Clin Orthop Surg.  2013 Jun;5(2):110-117. 10.4055/cios.2013.5.2.110.

Fifteen-year Results of Precoated Femoral Stem in Primary Hybrid Total Hip Arthroplasty

• Suh DH
• Yun HH
• Chun SK
• Shon WY

• KMID: 1705531
• DOI: http://doi.org/10.4055/cios.2013.5.2.110

Abstract

BACKGROUND
There has been controversy whether methylmethacrylate precoating of the cemented femoral stem is a solution for aseptic loosening or rather contributes to increased failure rates in cemented total hip arthroplasties.
METHODS
On a retrospective basis, we analyzed 76 primary hybrid total hip arthroplasties from 63 patients with precoated, cemented femoral stems between October 1990 and December 1995. The mean age of the patients was 46.8 years (range, 22 to 77 years) with a minimum follow-up of 14 years (mean, 15.5 years; range, 14 to 19.5 years). Third generation cementing techniques were employed in all cases.
RESULTS
Twenty-four out of 76 cases (31.6%) showed aseptic loosening of the femoral stems, of which 23 stems were revised at an average revision time of 8 years (range, 3 to 14.8 years). The main mode of loosening was cement-stem interface failure in 22 hips (91.7%). Twenty-one out of 24 failed hips (87.5%) demonstrated C2 cementing grades (p < 0.001). Kaplan-Meier survivorship analysis using radiographic aseptic loosening of the femoral stem as the endpoint for failure showed survival rates of 76.5% at 10 years (95% confidence interval [CI], 71.4 to 81.6) and 63.2% at 19 years (95% CI, 57.3 to 69.1).
CONCLUSIONS
An early failure of the precoated femoral stem in this study was mainly due to an insufficient cementing technique. Achievement of good cement mantle may improve the survival rates.

Keyword

Methylmethacrylate precoating; Femoral stem; Total hip arthroplasty

MeSH Terms

Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip/*instrumentation
*Coated Materials, Biocompatible
Equipment Failure Analysis
Female
Femur Head Necrosis/diagnosis/surgery
*Hip Prosthesis
Humans
Kaplan-Meier Estimate
Male
Methylmethacrylate
Middle Aged
Prosthesis Failure
Retrospective Studies
Treatment Outcome
Young Adult
Coated Materials, Biocompatible
Methylmethacrylate

Figure

• 

  Fig. 1 Follow-up radiographic images of a 32-year-old male with osteonecrosis of femoral head. (A) Postoperative radiograph of C2 cement mantle in Gruen zone 3. (B) Radiograph at 3 years follow-up demonstrating debonding in Gruen zone 1. (C) Radiographs at 6.2 years follow-up showing definitive loosening and lysis around C2 cement mantle (Gruen zones 3, 5, and 12). On translateral view, debonding was seen in Gruen zone 10, and osteolysis in Gruen zone 12.

• 

  Fig. 2 Kaplan-Meier survival rate for Precoat Plus and Centralign femoral stem was calculated using revision of the femoral stem for aseptic loosening as the endpoint. The survival rate at 19 years was 61.5% (95% confidence interval [CI], 51.7 to 71.3) in Precoat Plus stem and 64.3% (95% CI, 56.9 to 71.7) in Centralign stem.

• 

  Fig. 3 Kaplan-Meier survival rate for HG acetabular component using reoperation for acetabular component for any reason as the endpoint, the survival rate was 91.5% (95% confidence interval [CI], 88.2 to 94.8) at 10 years and 56.7% (95% CI, 45.2 to 68.2) at 19 years.

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