Clinical Orthopaedics and Related Research®

, Volume 470, Issue 11, pp 3024–3031 | Cite as

Femoral Bone Is Preserved Using Cemented Polished Stems in Young Patients

  • Donald W. Howie
  • Kerry Costi
  • Margaret A. McGee
  • Angela Standen
  • Lucian B. Solomon
Symposium: Papers Presented at the 2011 Meeting of the International Hip Society

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.

References

  1. 1.
    Aribindi R, Barba M, Solomon MI, Arp P, Paprosky W. Bypass fixation. Orthop Clin North Am. 1998;29:319–329.PubMedCrossRefGoogle Scholar
  2. 2.
    Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide, Australia: Australian Orthopaedic Association; 2010.Google Scholar
  3. 3.
    Burston BJ, Yates PJ, Hook S, Moulder E, Whitley E, Bannister GC. Cemented polished tapered stems in patients less than 50 years of age: a minimum 10-year follow-up. J Arthroplasty. 2010;25:692–699.PubMedCrossRefGoogle Scholar
  4. 4.
    Camberlin C, Vrjens F, De Guaquier K, Devriese S, Van de Sande S. Provider volume and short-term complications after elective total hip replacement: an analysis of Belgian administrative data. Acta Orthop Belg. 2011;77:311–319.PubMedGoogle Scholar
  5. 5.
    Carrington NC, Sierra RJ, Gie GA, Hubble MJ, Timperley AJ, Howell JR. The Exeter Universal cemented femoral component at 15 to 17 years: an update on the first 325 hips. J Bone Joint Surg Br. 2009;91:730–737.PubMedCrossRefGoogle Scholar
  6. 6.
    de Kam DC, Klarenbeek RL, Gardeniers JW, Veth RP, Schreurs BW. The medium-term results of the cemented Exeter femoral component in patients under 40 years of age. J Bone Joint Surg Br. 2008;90:1417–1421.PubMedCrossRefGoogle Scholar
  7. 7.
    Duncan CP, Masri BA. Fractures of the femur after hip replacement. Inst Course Lect. 1995;44:293–304.Google Scholar
  8. 8.
    Duncan WW, Hubble MJ, Howell JR, Whitehouse SL, Timperley AJ, Gie GA. Revision of the cemented femoral stem using a cement-in-cement technique: a five- to 15-year review. J Bone Joint Surg Br. 2009;91:577–582.PubMedCrossRefGoogle Scholar
  9. 9.
    Engelbrecht E, Heinert K. Klassifikation und Behandlungsrichtlinien von Knochensubstanzverlusten bei Revisionsoperationen am Hüftgelenk: mittelfristige Ergebnisse. In: Arcq M, ed. Primär- und Revisions-Alloarthroplastik Hüft- und Kniegelenk: 10 Jahre Endo-Klinik Hamburg. Berlin, Germany: Springer-Verlag; 1987:189–201.CrossRefGoogle Scholar
  10. 10.
    Franklin J, Robertsson O, Gestsson J, Lohmander LS, Ingvarsson T. Revision and complication rates in 654 Exeter total hip replacements, with a maximum follow-up of 20 years. BMC Musculoskelet Disord. 2003;4:1–5.CrossRefGoogle Scholar
  11. 11.
    Friesecke C, Plutat J, Block A. Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg Am. 2005;87:2693–2701.PubMedCrossRefGoogle Scholar
  12. 12.
    Goetz DD, Smith EJ, Harris WH. The prevalence of femoral osteolysis associated with components inserted with or without cement in total hip replacements: a retrospective matched-pair series. J Bone Joint Surg Am. 1994;76:1121–1129.PubMedGoogle Scholar
  13. 13.
    Goldring SR, Jasty M, Roelke MS, Rourke CM, Bringhurst FR, Harris WH. Reaction of bone to methacrylate after hip arthroplasty: a long-term gross, light microscopic, and scanning electron microscopic study. Arthritis Rheum. 1986;29:836–842.PubMedCrossRefGoogle Scholar
  14. 14.
    Gruen TA, McNiece GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.PubMedGoogle Scholar
  15. 15.
    Harris WH, McCarthy JC, O’Neil DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg Am. 1982;64:1063–1067.PubMedGoogle Scholar
  16. 16.
    Hook S, Moulder E, Yates PJ, Burston BJ, Whitley E, Bannister GC. The Exeter Universal stem: a minimum ten-year review from an independent centre. J Bone Joint Surg Br. 2006;88:1584–1590.PubMedCrossRefGoogle Scholar
  17. 17.
    Howie DW, Callary SA, McGee MA, Russell NC, Solomon LB. Reduced femoral component subsidence with improved impaction grafting at revision hip arthroplasty. Clin Orthop Relat Res. 2010;468:3314–3321.PubMedCrossRefGoogle Scholar
  18. 18.
    Hultmark P, Kärrholm J, Strömberg C, Herberts P, Möse CH, Malchau H. Cemented first-time revisions of the femoral component: prospective 7 to 13 years’ follow-up using second-generation and third-generation technique. J Arthroplasty. 2000;15:551–561.PubMedCrossRefGoogle Scholar
  19. 19.
