, Volume 470, Issue 11, pp 3024-3031

Femoral Bone Is Preserved Using Cemented Polished Stems in Young Patients

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Topic
Hip

Abstract

Background

Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery.

Questions/purposes

We examined femoral stem survival, bone deficiency at revision arthroplasty, and radiographic bone loss in hips implanted with a cemented polished double-taper stem in a cohort of patients younger than 55 years.

Methods

We reviewed 197 hips (median patient age, 47 years; range, 16–54 years) after a minimum followup of 2 years (median, 7 years; range, 2–19 years) since primary THA. Clinically, we determined survival to major and minor stem revision and cases of bone deficiency requiring a long stem or impaction bone grafting or created by the need for femoral osteotomy at revision arthroplasty. Radiographically, we assessed stem loosening, femoral osteolysis, and femoral bone deficiency.

Results

Stem survival to major revision for aseptic loosening was 100% at 13 years and for any reason was 97% (95% CI, 93–100%). At revision of seven stems, a long stem was used in one hip, a total femoral replacement in one hip and impaction bone grafting in one hip. No femoral osteotomies were required. Bone was preserved in four hips by cement-within-cement stem exchange. No stems were radiographically loose. Proximal osteolysis was present in 11% of femurs. Femoral bone deficiency was graded as Paprosky Type I (97%) or II (3%) and Endo-Klinik Grade 0 (79%) or I (21%).

Conclusions

Cemented polished taper stems have high survival at 13 years in young patients and enable femoral bone preservation for subsequent revision.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The institution of the authors has received, in any 1 year, research funding from the Australian Orthopaedic Association Research Foundation (Melbourne, Australia), the Royal Adelaide Hospital (Adelaide, Australia), Zimmer Ltd Australia (Sydney, Australia), and Bristol-Myers Squibb/Zimmer (Warsaw, IN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with the ethical principles of research.
This work was performed at Royal Adelaide Hospital, Adelaide, Australia.