Skip to main content
SpringerLink
Log in

Proximally Versus Fully Porous-coated Femoral Stems: A Multicenter Randomized Trial

  • Symposium: Papers Presented at the Hip Society Meetings 2009
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

There are two broad-based categories of cementless femoral component designs: proximally porous-coated and fully porous-coated. While both have been widely used, there remains debate regarding differences in clinical outcome scores, relative incidence of thigh pain, and development of stress shielding. We investigated these variables in a multicenter prospective randomized blinded clinical trial of 388 patients from three centers: 198 patients had a proximally porous-coated tapered cementless femoral component and 190 patients had a fully porous-coated cementless femoral component. A minimum followup of 2 years (mean, 6.7 years; range, 2.0–8.65 years) was available in 367 of the 388 patients (95%). We observed no differences in age at surgery, body mass index, or preoperative clinical outcome scores (WOMAC, SF-12, Harris hip score, UCLA activity, thigh pain) with the two groups. We determined serial bone density changes in a subcohort of 72 patients from two of the three centers. The postoperative clinical outcome scores were similar at all followup intervals, and we observed no differences in the incidence of thigh pain at any time. Bone density reduction in Gruen Zone 7 was greater with the fully coated stem than the proximally coated stem (24% versus 15% reduction, respectively). Both fully and proximally coated stems performed well, with no clinical differences at 2 years’ followup, except in bone mineral density evaluations.

Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baltopoulos P, Tsintzos C, Papadakou E, Karagounis P, Tsironi M. Hydroxyapatite-coated total hip arthroplasty: the impact on thigh pain and arthroplasty survival. Acta Orthop Belg. 2008;74:323–331.

    PubMed  Google Scholar 

  2. Barrack RL, Paprosky W, Butler RA, Palafox A, Szuszczewicz E, Myers L. Patients’ perception of pain after total hip arthroplasty. J Arthroplasty. 2000;15:590–596.

    Article  CAS  PubMed  Google Scholar 

  3. Bellamy N. WOMAC Osteoarthritis Index: A User’s Guide. London, Ontario, Canada: 1995.

  4. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.

    CAS  PubMed  Google Scholar 

  5. Bryan JM, Sumner DR, Hurwitz DE, Tompkins GS, Andriacchi TP, Galante JO. Altered load history affects periprosthetic bone loss following cementless total hip arthroplasty. J Orthop Res. 1996;14:762–768.

    Article  CAS  PubMed  Google Scholar 

  6. Bugbee WD, Culpepper WJ 2nd, Engh CA Jr, Engh CA Sr. Long-term clinical consequences of stress-shielding after total hip arthroplasty without cement. J Bone Joint Surg Am. 1997;79:1007–1012.

    CAS  PubMed  Google Scholar 

  7. Callaghan JJ, Templeton JE, Liu SS, Warth LC, Chung YY. Improved results using extensively coated THA stems at minimum 5-year followup. Clin Orthop Relat Res. 2006;453:91–96.

    Article  PubMed  Google Scholar 

  8. Chen CJ, Xenos JS, McAuley JP, Young A, Engh CA Sr. Second-generation porous-coated cementless total hip arthroplasties have high survival. Clin Orthop Relat Res. 2006;451:121–127.

    Article  PubMed  Google Scholar 

  9. Danesh-Clough T, Bourne RB, Rorabeck CH, McCalden R. The mid-term results of a dual offset uncemented stem for total hip arthroplasty. J Arthroplasty. 2007;22:195–203.

    Article  PubMed  Google Scholar 

  10. Dolhain P, Tsigaras H, Bourne RB, Rorabeck CH, Mac Donald S, Mc Calden R. The effectiveness of dual offset stems in restoring offset during total hip replacement. Acta Orthop Belg. 2002;68:490–499.

    CAS  PubMed  Google Scholar 

  11. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988;231:7–28.

    PubMed  Google Scholar 

  12. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69:45–55.

    CAS  PubMed  Google Scholar 

  13. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;257:107–128.

    PubMed  Google Scholar 

  14. Engh CA, O’Connor D, Jasty M, McGovern TF, Bobyn JD, Harris WH. Quantification of implant micromotion, strain shielding, and bone resorption with porous-coated anatomic medullary locking femoral prostheses. Clin Orthop Relat Res. 1992;285:13–29.

