Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients: Follow-up of 75 hips for 15–18 years

Background The high hip center technique used for a deficient acetabulum is reconstruction of the hip at a high center of rotation. In the literature, there is no consensus regarding the value of this technique. Questions/purposes We investigated whether the newgeneration biconical threaded Zweymüller 1 cup fixed in a high nonanatomic position in patients with arthritis secondary to congenital hip disease experienced different rates of polyethylene wear and long-term survivorship when compared with anatomically positioned cups. Patients and Methods We studied the polyethylene wear rate and Kaplan-Meier survivorship of 104 titanium threaded Zweymüller 1 cups in 88 patients (81 females), placed in 70 hips at near-normal hip center and in 34 hips at a high hip center position at a distance of 31.1 to 60 mm (mean, 39.7 mm) from the interteardrop line. Minimum followup was 2 years (mean ± SD, 8.6 ± 3.5 years; range, 2-15 years). ResultsThe mean linear polyethylene wear rates in the near-normal and high hip center groups were not different (0.110 ± 0.050 mm and 0.113 ± 0.057 mm, respectively

Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

High Hip Center Technique Using a Biconical Threaded Zweymüller® Cup in Osteoarthritis Secondary to Congenital Hip Disease

Christodoulou¹,

Dialetis²,

Christodoulou

2010

“…Most revisions within the first decade are due to cup failure (migration, wear, and osteolysis) [1,44,47], dislocation, and infection. Equally encouraging are reports of stem performance in the second decade for both cemented and uncemented designs [9,25,38,40,41]. However, there are relatively few reports with more than 15 years of followup.…”

Section: Introductionmentioning

confidence: 82%

Survival of the Cementless Spotorno® Stem in the Second Decade

Aldinger

Jung

Breusch

et al. 2009

High survival rates have been reported for the uncemented CLS Spotorno stem up to 10 years. To confirm survival at longer followup we report the minimum 15-year (mean, 17 years; range, 15-20 years) for 257 hips using this stem. We retrospectively evaluated the clinical and radiographic results of all 326 patients (354 THAs) operated between 1985 and 1989. The patients had a mean age of 57 years using an uncemented grit-blasted, tapered titanium femoral stem. Eighty-six patients (89 hips) died and eight patients (eight hips) were lost to followup, leaving 240 patients (257 hips) for evaluation. The femoral component was revised in 35 hips: eight for infection, nine for periprosthetic fracture, one for traumatic loosening, and 17 for aseptic loosening. Survival of the stem was 88% at 17 years (95% confidence interval, 84%-92%), and survival with femoral revision for aseptic loosening as an end point was 94% (95% confidence interval, 91%-97%). The median Harris hip score at followup was 80 points. No thigh pain was reported. Small osteolytic lesions (< 1 cm(2)) were found in the proximal Gruen zones (1 or/and 7) in 28 hips (15%). No distal femoral osteolysis was found. The long-term survival with this type of femoral component remains high in the second decade.

“…McAuley et al [41] reported a survivorship of 60% at 15-years followup in a series of 488 THAs performed in patients 50 years or younger. Reigstad et al [48] studied 75 cementless Zweymüller stems with titanium-backed threaded cups in 70 patients with a mean age of 52 years (range, 24-68 years) and the overall survival rate was 88% at 18 years followup. Aldinger et al [1] reported a survivorship of the stem of 90% at 20 years in 154 THAs performed with an uncemented grit-blasted straight tapered titanium femoral stem combined with a threaded socket in patients younger than 55 years.…”

Section: Discussionmentioning

confidence: 99%

Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

Flécher

Pearce

Parratte

et al. 2010

THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D'Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%-97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%-97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications.