Skip to main content
SpringerLink
Log in

Preliminary outcomes of the cementless UNITED hip system for primary total hip arthroplasty at a minimum 2-year follow-up

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years.

Methods

We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015–2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated defining failure as the need for any further femoral or acetabular revision, irrespective of the reason.

Results

No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively.

Conclusion

This cementless design showed excellent preliminary outcomes in terms of fixation and patient satisfaction, comparable to that of other well-known similar systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

Not applicable.

Code availability

All analyses were performed using Stata 13™ statistical software (StataCorp, College Station, TX).

Abbreviations

THA:

Total hip arthroplasty

HA:

Hydroxyapatite

ASA:

The American Society of Anaesthesiologists

MDA:

Merle D'Aubigné score

VAS:

Visual analogue scale

AP:

Anteroposterior

L:

Lateral

OR:

Odds ratios

CI:

Confidence intervals

EBRA-FCA:

Ein Bild Roentgen Analyse-femoral component analysis

PFF:

Periprosthetic femoral fractures

PTC:

Porous titanium-coated

PS:

Plasma-sprayed

IPI:

Iliopsoas impingement

References

  1. Evans JT, Evans JP, Walker RW et al (2019) How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 393(10172):647–654. https://doi.org/10.1016/S0140-6736(18)31665-9

    Article  PubMed  PubMed Central  Google Scholar 

  2. ODEP product ratings. Orthopaedic Data Evaluation Panel. Available at: URL:http://www.odep.org.uk/; 2017. [Internet].

  3. Streit MR, Lehner B, Peitgen DS et al (2020) What is the long-term (27- to 32-year) survivorship of an uncemented tapered titanium femoral component and survival in patients younger than 50 years? Clin Orthop Relat Res 478(6):1283–1291. https://doi.org/10.1097/CORR.0000000000001203

    Article  PubMed  PubMed Central  Google Scholar 

  4. McLaughlin JR, Lee KR (2016) Total hip arthroplasty with an uncemented tapered femoral component in patients younger than 50 years of age: a minimum 20-year follow-up study. J Arthroplasty 31(6):1275–1278. https://doi.org/10.1016/j.arth.2015.12.026

    Article  PubMed  Google Scholar 

  5. Cruz-Pardos A, García-Rey E, García-Cimbrelo E (2017) Total hip arthroplasty with use of the cementless Zweymüller Alloclassic System: a concise follow-up, at a minimum of 25 years, of a previous report. J Bone Joint Surg Am 99(22):1927–1931. https://doi.org/10.2106/JBJS.16.01109

    Article  PubMed  Google Scholar 

  6. Jacquot L, Bonnin MP, Machenaud A et al (2018) Clinical and radiographic outcomes at 25–30 years of a hip stem fully coated with hydroxylapatite. J Arthroplasty 33(2):482–490. https://doi.org/10.1016/j.arth.2017.09.040

    Article  PubMed  Google Scholar 

  7. Salvati EA, Sharrock NE, Westrich G et al (2007) The 2007 ABJS Nicolas Andry Award: three decades of clinical, basic, and applied research on thromboembolic disease after THA: rationale and clinical results of a multimodal prophylaxis protocol. Clin Orthop Relat Res 459:246–254. https://doi.org/10.1097/BLO.0b013e31805b7681

    Article  PubMed  Google Scholar 

  8. Dripps RD (1963) New classification of physical status. Anesthesiol 24:111

    Google Scholar 

  9. Dorr LD, Faugere MC, Mackel AM et al (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14(3):231–242. https://doi.org/10.1016/8756-3282(93)90146-2

    Article  CAS  PubMed  Google Scholar 

  10. Khanuja HS, Vakil JJ, Goddard MS, Mont MA (2011) Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am 93(5):500–509. https://doi.org/10.2106/JBJS.J.00774

    Article  PubMed  Google Scholar 

  11. D’Aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36-A(3):451–475

    Article  PubMed  Google Scholar 

  12. Gruen TA, McNeice GM, Amstutz HC (1979) Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27

    Google Scholar 

  13. DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32

    Google Scholar 

  14. Loudon JR, Charnley J (1980) Subsidence of the femoral prosthesis in total hip replacement in relation to the design of the stem. J Bone Joint Surg Br 62-B(4):450–453

    Article  CAS  PubMed  Google Scholar 

  15. Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 257:107–128

    Article  Google Scholar 

  16. Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–1632

    Article  CAS  PubMed  Google Scholar 

  17. White CA, Carsen S, Rasuli K et al (2012) High incidence of migration with poor initial fixation of the Accolade stem. Clin Orthop Relat Res 470(2):410–417. https://doi.org/10.1007/s11999-011-2160-z

    Article  PubMed  Google Scholar 

  18. Boylan MR, Riesgo AM, Paulino CB et al (2018) Mortality following periprosthetic proximal femoral fractures versus native hip fractures. J Bone Joint Surg Am 100(7):578–585. https://doi.org/10.2106/JBJS.17.00539

