Hip Pelvis.  2018 Sep;30(3):162-167. 10.5371/hp.2018.30.3.162.

Cementless Total Hip Arthroplasty Using the COREN Hip System: A Minimum Five-Year Follow-up Study

• Kim HJ
• Yoo JJ
• Seo W
• Kim MN
• Kang T

• KMID: 2419511
• DOI: http://doi.org/10.5371/hp.2018.30.3.162

Abstract

PURPOSE
This study presents the clinical and radiological outcomes of cementless total hip arthroplasty using the COREN hip system after a minimum duration of follow-up of 5 years.
MATERIALS AND METHODS
We evaluated the results of a consecutive series of the first 200 primary total hip arthroplasties that had been performed in our hospital in 169 patients between February 2007 and April 2011. Six patients (6 hips) had died within 5 years, and 12 patients (13 hips) had been lost to follow-up, leaving a total of 151 patients (181 hips) available for the study. All patients were evaluated clinically and radiologically with special attention to thigh pain, implant fixation, radiolucent line and osteolysis around implants.
RESULTS
The mean Harris hip score improved from 59.4 preoperatively to 97.2 postoperatively. No patient complained of thigh pain. All implants demonstrated radiographic evidence of stable fixation by bone ingrowth without any change in position. No implant was loose radiographically or was revised. Eleven hips (7.7%) had a radiolucent line around the femoral stem. Focal osteolytic area was detected in 3 cases (2.1%). An osteolytic lesion was stabilized in 1 case and further observation was needed in 2 cases in which the lesions were detected several years after surgery. Stress shielding was observed in 80.3% of cases (first degree, 35.9%; second degree, 44.4%); there were no cases of third or fourth degree stress shielding. One case was complicated by bacterial infection and repeated dislocation.
CONCLUSION
Mid-term results of total hip arthroplasty using the COREN hip system are very encouraging clinically and radiologically.

Keyword

Hip; Cementless total hip arthroplasty; COREN hip system

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Hip*
Bacterial Infections
Dislocations
Follow-Up Studies*
Hip*
Humans
Lost to Follow-Up
Osteolysis
Thigh

Figure

• 

  Fig. 1 A 21-year-old male patient underwent total hip arthroplasty for osteonecrosis of the femoral head. (A) Early postoperative radiograph shows well-implanted joint components. (B) Anteroposterior radiograph taken 1 year after index arthroplasty revealed an osteolytic lesion in zone 1, a radiolucent line in zone 7 and rounding of the most proximal medial edge of the cut femoral neck. (C) Anteroposterior radiograph taken 7.5 years after arthroplasty demonstrates no remarkable changes in the osteolytic lesion or radiolucent line, and the loss of the medial cortical density of the proximal femur.

• 

  Fig. 2 A 49-year-old male patient suffered from osteonecrosis of the femoral head. (A) Anteroposterior radiograph taken 4 years after surgery shows stably fixed implants. (B) Anteroposterior radiograph taken at 5 years after surgery demonstrates osteolytic lesions in zones 1 and 7. (C) Anteroposterior radiograph taken 7 years after surgery shows no marked change in the size of the osteolytic lesions, but their margins became sclerotic.

• 

  Fig. 3 A 46-year-old male patient had total hip arthroplasty because of degenerative arthritis secondary to acetabular dysplasia. (A) Anteroposterior radiograph taken at 1 year after arthroplasty shows stably fixed implants and mild rounding of the medial edge of the cut femoral neck. (B) Anteroposterior radiograph taken 6 years after arthroplasty demonstrates no marked changes. (C) Anteroposterior radiograph taken 9 years after arthroplasty shows osteolytic lesions in zones 1 and 7.

• 

  Fig. 4 Photograph of the alumina-on-alumina COREN hip system (Corentec, Seoul, Korea).

Reference

1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007; 370:1508–1519.

2. Charnley J. Anchorage of the femoral head prosthesis to the shaft of the femur. J Bone Joint Surg Br. 1960; 42-B:28–30.

3. Charnley J. Arthroplasty of the hip. A new operation. Lancet. 1961; 1:1129–1132.

4. Jones LC, Hungerford DS. Cement disease. Clin Orthop Relat Res. 1987; (225):192–206.

5. Sanfilippo JA, Austin MS. Implants for total hip arthroplasty. Expert Rev Med Devices. 2006; 3:769–776.

6. Ahn HY, Kim KH, Shim SH. A case of McKee-Farrar prosthetic replacement of the hip. J Korean Orthop Assoc. 1970; 5:29–34.

7. Kim YM, Kim HJ, Jin JS, Moon YW. Clinical study of Kim's femoral stem. J Korean Orthop Assoc. 1991; 26:1365–1370.

8. 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.

9. 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; (141):17–27.

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

11. Joshi RP, Eftekhar NS, McMahon DJ, Nercessian OA. Osteolysis after Charnley primary low-friction arthroplasty. A comparison of two matched paired groups. J Bone Joint Surg Br. 1998; 80:585–590.

12. 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.

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

14. Capello WN, D'Antonio JA, Feinberg JR, Manley MT, Naughton M. Ceramic-on-ceramic total hip arthroplasty: update. J Arthroplasty. 2008; 23:7 Suppl. 39–43.

15. Park YS, Kim YS, Lee JM, Sun DH, Moon YW, Lim SJ. Cementless total hip arthroplasty with use of the COREN hip system. J Korean Hip Soc. 2007; 19:457–462.

16. Lim YW, Kwon SY, Sun DH, Kim HE, Kim YS. Enhanced cell integration to titanium alloy by surface treatment with microarc oxidation: a pilot study. Clin Orthop Relat Res. 2009; 467:2251–2258.

17. Kim SM, Moon YW, Lim SJ, et al. Minimum seven-year follow-up of cementless total hip arthroplasty with the COREN hip system. Hip Pelvis. 2013; 25:173–181.

18. Lee JM, Jeon JB. Result of a minimum five-year follow-up of hip arthroplasty using the Bencox® hip stem. J Korean Orthop Assoc. 2014; 49:126–132.

19. Lim YW, Lee KH, Bae SH, Kwon SY. Comparative analysis of two cementless stems in total hip arthroplasties in patients with osteonecrosis of femoral head - Summit® stem and Bencox® stem. J Korean Hip Soc. 2012; 24:25–31.

20. Robinson RP, Deysine GR, Green TM. Uncemented total hip arthroplasty using the CLS stem: a titanium alloy implant with a corundum blast finish. Results at a mean 6 years in a prospective study. J Arthroplasty. 1996; 11:286–292.

21. Schramm M, Keck F, Hohmann D, Pitto RP. Total hip arthroplasty using an uncemented femoral component with taper design: outcome at 10-year follow-up. Arch Orthop Trauma Surg. 2000; 120:407–412.

22. Smeekes C, de Witte PB, Ongkiehong BF, van der Wal BCH, Barnaart AFW. Long-term results of total hip arthroplasty with the CementLess Spotorno (CLS) system. Hip Int. 2017; 27:465–471.

23. Yamasaki T, Yasunaga Y, Mori R, Hamanishi M, Shoji T, Ochi M. The Cementless Spotorno stem in THA: 10 year results. Hip Int. 2014; 24:98–102.

24. Yoo JJ, Kim YM, Yoon KS, Koo KH, Song WS, Kim HJ. Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study. J Bone Joint Surg Am. 2005; 87:530–535.