Is it Time for Cementless Hip Resurfacing?

Abstract

Metal-on-metal bearing with cemented femoral component and cementless acetabular fixation is the current standard in surface replacement arthroplasty (RSA) of the hip. Because of concerns about the long-term survivorship of cemented stems in conventional hip arthroplasty, it seems logical to achieve cementless fixation on the femoral side with RSA. The goals of this review were to evaluate clinical and radiological data reported from previously published cementless RSA series. In addition, we intend to review author's preliminary experience with Conserve Plus cementless devices specifically assessing the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels measured in follow-up. A references search was done with PubMed using the key words "cementless hip resurfacing", "cementless hip resurfacing prosthesis", and "femoral cementless hip resurfacing". Additionally, the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels were measured in 94 cementless Conserve Plus(©) devices in 90 patients (68 males and 22 females) with a mean age of 41.1years (18-59). Mean follow-up was 13.1months (8-16). No revision was performed during the observed follow-up. Neither radiological signs of loosening nor neck narrowing >10% were evident. Chromium and cobalt levels in whole blood samples rose respectively from 0.53μg/l (0.1-1.7) to 1.7μg/l (0.6-2.9) and from 0.54μg/l (0.1-1.4) to 1.98μg/l (0.1-2.8). Cementless "fit and fill" femoral-side fixation, which seems to be potentially evolved and design-related, should be considered for future hip-resurfacing device generations.