    Jones LC, Hungerford DS. Cement disease. Clin Orthop Relat Res. 1987;225:192–206.PubMedGoogle Scholar
  20. 20.
    Lerch M, von Lewinski G, Windhagen H, Thorey F. Revision of total hip arthroplasty: clinical outcome of extended trochanteric osteotomy and intraoperative femoral fracture. Technol Health Care. 2008;16:293–300.PubMedGoogle Scholar
  21. 21.
    Lewthwaite SC, Squires B, Gie GA, Timperley AJ, Ling RS. The Exeter Universal hip in patients 50 years or younger at 10–17 years’ followup. Clin Orthop Relat Res. 2008;466:324–331.PubMedCrossRefGoogle Scholar
  22. 22.
    Ling RS, Charity J, Lee AJ, Whitehouse SL, Timperley AJ, Gie GA. The long-term results of the original Exeter polished cemented femoral component: a follow-up report. J Arthroplasty. 2009;24:511–517.PubMedCrossRefGoogle Scholar
  23. 23.
    Lombardi AV Jr, Berend KR. The shattered femur: radical solution options. J Arthroplasty. 2006;21(4 suppl 1):107–111.PubMedCrossRefGoogle Scholar
  24. 24.
    Losina E, Barrett J, Mahomed NN, Baron JA, Katz JN. Early failures of total hip replacement: effect of surgeon volume. Arthritis Rheum. 2004;50:1338–1343.PubMedCrossRefGoogle Scholar
  25. 25.
    Malchau H, Kärrholm J, Wang YX, Herberts P. Accuracy of migration analysis in hip arthroplasty: digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand. 1995;66:418–424.PubMedCrossRefGoogle Scholar
  26. 26.
    Maloney WJ, Galante JO, Anderson M, Goldberg V, Harris WH, Jacobs J, Kraay M, Lachiewicz P, Rubash HE, Schutzer S, Woolson ST. Fixation, polyethylene wear, and pelvic osteolysis in primary total hip replacement. Clin Orthop Relat Res. 1999;369:157–164.PubMedCrossRefGoogle Scholar
  27. 27.
    Mandziak DG, Howie DW, Neale SD, McGee MA. Cement-within-cement stem exchange using the collarless polished double-taper stem. J Arthroplasty. 2007;22:1000–1006.PubMedCrossRefGoogle Scholar
  28. 28.
    Mardones R, Gonzalez C, Cabanela ME, Trousdale RT, Berry DJ. Extended femoral osteotomy for revision of hip arthroplasty: results and complications. J Arthroplasty. 2005;20:79–83.PubMedCrossRefGoogle Scholar
  29. 29.
    Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51:428–436.PubMedGoogle Scholar
  30. 30.
    Sarmiento A, Ebramzadeh E, Gogan WJ, McKellop HA. Total hip arthroplasty with cement: a long-term radiographic analysis in patients who are older than fifty and younger than fifty years. J Bone Joint Surg Am. 1990;72:1470–1476.PubMedGoogle Scholar
  31. 31.
    Schmidt J, Porsch M, Sulk C, Hillekamp J, Schneider T. Removal of well-fixed or porous-coated cementless stems in total hip revision arthroplasty. Arch Orthop Trauma Surg. 2002;122:48–50.PubMedGoogle Scholar
  32. 32.
    Simon JP, Robbens E, Maes M, Bellemans J. Single-stage bilateral total hip arthroplasty in patients less than 35 years: forty arthroplasties with 5–17 years follow-up. Acta Orthop Belg. 2009;75:189–199.PubMedGoogle Scholar
  33. 33.
    Springer BD, Connelly SE, Odum SM, Fehring TK, Griffin WL, Mason JB, Masonis JL. Cementless femoral components in young patients: review and meta-analysis of total hip arthroplasty and hip resurfacing. J Arthroplasty. 2009;24(6 suppl):2–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Springer BD, Fehring TK, Griffin WL, Odum SM, Masonis JL. Why revision total hip arthroplasty fails. Clin Orthop Relat Res. 2009;467:166–173.PubMedCrossRefGoogle Scholar
  35. 35.
    Williams HD, Browne G, Gie GA, Ling RS, Timperley AJ, Wendover NA. The Exeter Universal cemented femoral component at 8 to 12 years: a study of the first 325 hips. J Bone Joint Surg Br. 2002;84:324–334.PubMedCrossRefGoogle Scholar
  36. 36.
    Yates PJ, Burston BJ, Whitley E, Bannister GC. Collarless polished tapered stem: clinical and radiological results at a minimum of ten years’ follow-up. J Bone Joint Surg Br. 2008;90:16–22.PubMedGoogle Scholar
  37. 37.
    Young L, Duckett S, Dunn A. The use of the cemented Exeter Universal femoral stem in a district general hospital: a minimum ten-year follow-up. J Bone Joint Surg Br. 2009;91:170–175.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Donald W. Howie
    • 1
    • 2
  • Kerry Costi
    • 1
  • Margaret A. McGee
    • 1
    • 2
  • Angela Standen
    • 1
  • Lucian B. Solomon
    • 1
    • 2
  1. 1.Department of Orthopaedics and TraumaRoyal Adelaide HospitalAdelaideAustralia
  2. 2.Discipline of Orthopaedics and Trauma, School of MedicineUniversity of AdelaideAdelaideAustralia

Personalised recommendations