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Systematic Review of Literature of Cemented Femoral Components: What Is the Durability at Minimum 20 Years Followup?

  • Symposium: 2014 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 04 September 2014

Abstract

Background

Cemented femoral total hip arthroplasty may be one of the most successful surgical interventions of all time. However, although results are very encouraging over the early to mid-term followup, relatively few studies have analyzed the durability of these implants beyond 20 years followup. To evaluate the performance of contemporary implants, it is important to understand how previous implants perform at 20 or more years of followup; one way to do this is to aggregate the available data in the form of a systematic review.

Questions/purposes

(1) How durable is cemented femoral fixation in the long term (minimum 20-year followup) with respect to aseptic loosening? (2) Is the durability of cemented femoral fixation dependent on age of the patient? (3) Are the long-term results of the cemented femoral fixation dependent on any identifiable characteristics of the prosthesis such as surface finish?

Methods

A systematic review was performed to identify long-term studies of cemented femoral components. After application of inclusion and exclusion criteria to 1228 articles found with a search in PubMed and EMBASE, 17 studies with a minimum of 20-year followup on cemented femoral components were thoroughly analyzed in an attempt to answer the questions of this review. The quality of the studies reviewed was assessed with the Methodological Index for Nonrandomized Studies (MINORS) instrument. All studies were case series and cohort sizes ranged from 110 to 2000 hips for patients older than 50 years of age and 41 to 93 hips for patients younger than 50 years at the time of surgery.

Results

Among the six case series performed in patients older than 50 years of age, survivorship for aseptic loosening of the femoral component ranged from 86% to 98% at 20 years followup. There were no obvious differences for younger patients when analyzing the five studies in patients younger than age 50 years in which survivorship free from aseptic loosening for these studies ranged from 77% at 20 years in one study and 68% to 94% at 25 years in the other studies. Although data pooling could not be performed because of heterogeneity of the studies included here, it appeared that stems with a rougher surface finish did not perform as well as polished stems; survivorship of stems with rougher surface finishes varied between 86% and 87%, whereas those with smoother finishes ranged between 93.5% and 98% at 20 years.

Conclusions

Excellent long-term fixation in both older and younger patients can be obtained with cemented, polished femoral stems. These results provide material for comparison with procedures performed with newer cementing techniques and newer designs, both cemented and cementless, at this extended duration of followup.

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Author information

Authors and Affiliations

  1. University of Iowa, Iowa City, IA, USA

    Nicholas A. Bedard MD, John J. Callaghan MD & Steve S. Liu MD

  2. VA Medical Center, Iowa City, IA, USA

    John J. Callaghan MD

  3. Department of Orthopaedics, University of Iowa, 200 Hawkins Drive, UIHC, 01029 JPP, Iowa City, IA, 52242, USA

    John J. Callaghan MD

  4. University of Sothern California, Los Angeles, Los Angeles, CA, USA

    Michael D. Stefl MD

Authors
  1. Nicholas A. Bedard MD
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  2. John J. Callaghan MD
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  3. Michael D. Stefl MD
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  4. Steve S. Liu MD
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Corresponding author

Correspondence to John J. Callaghan MD.

Additional information

One of the authors (JJC) receives royalties for intellectual property transfer from DePuy (Warsaw, IN, USA) and royalties for books edited from Lippincott Williams & Wilkins (Baltimore, MD, 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 prior to clinical use.

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Bedard, N.A., Callaghan, J.J., Stefl, M.D. et al. Systematic Review of Literature of Cemented Femoral Components: What Is the Durability at Minimum 20 Years Followup?. Clin Orthop Relat Res 473, 563–571 (2015). https://doi.org/10.1007/s11999-014-3876-3

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  • DOI: https://doi.org/10.1007/s11999-014-3876-3

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