Yonsei Med J.  2012 Jan;53(1):186-192. 10.3349/ymj.2012.53.1.186.

Long-Term Follow-Up Results of a Second-Generation Cementless Femoral Prosthesis with a Collar and Straight Distal Fixation Channels

• Han CW
• Yang IH
• Lee HY
• Han CD

• KMID: 1779705
• DOI: http://doi.org/10.3349/ymj.2012.53.1.186

Abstract

PURPOSE
We evaluated the results of more than 10 years of follow-up of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels.
MATERIALS AND METHODS
One hundred five patients (129 hips) who underwent surgery between 1991 and 1996 for primary total hip arthroplasty using cementless straight distal fluted femoral stems were followed for more than 10 years. Ninety-four hips in 80 patients were available for clinical and radiologic analysis. The mean age at the time of surgery was 47 years, and the mean duration of follow-up was 14.3 years.
RESULTS
The mean Harris hip scores had improved from 58 points to 88 points at the time of the 10-year follow-up. Activity-related thigh pain was reported in nine hips (10%). At the last follow-up, 93 stems (99%) were biologically stable and one stem (1%) was revised because of loosening. No hip had distal diaphyseal osteolysis. Proximal femoral stress-shielding was reported in 86 hips (91%). We found no significant relationship between collar-calcar contact and thigh pain, stem fixation status, or stress-shielding. The cumulative survival of the femoral stem was 99% (95% confidence interval, 98-100%) after 10 years.
CONCLUSION
The long-term results of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels were satisfactory; however, the high rate of proximal stress-shielding and the minimal effect of the collar indicate the need for some changes in the stem design.

Keyword

Total hip arthroplasty; second-generation; cementless; collar; straight distal fixation channel

MeSH Terms

Adult
Aged
Arthroplasty, Replacement, Hip/*instrumentation/*methods
Bone Cements
Female
Femoral Neck Fractures/radiography/*surgery
Femur Head Necrosis/radiography/*surgery
Follow-Up Studies
*Hip Prosthesis
Humans
Male
Middle Aged
Osteoarthritis, Hip/radiography/*surgery
Time Factors
Treatment Outcome

Figure

• 

  Fig. 1 (A) Anteroposterior and (B) lateral postoperative radiographs of the Harris-Galante Multilock femoral prosthesis.

• 

  Fig. 2 Kaplan-Meier survivorship curve, with 95% confidence intervals, showing a 99% rate of implant survival at 10 years and 97% at 15 years with revision of femoral component as the end point.

Reference

1. Salvati EA, Wilson PD Jr, Jolley MN, Vakili F, Aglietti P, Brown GC. A ten-year follow-up study of our first one hundred consecutive Charnley total hip replacements. J Bone Joint Surg Am. 1981. 63:753–767.

2. Sutherland CJ, Wilde AH, Borden LS, Marks KE. A ten-year follow-up of one hundred consecutive Muller curved-stem total hip-replacement arthroplasties. J Bone Joint Surg Am. 1982. 64:970–982.

3. Stauffer RN. Ten-year follow-up study of total hip replacement. J Bone Joint Surg Am. 1982. 64:983–990.

4. Galante JO. New developments in hip arthroplasty. Overview of current attempts to eliminate methylmethacrylate. Hip. 1983. 181–189.

5. Pilliar RM, Lee JM, Maniatopoulos C. Observations on the effect of movement on bone ingrowth into porous-surfaced implants. Clin Orthop Relat Res. 1986. 108–113.

6. Engh CA, Massin P. Cementless total hip arthroplasty using the anatomic medullary locking stem. Results using a survivorship analysis. Clin Orthop Relat Res. 1989. 141–158.

7. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987. 69:45–55.

8. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988. 7–28.

9. Pellegrini VD Jr, Hughes SS, Evarts CM. A collarless cobalt-chrome femoral component in uncemented total hip arthroplasty. Five- to eight-year follow-up. J Bone Joint Surg Br. 1992. 74:814–821.