    PubMed  Google Scholar 

  15. Engh CA Jr, McAuley JP, Sychterz CJ, Sacco ME, Engh CA Sr. The accuracy and reproducibility of radiographic assessment of stress-shielding: a postmortem analysis. J Bone Joint Surg Am. 2000;82:1414–1420.

    PubMed  Google Scholar 

  16. Engh CA Jr, Young AM, Engh CA Sr, Hopper RH Jr. Clinical consequences of stress shielding after porous-coated total hip arthroplasty. Clin Orthop Relat Res. 2003;417:157–163.

    PubMed  Google Scholar 

  17. Faraj AA, Yousuf M. Anterior thigh pain after cementless total hip arthroplasty. Int Orthop. 2005;29:149–151.

    Article  CAS  PubMed  Google Scholar 

  18. Glassman AH, Bobyn JD, Tanzer M. New femoral designs: do they influence stress shielding? Clin Orthop Relat Res. 2006;453:64–74.

    Article  CAS  PubMed  Google Scholar 

  19. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    CAS  PubMed  Google Scholar 

  20. Hughes SS, Furia JP, Smith P, Pellegrini VD Jr. Atrophy of the proximal part of the femur after total hip arthroplasty without cement: a quantitative comparison of cobalt-chromium and titanium femoral stems with use of dual x-ray absorptiometry. J Bone Joint Surg Am. 1995;77:231–239.

    CAS  PubMed  Google Scholar 

  21. Hui S, Gao S, Zhou XH, Johnston CC Jr, Lu Y, Gluer CC, Grampp S, Genant H. Universal standardization of bone density measurements: a method with optimal properties for calibration among several instruments. J Bone Miner Res. 1997;12:1463–1470.

    Article  CAS  PubMed  Google Scholar 

  22. Karachalios T, Tsatsaronis C, Efraimis G, Papadelis P, Lyritis G, Diakoumopoulos G. The long-term clinical relevance of calcar atrophy caused by stress shielding in total hip arthroplasty: a 10-year, prospective, randomized study. J Arthroplasty. 2004;19:469–475.

    Article  PubMed  Google Scholar 

  23. Khoo BC, Brown K, Cann C, Zhu K, Henzell S, Low V, Gustafsson S, Price RI, Prince RL. Comparison of QCT-derived and DXA-derived areal bone mineral density and T scores. Osteoporos Int. 2008 December 24 [Epub ahead of print].

  24. Kilgus DJ, Shimaoka EE, Tipton JS, Eberle RW. Dual-energy x-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants: methods and preliminary results. J Bone Joint Surg Br. 1993;75:279–287.

    CAS  PubMed  Google Scholar 

  25. Kinov P, Radl R, Zacherl M, Leithner A, Windhager R. Correlation between thigh pain and radiological findings with a proximally porous-coated stem. Acta Orthop Belg. 2007;73:618–624.

    PubMed  Google Scholar 

  26. Kiratli BJ, Checovich MM, McBeath AA, Wilson MA, Heiner JP. Measurement of bone mineral density by dual-energy x-ray absorptiometry in patients with the Wisconsin hip, an uncemented femoral stem. J Arthroplasty. 1996;11:184–193.

    Article  CAS  PubMed  Google Scholar 

  27. Kronick JL, Barba ML, Paprosky WG. Extensively coated femoral components in young patients. Clin Orthop Relat Res. 1997;344:263–274.

    Article  PubMed  Google Scholar 

  28. Loupasis G, Hyde ID, Morris EW. The Furlong hydroxyapatite-coated femoral prosthesis: a 4- to 7-year follow-up study. Arch Orthop Trauma Surg. 1998;117:132–135.

    Article  CAS  PubMed  Google Scholar 

  29. Mallory TH, Head WC, Lombardi AV Jr, Emerson RH Jr, Eberle RW, Mitchell MB. Clinical and radiographic outcome of a cementless, titanium, plasma spray-coated total hip arthroplasty femoral component: justification for continuance of use. J Arthroplasty. 1996;11:653–660.

