, Volume 471, Issue 10, pp 3262-3269
Date: 14 May 2013

Long-term (20- to 25-year) Results of an Uncemented Tapered Titanium Femoral Component and Factors Affecting Survivorship

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Topic
Hip

Abstract

Background

Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade.

Questions/purposes

We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem.

Methods

We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13–81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20–25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed.

Results

Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%–90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%–96%). Undersized stems (canal fill index ≤ 80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets.

Conclusions

Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening.

Level of Evidence

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

The institution of one or more of the authors (MRS, MMI, CM, PRA, TG) has received funding from the noncommercial research fund of Deutsche Arthrose-Hilfe e.V. and Zimmer Europe (Winterthur, Switzerland).
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 prior to clinical use.
Each author certifies that his or her institution 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 the University of Heidelberg, Heidelberg, Germany.