Hip Pelvis.  2012 Jun;24(2):79-86. 10.5371/hp.2012.24.2.79.

Midterm Results of Total Hip Arthroplasty Using the VerSys Fiber Metal Tapered Femoral Stem

• Kang JS
• Moon KH
• Kim BS
• Kwon DK
• Choi JM

• KMID: 1439095
• DOI: http://doi.org/10.5371/hp.2012.24.2.79

Abstract

PURPOSE
We evaluated the clinical and radiological results of patients who received the cementless VerSys fiber metal tapered stem for total hip arthroplasty.
MATERIALS AND METHODS
Thirty seven hip joint replacements(31 patients) were evaluated over a minimum four year period following the procedure with an average follow-up period of 56 months(48-96 months). The mean patient age was 47.9 years old. Clinical results were analyzed using Harris hip scores, incidence of thigh pain and radiographic analysis was used to assess fixation of the stem, stress shielding, cortical hypertrophy and radiolucent lines around the femoral stem.
RESULTS
The average Harris hip score was 90.7 points(82-99 points). Thigh pain was noticed in 6 hips(16%). Proximal femoral bone resorption by stress shielding was observed in 32 hips(86.5%). Cortical hypertrophy was noticed in 16 hips(43.2%) and was statistically correlated with stress shielding of 2nd degree or more according to the Engh classification. Stable bone ingrowth at the last follow-up was seen in 36 hips(97.2%).
CONCLUSION
Cementless total hip arthroplasty using the cementless VerSys fiber metal tapered stem demonstrated excellent midterm clinical results as well as excellent radiologic results for stable fixation and endosteal new bone formtion. However, long term follow-up evaluation will be required because of the high rates of proximal bone resorption by stress shielding.

Keyword

Thigh pain; Stress shielding; Bone resorption; Total hip arthroplasty; Cementless; VerSys fiber metal tapered stem

MeSH Terms

Arthroplasty
Bone Resorption
Follow-Up Studies
Hip
Hip Joint
Humans
Hypertrophy
Incidence
Thigh

Figure

• 

  Fig. 1 VerSys fiber metal tapered femoral stem.

• 

  Fig. 2 Radiographs show right femur neck fracture in 62 year old woman. (A) Preoperative radiography. (B) Immediate postoperative radiography. (C) At the last follow-up (56 months after total hip arthroplasty), extensive proximal bone resorption at zone 1 and 7 is observed. The clinical result was excellent.

Reference

1. Ahnfelt L, Herberts P, Malchau H, Andersson GB. Prognosis of total hip replacement. A Swedish multicenter study of 4,664 revisions. Acta Orthop Scand Suppl. 1990. 238:1–26.

2. Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg Am. 1985. 67:1074–1085.

3. Hellman EJ, Capello WN, Feinberg JR. Omnifit cementless total hip arthroplasty. A 10-year average followup. Clin Orthop Relat Res. 1999. (364):164–174.

4. Heekin RD, Callaghan JJ, Hopkinson WJ, Savory CG, Xenos JS. The porous-coated anatomic total hip prosthesis inserted without cement. Results after five to seven years in a prospective study. J Bone Joint Surg Am. 1993. 75:77–91.

5. Hofmann AA, Feign ME, Klauser W, VanGorp CC, Camargo MP. Cementless primary total hip arthroplasty with a tapered, proximally porous-coated titanium prosthesis: a 4- to 8-year retrospective review. J Arthroplasty. 2000. 15:833–839.

6. Kim YH, Kim VE. Early migration of uncemented porous coated anatomic femoral component related to aseptic loosening. Clin Orthop Relat Res. 1993. (295):146–155.

7. 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.

8. Petersilge WJ, D'Lima DD, Walker RH, Colwell CW Jr. Prospective study of 100 consecutive Harris-Galante porous total hip arthroplasties. 4- to 8-year follow-up study. J Arthroplasty. 1997. 12:185–193.

9. 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.

10. 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.

11. Callaghan JJ, Dysart SH, Savory CG. The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg Am. 1988. 70:337–346.

12. 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.

13. 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.

14. Bobyn JD, Mortimer ES, Glassman AH, Engh CA, Miller JE, Brooks CE. Producing and avoiding stress shielding. Laboratory and clinical observations of noncemented total hip arthroplasy. Clin Orthop Relat Res. 1992. (274):79–96.

15. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasy. Clin Orthop Relat Res. 1988. (231):7–28.

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

17. Sakalkale DP, Eng K, Hozack WJ, Rothman RH. Minimum 10-year results of a tapered cementless hip replacement. Clin Orthop Relat Res. 1999. (362):138–144.

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

19. Brooker Af, Browerman 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.

20. Barrack RL, Jasty M, Bragdon C, Haire T, Harris WH. Thigh pain despite bone ingrowth into uncemented femoral stems. J Bone Joint Surg Br. 1992. 74:507–510.

21. 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.

22. Ragab AA, Kraay MJ, Goldberg VM. Clinical and radiographic outcomes of total hip arthroplasty with insertion of an anatomically designed femoral component without cement for the treatment of primary osteoarthritis. A study with a minimum of six years of follow-up. J Bone Joint Surg Am. 1999. 81:210–218.

23. Yoo JH, Kim SG, Han CD, Oh HC, Yoon HK. Cementless total hip arthoroplasty using VerSys fiber metal midcoat stem: a minimum 3-years follow-up. J Korean Hip Soc. 2010. 22:45–51.

24. Huiskes R, Weinans H, van Rietbergen B. The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials. Clin Orthop Ralat Res. 1992. (274):124–134.

25. Kim SB, Park SW, Cho HJ, Jung NY. Primary total hip arthroplasty with cementless VerSys femoral stem: a minimum 5-years follow-up. J Korean Hip Soc. 2007. 19:1–8.

26. Suh KT, Kang DJ, Lee JS, Kim JI. Short term results of cementless total hip arthroplasty with a tapered femoral component. J Korean Orthop Assoc. 2005. 40:623–629.

27. Engh CA, McGovern TF, Bobyn JD, Harris WH. A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg Am. 1992. 74:1009–1020.

28. Engh CA Jr, McAuley JP, Sychterz CJ, Sacco ME, Engh CA Sr. The accuracy and reproducibility of radiographic assessment of stress-shielding. A postmortem analysis. J Bone Joint Surg Am. 2000. 82-A:1414–1420.

29. Han CD, Kim HJ, Yang IH. The results of hip arthroplasty with hydroxyapatite coated anatomical profile (R) femoral stem: result after 5-years to 10-years follow up. J Korean Orthop Assoc. 2004. 39:654–661.

30. Jaffe WL, Scott DF. Total hip arthroplasty with hydroxyapatite-coated prostheses. J Bone Joint Surg Am. 1996. 78:1918–1934.

31. Shin HK, Choi JY, Jeong HJ, Lim JJ. The clinical and radiologic results of total hip arthroplasty with an AML hip prosthesis: minimum 7 year's follow-up study. J Korean Hip Soc. 2009. 21:314–319.