10. Xenos JS, Callaghan JJ, Heekin RD, Hopkinson WJ, Savory CG, Moore MS. The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up. J Bone Joint Surg Am. 1999. 81:74–82.

11. Clohisy JC, Harris WH. The Harris-Galante uncemented femoral component in primary total hip replacement at 10 years. J Arthroplasty. 1999. 14:915–917.

12. Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg Am. 2001. 83-A:1333–1338.

13. Schmalzried TP, Jasty M, Harris WH. Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am. 1992. 74:849–863.

14. Kim YH, Kim VE. Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg Br. 1993. 75:6–13.

15. Sinha RK, Dungy DS, Yeon HB. Primary total hip arthroplasty with a proximally porous-coated femoral stem. J Bone Joint Surg Am. 2004. 86-A:1254–1261.

16. Lachiewicz PF, Soileau ES, Bryant P. Second-generation proximally coated titanium femoral component: minimum 7-year results. Clin Orthop Relat Res. 2007. 465:117–121.

17. Surdam JW, Archibeck MJ, Schultz SC Jr, Junick DW, White RE Jr. A second-generation cementless total hip arthroplasty mean 9-year results. J Arthroplasty. 2007. 22:204–209.

18. Harris WH. 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. J Bone Joint Surg Am. 1969. 51:737–755.

19. Meding JB, Ritter MA, Keating EM, Faris PM. Comparison of collared and collarless femoral components in primary uncemented total hip arthroplasty. J Arthroplasty. 1997. 12:273–280.

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

21. Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Muller ME, Sledge CB. Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am. 1990. 72:161–168.

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

23. Campbell AC, Rorabeck CH, Bourne RB, Chess D, Nott L. Thigh pain after cementless hip arthroplasty. Annoyance or ill omen. J Bone Joint Surg Br. 1992. 74:63–66.

24. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990. 72:518–528.

25. Min BW, Song KS, Bae KC, Cho CH, Lee KJ, Kim HJ. Second-generation cementless total hip arthroplasty in patients with osteonecrosis of the femoral head. J Arthroplasty. 2008. 23:902–910.

26. Dorr LD, Lewonowski K, Lucero M, Harris M, Wan Z. Failure mechanisms of anatomic porous replacement I cementless total hip replacement. Clin Orthop Relat Res. 1997. 157–167.

27. 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.

28. Martell JM, Pierson RH 3rd, Jacobs JJ, Rosenberg AG, Maley M, Galante JO. Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. J Bone Joint Surg Am. 1993. 75:554–571.

29. Bobyn JD, Pilliar RM, Cameron HU, Weatherly GC. The optimum pore size for the fixation of porous-surfaced metal implants by the ingrowth of bone. Clin Orthop Relat Res. 1980. 263–270.

30. Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg Am. 2004. 86-A:92–97.

31. Kim YH, Kim VE. Results of the Harris-Galante cementless hip prosthesis. J Bone Joint Surg Br. 1992. 74:83–87.

32. Maloney WJ, Jasty M, Harris WH, Galante JO, Callaghan JJ. Endosteal erosion in association with stable uncemented femoral components. J Bone Joint Surg Am. 1990. 72:1025–1034.

33. Mallory TH, Lombardi AV Jr, Leith JR, Fujita H, Hartman JF, Capps SG, et al. Why a taper? J Bone Joint Surg Am. 2002. 84-A:Suppl 2. 81–89.

34. Sano K, Ito K, Yamamoto K. Changes of bone mineral density after cementless total hip arthroplasty with two different stems. Int Orthop. 2008. 32:167–172.

35. Klein GR, Levine HB, Nafash SC, Lamothe HC, Hartzband MA. Total hip arthroplasty with a collarless, tapered, fiber metal proximally coated femoral stem: minimum 5-year follow-up. J Arthroplasty. 2009. 24:579–585.