Primary total hip arthroplasty with a proximally porous-coated femoral stem.

BACKGROUND The use of cementless, proximally porous-coated femoral stems for total hip arthroplasty has increased in popularity. The purpose of the present report was to examine the five to ten-year results associated with the use of a so-called second-generation circumferentially proximally porous-coated titanium-alloy stem. METHODS Between 1991 and 1994, 123 Harris-Galante Multilock femoral stems were implanted in 101 patients. The average age of the patients at the time of surgery was 53.8 years. The patients were followed prospectively and were reevaluated at a minimum of five years postoperatively. No patient was lost to follow-up. Twenty-five patients (thirty hips) were interviewed by telephone, and four patients (five hips) died during the study period because of problems that were unrelated to the operation. The remaining seventy-two patients (eighty-eight hips) had a minimum of five years of clinical and radiographic follow-up. RESULTS The average duration of follow-up was seventy-eight months. At the time of the most recent follow-up, the average Harris Hip Score was 95 points. Eighty-seven (99%) of eighty-eight stems were biologically stable, with eighty-four hips (95%) having osseous ingrowth and three hips (3%) having stable fibrous fixation. One stem was revised because of loosening. Thirty-three hips (38%) had minimal proximal osteolysis, and no hip had diaphyseal osteolysis. Seventy-two hips (82%) had some degree of stress-shielding in the proximal metaphysis, but only two hips had cortical resorption. None of these patients required additional surgery, and all reported a satisfactory outcome. CONCLUSIONS Given the young age and high activity level of these patients, this stem fared well: the levels of patient function and satisfaction were high, the rates of loosening and revision were very low, and distal osteolysis did not occur. Osseous fixation occurred reliably. Proximal stress-shielding was seen but did not seem to be clinically important.

[1]  W. Hozack,et al.  Minimum 10-year results of a tapered cementless hip replacement. , 1999, Clinical orthopaedics and related research.

[2]  I. Clarke,et al.  Porous ingrowth fixation of the femoral component in a canine surface replacement of the hip. , 1982, Clinical orthopaedics and related research.

[3]  D. Hungerford,et al.  Two-year follow-up of the PCA noncemented total hip replacement. , 1987, The Hip.

[4]  R. N. Stauffer.  Ten-year follow-up study of total hip replacement. , 1982, The Journal of bone and joint surgery. American volume.

[5]  J. Callaghan,et al.  The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up. , 1999, The Journal of bone and joint surgery. American volume.

[6]  D G Altman,et al.  Survival probabilities (the Kaplan-Meier method) , 1998, BMJ.

[7]  Total hip arthroplasty with the porous-coated anatomic (PCA) prosthesis: the femoral component. , 1993, Acta orthopaedica Belgica.

[8]  James J. Patterson,et al.  Tapered Titanium Cementless Total Hip Replacements: A 10-to 13-Year Followup Study , 2001, Clinical orthopaedics and related research.

[9]  L. Dorr,et al.  Radiographic anatomic structure of the arthritic acetabulum and its influence on total hip arthroplasty. , 2000, The Journal of arthroplasty.

[10]  C. Engh,et al.  Cementless total hip arthroplasty using the anatomic medullary locking stem. Results using a survivorship analysis. , 1989, Clinical orthopaedics and related research.

[11]  C. Engh,et al.  The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. , 1988, Clinical orthopaedics and related research.

[12]  B. Love.  A femoral component inserted without cement in total hip arthroplasty. A study of the Tri-Lock component with an average ten-year duration of follow-up. , 1999, The Journal of bone and joint surgery. American volume.

[13]  P. D. Wilson,et al.  A ten-year follow-up study of our first one hundred consecutive Charnley total hip replacements. , 1981, The Journal of bone and joint surgery. American volume.

[14]  Engh Ca,et al.  The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. , 1988 .

[15]  C. Engh,et al.  Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. , 1990, Clinical orthopaedics and related research.

