Clinical Orthopaedics and Related Research®

, Volume 468, Issue 2, pp 433–440 | Cite as

Survivorship of a Low-stiffness Extensively Porous-coated Femoral Stem at 10 Years

  • Mark A. Hartzband
  • Andrew H. Glassman
  • Victor M. Goldberg
  • Louis R. Jordan
  • Roy D. Crowninshield
  • Kevin B. Fricka
  • Louis C. Jordan
Symposium: Papers Presented at the Hip Society Meetings 2009


A novel low-stiffness extensively porous-coated total hip femoral component was designed to achieve stable skeletal fixation, structural durability, and reduced periprosthetic femoral stress shielding. In short- to intermediate-term clinical review, this implant achieved secure biologic fixation and preserved periprosthetic bone. We retrospectively reviewed all 102 prospectively followed patients (106 implants) with this implant to document the longer-term implant survivorship, clinical function, fixation quality, and periprosthetic bone preservation. Ninety-seven patients with 101 implants had current followup or were followed to patient death (range, 1–14 years; average, 10 years). Eighty-six living patients were followed for an average implant survivorship of 10 years. There were no known femoral implant removals. The average Harris hip score at 10-year followup was 98. Radiographs demonstrated secure implant fixation and maintenance of periprosthetic bone. These data suggest this implant design provided long-term function characterized by extensive fixation, structural durability, and radiographic appearance of maintained periprosthetic cortical thickness and density.

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


Slip Capital Femoral Epiphysis Periprosthetic Bone Structural Durability Distal Stem Investigational Device Exemption 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Kimberly J. Rowe and Daniel Reyner, PhD, for their assistance in this study.


