Comparison of Clinical Outcomes in Total Hip Arthroplasty Using Rough and Polished Cemented Stems with Essentially the Same Geometry

Background: Aseptic loosening of the cemented stem is the most common cause of revision of total hip arthroplasties. The loosening is often associated with substantial lysis of the surrounding bone. The surface finish of femoral components is suspected as a contributing factor to this bone lysis. The purpose of this study was to compare the results associated with a rough surface and those associated with a polished surface in a consecutive series of cemented stems with essentially the same geometry. Methods: The study included 244 consecutive total hip arthroplasties with a cemented femoral component performed by one surgeon. There was no difference in patient selection criteria or surgical techniques between the group treated with a polished stem and that treated with a grit-blasted stem. All arthroplasties were hybrid, with an uncemented acetabular component. Generally, patients were over the age of sixty years (mean age, 70.6 years). The stems inserted in the initial 122 hips had a grit-blasted surface with a roughness of 2.1 mm. The stem surface in the second 122 hips was polished (roughness, 0.1 mm). The results of clinical and radiographic assessments performed immediately after surgery were compared with those performed at the most recent visit. The average duration of clinical follow-up for the patients treated with the grit-blasted and polished stems was 5.98 years and 5.32 years, respectively. Results: Four hips treated with the grit-blasted stem had aseptic loosening with substantial surrounding lysis and required revision. An additional two hips in this group had radiographic evidence of substantial lysis and were judged to have an impending need for revision. In contrast, no hip treated with the polished stem required revision, and only one had minimal lysis. This difference regarding failures and impending failures was significant (p = 0.05). The clinical results were comparable, with an Iowa hip rating of 98 points at the time of follow-up in both groups. Conclusions: There was a significant difference between grit-blasted and polished stems with respect to the prevalence of revisions and impending revisions, all of which were identified in a relatively short follow-up period. The results in this series favor the use of a polished stem when cement is employed for fixation of the femoral component.

[1]  A. J. Lee,et al.  Experience with the Exeter total hip replacement since 1970. , 1988, The Orthopedic clinics of North America.

[2]  R C Johnston,et al.  The outcome of Charnley total hip arthroplasty with cement after a minimum twenty-year follow-up. The results of one surgeon. , 1993, The Journal of bone and joint surgery. American volume.

[3]  I A Trail,et al.  Long-term results of Charnley low-friction arthroplasty in young patients. , 1993, The Journal of bone and joint surgery. British volume.

[4]  J. Galante,et al.  Hybrid Total Hip Arthroplasty with a Precoated Offset Stem: Four to Nine-Year Results* , 2000, The Journal of bone and joint surgery. American volume.

[5]  D. Hungerford,et al.  Long-term (twelve to eighteen-year) follow-up of cemented total hip replacements in patients who were less than fifty years old. A follow-up note. , 1992, The Journal of bone and joint surgery. American volume.

[6]  B. Wroblewski.  15–21‐year Results of the Charnley Low‐friction Arthroplasty , 1986, Clinical orthopaedics and related research.

[7]  M. B. Coventry,et al.  Charnley low-friction arthroplasty of the hip. Twenty-year results with cement. , 1994, The Journal of arthroplasty.

[8]  R. Betz,et al.  A syndrome of dislocated hips and radial heads, carpal coalition, and short stature in Puerto Rican children. , 1993, The Journal of bone and joint surgery. American volume.

[9]  J. Charnley,et al.  Subsidence of the femoral prosthesis in total hip replacement in relation to the design of the stem. , 1980, The Journal of bone and joint surgery. British volume.

[10]  J. Galante,et al.  Total hip replacement with insertion of an acetabular component without cement and a femoral component with cement. Four to seven-year results. , 1995, The Journal of bone and joint surgery. American volume.

[11]  J. Kaufman.  Charnley total hip arthroplasty in patients less than fifty years old. A twenty to twenty-five-year follow-up note. , 1999, The Journal of bone and joint surgery. American volume.

[12]  W H Harris,et al.  Proximal strain distribution in the loaded femur. An in vitro comparison of the distributions in the intact femur and after insertion of different hip-replacement femoral components. , 1978, The Journal of bone and joint surgery. American volume.

