this study.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedics, Epsom General Hospital, Dorking Road, Epsom, Surrey, KT18 7EG, UK

    Jonathan Hutt, Alexandra Hazlerigg, Ansari Aneel, Geoffrey Epie, Husam Dabis, Roy Twyman & Andrew Cobb

Authors
  1. Jonathan Hutt
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  2. Alexandra Hazlerigg
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  3. Ansari Aneel
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  4. Geoffrey Epie
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  5. Husam Dabis
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  6. Roy Twyman
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  7. Andrew Cobb
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Corresponding author

Correspondence to Jonathan Hutt.

Appendix

Appendix

Fig. 7
figure 7

Consolidated Standards of Reporting Trials (CONSORT) flow diagram

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Hutt, J., Hazlerigg, A., Aneel, A. et al. The effect of a collar and surface finish on cemented femoral stems: a prospective randomised trial of four stem designs. International Orthopaedics (SICOT) 38, 1131–1137 (2014). https://doi.org/10.1007/s00264-013-2256-z

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  • DOI: https://doi.org/10.1007/s00264-013-2256-z

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