    Article  PubMed  Google Scholar 

  19. Carli AV, Negus JJ, Haddad FS (2017) Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Joint J 99-B((1 Supple A)):50–59. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0220.R1

    Article  CAS  PubMed  Google Scholar 

  20. Abdel MP, Watts CD, Houdek MT et al (2016) Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J 98-B(4):461–467. https://doi.org/10.1302/0301-620X.98B4.37201

    Article  CAS  PubMed  Google Scholar 

  21. Reina RJ, Rodriguez JA, Rasquinha VJ, Ranawat CS (2007) Fixation and osteolysis in plasma-sprayed hemispherical cups with hybrid total hip arthroplasty. J Arthroplasty 22(4):531–534. https://doi.org/10.1016/j.arth.2006.11.008

    Article  PubMed  Google Scholar 

  22. Lindgren V, Galea VP, Nebergall A et al (2018) Radiographic and clinical outcomes of porous titanium-coated and plasma-sprayed acetabular shells: a five-year prospective multicenter study. J Bone Joint Surg Am 100(19):1673–1681. https://doi.org/10.2106/JBJS.17.00729

    Article  PubMed  Google Scholar 

  23. Chalmers BP, Sculco PK, Sierra RJ et al (2017) Iliopsoas impingement after primary total hip arthroplasty: operative and nonoperative treatment outcomes. J Bone Joint Surg Am 99(7):557–564. https://doi.org/10.2106/JBJS.16.00244

    Article  PubMed  Google Scholar 

  24. Ueno T, Kabata T, Kajino Y et al (2018) Risk factors and cup protrusion thresholds for symptomatic iliopsoas impingement after total hip arthroplasty: a retrospective case-control study. J Arthroplasty 33(10):3288-3296.e1. https://doi.org/10.1016/j.arth.2018.05.017

    Article  PubMed  Google Scholar 

  25. O’Sullivan M, Tai CC, Richards S et al (2007) Iliopsoas tendonitis a complication after total hip arthroplasty. J Arthroplasty 22(2):166–170. https://doi.org/10.1016/j.arth.2006.05.034

    Article  PubMed  Google Scholar 

  26. Schütz U, Decking J, Decking R, Puhl W (2005) Assessment of femoral component migration in total hip arthroplasty: digital measurements compared to RSA. Acta Orthop Belg 71(1):65–75

    PubMed  Google Scholar 

  27. Biedermann R, Krismer M, Stöckl B et al (1999) Accuracy of EBRA-FCA in the measurement of migration of femoral components of total hip replacement. Einzel-Bild-Röntgen-Analyse-femoral component analysis. J Bone Joint Surg Br 81(2):266–272. https://doi.org/10.1302/0301-620x.81b2.8842

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable/No funding was received

Funding

Not applicable/No funding was received.

Author information

Authors and Affiliations

  1. Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, 4247 Potosí St., C1199ACK, Buenos Aires, Argentina

    Fernando Díaz-Dilernia, Agustín M. García-Mansilla, Agustín Albani-Forneris, Pablo A. Slullitel, Gerardo Zanotti, Fernando Comba, Francisco Piccaluga & Martin Buttaro

Authors
  1. Fernando Díaz-Dilernia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Agustín M. García-Mansilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Agustín Albani-Forneris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pablo A. Slullitel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gerardo Zanotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fernando Comba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francisco Piccaluga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin Buttaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design, and read and approved the final manuscript. Conceptualization: Martin Buttaro. Data curation: Fernando Diaz Dilernia, Agustin Garcia-Mansilla, Agustin Albani-Forneris. Methodology: Fernando Diaz Dilernia. Formal analysis and investigation: Fernando Diaz Dilernia, Pablo Slullitel. Writing—original draft preparation: Fernando Diaz Dilernia, Agustin Garcia-Mansilla, Agustin Albani-Forneris. Writing—review and editing: Fernando Diaz Dilernia, Pablo Slullitel. Resources: Gerardo Zanotti, Fernando Comba, Francisco Piccaluga. Project administration: Gerardo Zanotti, Fernando Comba, Francisco Piccaluga. Supervision: Martin Buttaro.

Corresponding author

Correspondence to Fernando Díaz-Dilernia.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institution's Research Ethics Board (November 25th 2019/No. 5179).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Patients signed informed consent regarding publishing their data and images.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Díaz-Dilernia, F., García-Mansilla, A.M., Albani-Forneris, A. et al. Preliminary outcomes of the cementless UNITED hip system for primary total hip arthroplasty at a minimum 2-year follow-up. Eur J Orthop Surg Traumatol 32, 745–752 (2022). https://doi.org/10.1007/s00590-021-03038-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-021-03038-5

Keywords

Search

Navigation