    Article  CAS  PubMed  Google Scholar 

  30. McAuley JP, Culpepper WJ, Engh CA. Total hip arthroplasty: concerns with extensively porous coated femoral components. Clin Orthop Relat Res. 1998;355:182–188.

    Article  PubMed  Google Scholar 

  31. McCarthy CK, Steinberg GG, Agren M, Leahey D, Wyman E, Baran DT. Quantifying bone loss from the proximal femur after total hip arthroplasty. J Bone Joint Surg Br. 1991;73:774–778.

    CAS  PubMed  Google Scholar 

  32. Nishino T, Mishima H, Miyakawa S, Kawamura H, Ochiai N. Midterm results of the Synergy cementless tapered stem: stress shielding and bone quality. J Orthop Sci. 2008;13:498–503.

    Article  PubMed  Google Scholar 

  33. Pritchett JW. Fracture of the greater trochanter after hip replacement. Clin Orthop Relat Res. 2001;390:221–226.

    Article  PubMed  Google Scholar 

  34. Qureshi AA, Virdi AS, Didonna ML, Jacobs JJ, Masuda K, Paprosky WP, Thonar EJ, Sumner DR. Implant design affects markers of bone resorption and formation in total hip replacement. J Bone Miner Res. 2002;17:800–807.

    Article  PubMed  Google Scholar 

  35. Sabo D, Reiter A, Simank HG, Thomsen M, Lukoschek M, Ewerbeck V. Periprosthetic mineralization around cementless total hip endoprosthesis: longitudinal study and cross-sectional study on titanium threaded acetabular cup and cementless Spotorno stem with DEXA. Calcif Tissue Int. 1998;62:177–182.

    Article  CAS  PubMed  Google Scholar 

  36. Scott DF, Jaffe WL. Host-bone response to porous-coated cobalt-chrome and hydroxyapatite-coated titanium femoral components in hip arthroplasty: dual-energy x-ray absorptiometry analysis of paired bilateral cases at 5 to 7 years. J Arthroplasty. 1996;11:429–437.

    Article  CAS  PubMed  Google Scholar 

  37. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.

    Article  PubMed  Google Scholar 

  38. Whiteside LA. Major femoral bone loss in revision total hip arthroplasty treated with tapered, porous-coated stems. Clin Orthop Relat Res. 2004;429:222–226.

    Article  PubMed  Google Scholar 

  39. Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Kory Charron for his assistance in statistical analysis.

Author information

Authors and Affiliations

  1. London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Steven J. MacDonald MD, FRCSC, Jeffrey S. Guerin BMath, Richard W. McCalden MD, FRCSC, Robert B. Bourne MD, FRCSC & Cecil H. Rorabeck MD, FRCSC

  2. Washington University School of Medicine, St Louis, MO, USA

    Robert L. Barrack MD

  3. University of Alabama at Birmingham Orthopaedics, Birmingham, AL, USA

    Seth Rosenzweig MD

  4. University of Manitoba Joint Replacement Group, Winnipeg, MB, Canada

    Eric R. Bohm MD, FRCSC

Authors
  1. Steven J. MacDonald MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seth Rosenzweig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey S. Guerin BMath
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard W. McCalden MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric R. Bohm MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert B. Bourne MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cecil H. Rorabeck MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert L. Barrack MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven J. MacDonald MD, FRCSC.

Additional information

The institution of one or more of the authors has received funding from Physicians Services Inc (SJM, JSG, RWM, RBB, CHR), Smith and Nephew Inc, Memphis, TN (SR, ERB, RLB), and DePuy Inc, Warsaw, IN (SR, ERB, RLB).

One or more of the authors certifies that he (RBB, CHR, RLB) has or may receive payments or benefits from a commercial entity related to this work.

Each author certifies that his or her institution has approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at London Health Sciences Centre, Tulane University Medical Center, University of Alabama at Birmingham Orthopaedics, and University of Manitoba Joint Replacement Group.

About this article

Cite this article

MacDonald, S.J., Rosenzweig, S., Guerin, J.S. et al. Proximally Versus Fully Porous-coated Femoral Stems: A Multicenter Randomized Trial. Clin Orthop Relat Res 468, 424–432 (2010). https://doi.org/10.1007/s11999-009-1092-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-1092-3

Keywords

Search

Navigation