  1. 1.
    Adam F, Hammer DS, Pfautsch S, Westermann K. Early failure of a press-fit carbon fiber hip prosthesis with a smooth surface. J Arthroplasty. 2002;17:217–223.CrossRefPubMedGoogle Scholar
  2. 2.
    Akhavan S, Matthiesen MM, Schulte L, Penoyar T, Kraay MJ, Rimnac CM, Goldberg VM. Clinical and histologic results related to a low-modulus composite total hip replacement stem. J Bone Joint Surg Am. 2006;88:1308–1314.CrossRefPubMedGoogle Scholar
  3. 3.
    Bargmann LS, Bargmann BC, Collier JP, Currier BH, Mayor MB. Current sterilization and packaging methods for polyethylene. Clin Orthop Relat Res. 1999;369:49–58.CrossRefPubMedGoogle Scholar
  4. 4.
    Brown TE, Larson B, Shen F, Moskal JT. Thigh pain after cementless total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2002;10:385–392.PubMedGoogle Scholar
  5. 5.
    Cheal EJ, Spector M, Hayes WC. Role of loads and prosthesis material properties on the mechanics of the proximal femur after total hip arthroplasty. J Orthop Res. 1992;10:405–422.CrossRefPubMedGoogle Scholar
  6. 6.
    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.PubMedGoogle Scholar
  7. 7.
    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.PubMedGoogle Scholar
  8. 8.
    Faris PM, Ritter MA, Pierce AL, Davis KE, Faris GW. Polyethylene sterilization and production affects wear in total hip arthroplasties. Clin Orthop Relat Res. 2006;453:305–308.CrossRefPubMedGoogle Scholar
  9. 9.
    Glassman AH, Bobyn JD, Tanzer M. New femoral designs: do they influence stress shielding? Clin Orthop Relat Res. 2006;453:64–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Glassman AH, Crowninshield RD, Schenck R, Herberts P. A low stiffness composite biologically fixed prosthesis. Clin Orthop Relat Res. 2001;393:128–136.CrossRefPubMedGoogle Scholar
  11. 11.
    Kärrholm J, Anderber C, Snorrason F, Thanner J, Langeland N, Malchau H, Herberts P. Evaluation of a femoral stem with reduced stiffness: a randomized study with use of radiostereometry and bone densitometry. J Bone Joint Surg Am. 2002;84:1651–1658.PubMedGoogle Scholar
  12. 12.
    Katoozian H, Davy DT, Arshi A, Saadati U. Material optimization of femoral component of total hip prosthesis using fiber reinforced polymeric composites. Med Eng Phys. 2001;23:503–509.CrossRefPubMedGoogle Scholar
  13. 13.
    Li C, Granger C, Del Schutte H Jr, Biggers SB Jr, Kennedy JM, Latour RA Jr. Progressive failure analysis of laminated composite femoral prostheses for total hip arthroplasty. Biomaterials. 2002;23:4249–4262.CrossRefPubMedGoogle Scholar
  14. 14.
    Maathuis PG, Visser JD. High failure rate of soft-interface stem coating for fixation of femoral endoprostheses. J Arthroplasty. 1996;11:548–552.CrossRefPubMedGoogle Scholar
  15. 15.
    McAuley JP, Sychterz CJ, Engh CA. Influence of porous coating level on proximal femoral remodeling. Clin Orthop Relat Res. 2000;371:146–153.CrossRefPubMedGoogle Scholar
  16. 16.
    Morscher EW, Dick W. Cementless fixation of “isoelastic” hip endoprostheses manufactured from plastic materials. Clin Orthop Relat Res. 1983;176:77–87.PubMedGoogle Scholar
  17. 17.
    Mukherjee DP, Saha S. The application of new composite materials for total joint arthroplasty. J Long Term Eff Med Implants. 1993;3:131–141.PubMedGoogle Scholar
  18. 18.
    Otani T, Whiteside LA, White SE. Strain distribution in the proximal femur with flexible composite and metallic femoral components under axial and torsional loads. J Biomed Mater Res. 1993;27:575–585.CrossRefPubMedGoogle Scholar
  19. 19.
    Ritter MA, Keating EM, Faris PM. A porous polyethylene-coated femoral component of a total hip arthroplasty. J Arthroplasty. 1990;5:83–88.CrossRefPubMedGoogle Scholar
  20. 20.
    Runne WC, Van Sambeek KJ, Stierum JL, van Tongerloo RB. Femoral endoprosthesis fixation with a soft, flexible low modulus stem coating (four- to six-year clinical results). Orthopedics. 1989;12:529–535.PubMedGoogle Scholar
  21. 21.
    Skinner HB. Composite technology for total hip arthroplasty. Clin Orthop Relat Res. 1988;235:224–236.PubMedGoogle Scholar
  22. 22.
    Skinner HB. Isoelasticity and total hip arthroplasty. Orthopedics. 1991;14:323–328.PubMedGoogle Scholar
  23. 23.
    Sychterz CJ, Engh CA. The influence of clinical factors on periprosthetic bone remolding. Clin Orthop Relat Res. 1996;322:285–292.CrossRefPubMedGoogle Scholar
  24. 24.
    Sychterz CJ, Orishimo KF, Engh CA. Sterilization and polyethylene wear: clinical studies to support laboratory data. J Bone Joint Surg Am. 2004;86:1017–1022.PubMedGoogle Scholar
  25. 25.
    Trebse R, Milosev I, Kovac S, Mikek M, Pisot V. Poor results from the isoelastic total hip replacement: 14-17-year follow-up of 149 cementless prostheses. Acta Orthop. 2005;76:169–176.CrossRefPubMedGoogle Scholar
  26. 26.
    Turner AW, Gillies RM, Sekel R, Morris P, Bruce W, Walsh WR. Computational bone remodelling simulations and comparisons with DEXA results. J Orthop Res. 2004;23:705–712.CrossRefGoogle Scholar
  27. 27.
    Volz RG, Benjamin JB. The current status of total joint replacement. Invest Radiol. 1990;25:86–92.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Mark A. Hartzband
    • 1
  • Andrew H. Glassman
    • 2
  • Victor M. Goldberg
    • 3
  • Louis R. Jordan
    • 4
  • Roy D. Crowninshield
    • 5
  • Kevin B. Fricka
    • 6
  • Louis C. Jordan
    • 4
  1. 1.Hartzband Center for Hip and Knee ReplacementParamusUSA
  2. 2.Orthopaedic Surgery DepartmentThe Ohio State UniversityColumbusUSA
  3. 3.Orthopaedic Surgery DepartmentCase Western UniversityClevelandUSA
  4. 4.Jordan-Young InstituteVirginia BeachUSA
  5. 5.40 Windcliff DriveAshevilleUSA
  6. 6.Anderson Orthopaedic ClinicAlexandraUSA

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