Femoral Bone Is Preserved Using Cemented Polished Stems in Young Patients
Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery.
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.
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.
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%).
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.
- 2.Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide, Australia: Australian Orthopaedic Association; 2010.Google Scholar
- 7.Duncan CP, Masri BA. Fractures of the femur after hip replacement. Inst Course Lect. 1995;44:293–304.Google Scholar
- 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