Abstract
Optimal osseointegration of cementless total hip arthroplasty is essential for high stability and long-term survival. The purpose of this follow-up study was to evaluate the clinical and radiological outcome, the complications, and survival rates of a beta-titanium alloy stem with a specific grit-blasted-free surface. In 192 patients (mean age of 64.4 years), 202 consecutive primary total hip arthroplasties were performed using a cementless Hipstar® stem (Stryker, Duisburg, DE). The Harris Hip Score (HHS) was assessed pre-operatively and post-operatively. Radiolucent lines were evaluated and the implant survival rate was calculated using Kaplan-Meier analysis. The mean follow-up was 7.71 years (range of 5.0–14.0 years). Overall, 15 revisions were performed. Early aseptic stem loosening was observed in six cases (2.97%). Radiolucent-lines adjacent to the stem were detected in 73 cases (83.02%), especially (70.46%) in the Gruen zones 1, 7, 8, and 14. The mean postoperative HHS was 92.65 points (range 42–100). The cumulative survival probability of the stem was 94.4% (95% CI 90.3 to 98.5%). Considering aseptic failure as an endpoint, the cumulative survival rate of the stem was 95.3% (95% CI 0.914 to 0.992) at six years of follow-up. Overall, an inferior mid-term implant survival was observed in comparison to well-established cementless stem designs.
Highlights
Cementless total hip arthroplasty (THA) is a well-established procedure in orthopedic surgery for treating osteoarthritis (OA) of the hip joint
Optimal osseointegration of cementless total hip arthroplasty is essential for high stability and long-term survival
Considering aseptic failure as an endpoint, the cumulative survival rate of the stem was 95.3% at six years of follow-up
Summary
Cementless total hip arthroplasty (THA) is a well-established procedure in orthopedic surgery for treating osteoarthritis (OA) of the hip joint. Improvements in fixation and osseointegration are of special interest in cementless hip stems to achieve long-term stability and high survival rates. Hydroxyapatite, porous coatings, grit-blasted surfaces, plasma spraying, and osteoconductive materials like specific titanium alloys have been designed to improve biological integration [1,3,4]. During osseointegration of cementless stems, dynamic bone tissue involves the implant interface. The interface, which is a microscopically amorphous rough structure of approximately 20 to 50 μm, should be nearly filled with regenerated bone [5]. Kahnuja et al [1] mentioned an optimal pore size between 50 and 400 μm of 30–40% of the stem surface in porous metal-coating procedures to maintain mechanical strength
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