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Long-term survival and complication rate of cementless prosthetic stems in primary total hip arthroplasty categorized by types according to Mont classification: a regional registry-based study on 53,626 implants

  • Hip Arthroplasty
  • Published:
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Abstract

Introduction

The purpose of this retrospective registry-based study is to assess survival and causes of failure of cementless stem implants used in total hip arthroplasty (THAs), to ascertain if there are differences when these are categorized according to the six types described by Mont.

Methods

Data collected from the regional registry regarding all primary THAs performed from 2000 to 2019 were analyzed. Femoral prosthetic stems were divided into the six types of Mont classification. For each stem type, number of implants, survival and causes of failure were evaluated and compared.

Results

The most frequently implanted stem type was the 3c type (53.4%). Type 1 had the lowest stem failure rate (1.6%), and type 6 showed the highest (3.9%). Periprosthetic fracture was the most frequent complication in type 6, accounting for 34.5% of failures. Aseptic loosening was the main complication in type 2 stems, accounting for 36.4% of failures. Pairwise comparisons showed significant higher survival of type 1 compared to type 3c (p = 0.000026) and type 6 (p = 0.000076), and between type 3a compared to type 3c (p = 0.03) and type 6 (p = 0.026).

Conclusion

Significant variations in implant survival rates were found among the six Mont-types of cementless stems. These findings emphasize the paramount importance of stem design and fixation area in determining long-term survival, providing a guidance for orthopedic surgeons in the selection of the most appropriate stem for primary THA, contributing to our understanding of cementless stem performance, presenting invaluable insights to further improve patient outcomes in THA surgery.

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Data availability

The data that support the findings of this study are available from the corresponding author, A.D.M., upon reasonable request.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy

    Alberto Di Martino, Riccardo Ferri, Matteo Brunello, Valentino Rossomando, Vitantonio Digennaro & Cesare Faldini

  2. Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy

    Alberto Di Martino, Riccardo Ferri, Matteo Brunello, Valentino Rossomando, Francesco Traina & Cesare Faldini

  3. Medical Technology Lab, IRCCS – Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy

    Barbara Bordini

  4. Ortopedia, Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy

    Francesco Traina

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  1. Alberto Di Martino
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Contributions

All authors contributed to the study conception and design. All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by RF, MB, BB, VR, VD, FT, ADM. The first draft of the manuscript was written by CF and all authors commented on previous versions of the manuscript.

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Correspondence to Alberto Di Martino.

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All the authors declare that they have no conflict of interest. The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki. Ethical approval for the study was not necessary because the registry collects data as standard practice on all patients, using a format protecting their identity.

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Di Martino, A., Ferri, R., Bordini, B. et al. Long-term survival and complication rate of cementless prosthetic stems in primary total hip arthroplasty categorized by types according to Mont classification: a regional registry-based study on 53,626 implants. Arch Orthop Trauma Surg 144, 1423–1435 (2024). https://doi.org/10.1007/s00402-023-05144-x

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