[16]  G. Macalino,et al.  Porous-coated total hip replacement. , 1994, Clinical orthopaedics and related research.

[17]  W. Harris,et al.  The Harris-Galante uncemented femoral component in primary total hip replacement at 10 years. , 1999, The Journal of arthroplasty.

[18]  W. Harris,et al.  Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. , 1969, The Journal of bone and joint surgery. American volume.

[19]  J O Galante,et al.  Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results , 2001, The Journal of bone and joint surgery. American volume.

[20]  K. Hardinge.  The direct lateral approach to the hip. , 1982, The Journal of bone and joint surgery. British volume.

[21]  L. Riley,et al.  Ectopic ossification following total hip replacement. Incidence and a method of classification. , 1973, The Journal of bone and joint surgery. American volume.

[22]  N. S. Murthy,et al.  Survival analysis: caveats and pitfalls. , 1999, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[23]  M. Pagano,et al.  Survival analysis. , 1996, Nutrition.

[24]  R. Pilliar,et al.  Biologic fixation and bone modeling with an unconstrained canine total knee prosthesis. , 1982, Clinical orthopaedics and related research.

[25]  W. Harris,et al.  The prevalence of femoral osteolysis associated with components inserted with or without cement in total hip replacements. A retrospective matched-pair series. , 1994, The Journal of bone and joint surgery. American volume.

[26]  Y. Kim,et al.  Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. , 1993, The Journal of bone and joint surgery. British volume.

[27]  David Feeny,et al.  Comparison of Total Hip Arthroplasty Performed with and without Cement: A Randomized Trial , 2002, The Journal of bone and joint surgery. American volume.

[28]  L. Dorr,et al.  The effect of diaphyseal biologic fixation on clinical results and fixation of the APR-II stem. , 2000, The Journal of arthroplasty.

[29]  B. Persson,et al.  Revision of total hip replacement for primary osteoarthritis. , 1988, The Journal of bone and joint surgery. British volume.

[30]  L. Dorr,et al.  Failure mechanisms of anatomic porous replacement I cementless total hip replacement. , 1997, Clinical orthopaedics and related research.

[31]  M J Dunbar,et al.  The Porous Coated Anatomic Total Hip Replacement: A Ten to Fourteen-Year Follow-up Study of a Cementless Total Hip Arthroplasty , 2001, The Journal of bone and joint surgery. American volume.

[32]  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.

[33]  D.,et al.  Regression Models and Life-Tables , 2022 .

[34]  R. Crowninshield,et al.  Roentgenologic results of total hip arthroplasty. A ten-year follow-up study. , 1983, Clinical orthopaedics and related research.

[35]  T M Turner,et al.  A canine cementless total hip prosthesis model. , 1983, Clinical orthopaedics and related research.

[36]  J. McLaughlin,et al.  Total hip arthroplasty with an uncemented femoral component. Excellent results at ten-year follow-up. , 1997, The Journal of bone and joint surgery. British volume.

[37]  R Poss,et al.  Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. , 1990, The Journal of bone and joint surgery. American volume.

[38]  L. Ryd,et al.  Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from The Swedish Knee Arthroplasty Registry. , 2001, The Journal of bone and joint surgery. British volume.

[39]  J O Galante,et al.  Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. , 1993, The Journal of bone and joint surgery. American volume.

[40]  S. S. Hughes,et al.  A collarless cobalt-chrome femoral component in uncemented total hip arthroplasty. Five- to eight-year follow-up. , 1992, The Journal of bone and joint surgery. British volume.

[41]  A C Campbell,et al.  Thigh pain after cementless hip arthroplasty. Annoyance or ill omen. , 1992, The Journal of bone and joint surgery. British volume.

[42]  C. Engh,et al.  Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. , 1987, The Journal of bone and joint surgery. British volume.

[43]  J J Callaghan,et al.  The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. , 1988, The Journal of bone and joint surgery. American volume.

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