Abstract
BackgroundProximal cementless fixation using anatomic stems reportedly increases femoral fit and avoids stress-shielding. However, thigh pain was reported with the early stem designs. Therefore, a new anatomic cementless stem design was based on an average three-dimensional metaphyseal femoral shape. However, it is unclear whether this stem reduces the incidence of thigh pain.Questions/purposesWe asked whether this stem design was associated with a low incidence of thigh pain and provided durable fixation and high function.MethodsOne hundred seventy-one patients (176 THAs) who had the anatomic proximal hydroxyapatite-coated stem implanted were reviewed. Eleven (6%) patients were lost to followup and 34 (20%) died without revision surgery. We used the Harris hip score (HHS) to assess pain and function. We evaluated femoral stem fixation and stability with the score of Engh et al. and also calculated a 10-year survival analysis. We assessed 126 patients (131 hips) at a mean followup of 10 years (range, 8–11 years)ResultsAt last followup, two patients described slight thigh pain that did not limit their physical activities. All stems appeared radiographically stable and one stem was graded nonintegrated but stable. Five patients had revision surgery: one on the femoral side (for posttraumatic fracture) and four on the acetabular side. Considering stem revision for aseptic loosening as the end point, survivorship was 100% (range, 95.4%–99.9%) at 10 years.ConclusionThis anatomic cementless design using only metaphyseal fixation with a wide mediolateral flare, a sagittal curvature, and torsion, allowed durable proximal stem stability and fixation.Level of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Highlights
The survivorship rates for uncemented stems are as good as those for cemented stems, but depend on the stem’s design, material, and type of coating [4, 6, 7]
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request
We looked for radiolucencies and osteolysis in the seven zones described by Gruen et al [16] and the corresponding seven zones on the lateral view
Summary
The survivorship rates for uncemented stems are as good as those for cemented stems, but depend on the stem’s design, material, and type of coating [4, 6, 7]. Using a proximal metaphyseal fit cementless custom anatomic stem in patients younger than 50 years, Flecher et al [14] reported high functional scores and a 15-year survival rate of 93% with minimal osteolysis, even in patients with severe deformities. These data suggested anatomic cementless stems with metaphyseal fit and fill can provide durable pain relief and function in physically active patients. A new anatomic cementless stem design was based on an average three-dimensional metaphyseal femoral shape It is unclear whether this stem reduces the incidence of thigh pain. This work was performed at Hopital Pitie Salpetriere, Paris, France
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