Long Term Performance of an Uncemented, Proximally Hydroxyapatite Coated, Double Tapered, Titanium-Alloy Femoral Stem: Results From 1465 Hips at 10 years Minimum Follow-Up

Abstract

BackgroundWe assessed the survivorship of a proximally hydroxyapatite coated, double tapered, titanium-alloy femoral stem in a single center, at an average follow up of 12.5 years (10.1-15.8). The majority of stems were inserted as part of a Metal on Metal (MoM) Total Hip Replacement (THR). MethodsData was collected prospectively in a local database. A retrospective review was performed of all patients undergoing a primary THR with the prosthesis between 2003 and 2010. Primary outcome was revision of the stem for any cause. Analysis was also performed for stem revision for aseptic loosening, stem revision in the MoM setting and a worst case scenario whereby lost to follow up were presumed to have failed. True stem failure was considered if revision occurred for a stem related complication. Results1465 stems were included (1310 patients, 155 bilateral). The bearing surface was cobalt chrome on cobalt chrome in 1351 cases (92%). Seven hips were lost to follow up. Thirty-two stems (31 part of a MoM THR) underwent revision for any cause. Kaplan Meier survival analysis demonstrates an overall 97.4% survivorship. Subset analysis demonstrates 100% survivorship for aseptic loosening, 97.3% in the MoM setting and 96.7% for the worst case senario. Of the 32 cases of stem revision, only 13 were classified as ’true’ stem failure. ConclusionThis study represents the largest cohort of this uncemented femoral component with a minimum follow-up longer than 10 years. Our results demonstrate excellent long-term survivorship even in the presence of a challenging MoM environment.