Femoral Bone Is Preserved Using Cemented Polished Stems in Young Patients

• Published in: Clinical orthopaedics and related research Vol. 470; no. 11; pp. 3024 - 3031
• Main Authors: Howie, Donald W., Costi, Kerry, McGee, Margaret A., Standen, Angela, Solomon, Lucian B.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York Springer-Verlag 01.11.2012; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adolescent; Adult; Age; Age Factors; Arthroplasty; Arthroplasty, Replacement, Hip; Biological and medical sciences; Bone (long); Bone Cements; Bone grafts; Bone implants; Bone loss; Bone surgery; Conservative Orthopedics; Diseases of the osteoarticular system; Female; Femur; Femur - diagnostic imaging; Hip; Hip Joint - diagnostic imaging; Hip Prosthesis; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteolysis; osteotomy; Prosthesis Failure; Radiography; Reoperation; Sports Medicine; Stems; Surgery; Surgical Orthopedics; Survival; Symposium: Papers Presented at the 2011 Meeting of the International Hip Society; Young Adult; Gruen Zone; Femoral Osteotomy; Bone Deficiency; Femoral Stem; Periprosthetic Fracture; Human; Femur; Orthopedics; Young adult; Cement; Bone; Stem
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-012-2327-2

Background Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery. Questions/purposes We examined femoral stem survival, bone deficiency at revision arthroplasty, and radiographic bone loss in hips implanted with a cemented polished double-taper stem in a cohort of patients younger than 55 years. Methods We reviewed 197 hips (median patient age, 47 years; range, 16–54 years) after a minimum followup of 2 years (median, 7 years; range, 2–19 years) since primary THA. Clinically, we determined survival to major and minor stem revision and cases of bone deficiency requiring a long stem or impaction bone grafting or created by the need for femoral osteotomy at revision arthroplasty. Radiographically, we assessed stem loosening, femoral osteolysis, and femoral bone deficiency. Results Stem survival to major revision for aseptic loosening was 100% at 13 years and for any reason was 97% (95% CI, 93–100%). At revision of seven stems, a long stem was used in one hip, a total femoral replacement in one hip and impaction bone grafting in one hip. No femoral osteotomies were required. Bone was preserved in four hips by cement-within-cement stem exchange. No stems were radiographically loose. Proximal osteolysis was present in 11% of femurs. Femoral bone deficiency was graded as Paprosky Type I (97%) or II (3%) and Endo-Klinik Grade 0 (79%) or I (21%). Conclusions Cemented polished taper stems have high survival at 13 years in young patients and enable femoral bone preservation for subsequent revision. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.