[13]  J. Callaghan,et al.  Early loosening of the femoral component at the cement-prosthesis interface after total hip replacement. , 1995, The Journal of bone and joint surgery. American volume.

[14]  C. Ranawat,et al.  Survivorship analysis of total hip replacements. Results in a series of active patients who were less than fifty-five years old. , 1986, The Journal of bone and joint surgery. American volume.

[15]  P. Rockborn,et al.  Loosening and bone resorption in exeter hip arthroplasties. Review at a minimum of five years. , 1993, The Journal of bone and joint surgery. British volume.

[16]  R. Barrack,et al.  Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review. , 1992, The Journal of bone and joint surgery. British volume.

[17]  E. Will,et al.  Dropped hallux after the intramedullary nailing of tibial fractures. , 1999, The Journal of bone and joint surgery. British volume.

[18]  John Charnley,et al.  Low Friction Arthroplasty of the Hip: Theory and Practice , 1978 .

[19]  E. Ippolito,et al.  Post-traumatic cubitus varus. Long-term follow-up of corrective supracondylar humeral osteotomy in children. , 1990, The Journal of bone and joint surgery. American volume.

[20]  H. Amstutz,et al.  "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. , 1979, Clinical orthopaedics and related research.

[21]  Long-term results of an individual surgeon. , 1988, The Orthopedic clinics of North America.

[22]  R C Johnston,et al.  The effects of surface roughness and polymethylmethacrylate precoating on the radiographic and clinical results of the Iowa hip prosthesis. A study of patients less than fifty years old. , 1999, The Journal of bone and joint surgery. American volume.

[23]  M. Simon,et al.  Biopsy of bone and soft-tissue lesions. , 1993, Instructional course lectures.

[24]  R. Crowninshield,et al.  An analysis of femoral component stem design in total hip arthroplasty. , 1980, The Journal of bone and joint surgery. American volume.

[25]  W. Harris,et al.  Total Hip Arthroplasty with Use of Second-Generation Cementing Techniques. An Eighteen-Year-Average Follow-up Study* , 1998, The Journal of bone and joint surgery. American volume.

[26]  D. Collis,et al.  Loosening Rates and Bone Lysis With Rough Finished and Polished Stems , 1998, Clinical orthopaedics and related research.

[27]  W H Harris,et al.  Centrifugation as a method of improving tensile and fatigue properties of acrylic bone cement. , 1984, The Journal of bone and joint surgery. American volume.

[28]  Collis Dk.  Long-term results of an individual surgeon. , 1988 .

[29]  D. Collis.  The value of maintaining outcomes in an individual practice for 25 years. , 1997, Clinical orthopaedics and related research.

[30]  K E Marks,et al.  A ten-year follow-up of one hundred consecutive Müller curved-stem total hip-replacement arthroplasties. , 1982, The Journal of bone and joint surgery. American volume.

[31]  J. Charnley,et al.  The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. , 1972, The Journal of bone and joint surgery. British volume.

[32]  R. Grelsamer.  The results of improved cementing techniques for total hip arthroplasty in patients less than fifty years old. A ten-year follow-up study. , 1995, The Journal of bone and joint surgery. American volume.

[33]  J. Callaghan,et al.  Total hip arthroplasty in the young adult. , 1997, Clinical orthopaedics and related research.

[34]  C. Larson.  Rating Scale for Hip Disabilities , 1963, Clinical orthopaedics and related research.

[35]  I. Learmonth,et al.  Fracture and loosening of Charnley femoral stems. Comparison between first-generation and subsequent designs. , 1993, The Journal of bone and joint surgery. British volume.

[36]  W H Harris,et al.  The effect of improved cementing techniques on component loosening in total hip replacement. An 11-year radiographic review. , 1990, The Journal of bone and joint surgery. British volume.

[37]  W. Harris,et al.  Loosening of the femoral component after use of the medullary-plug cementing technique. Follow-up note with a minimum five-year follow-up. , 1986, The Journal of bone and joint surgery. American volume.