Second-generation Extensively Porous-coated THA Stems at Minimum 10-year Followup

Abstract

The relatively high prevalence of thigh pain and stress shielding associated with the AML porous-coated cementless femoral component led to the development of the Prodigy, a femoral component with more extensive porous-coating and a distal polished bullet tip with medial diaphyseal relief to potentially decrease the flexural rigidity. We prospectively evaluated a cohort of 100 consecutive cementless total hip arthroplasties performed using this device. The minimum followup was 10 years (mean, 11.4 years; range, 10-12 years). At 10-year followup, 69 of the 86 patients (82 hips) were living, 14 patients with 15 hips were deceased, and three patients with three hips were lost to followup. No hips required a stem revision. Two patients (two hips) complained of thigh pain. All hips were bone ingrown. Distal tip radiolucencies and osteolysis occurred in 13 hips (17%) and none, respectively. Twenty-one hips (28%) demonstrated moderate or severe stress shielding. Only further followup will determine if this could be a clinical problem or one with revision surgery. These results encourage the authors to continue using second-generation extensively coated stems in their primary total hip arthroplasty constructs.

The Frank Stinchfield Award: The Impact of Socioeconomic Factors on Outcome After THA: A Prospective, Randomized Study

“…Historically, studies have focused on the effect of surgical technique and implant designs on clinical results [5,7,10,13,20,24,30,32,38,40,43]. This trend focuses on techniques such as minimal incision surgery [9] and image guided surgery [13], as well as design features such as decreased stem stiffness [1] and shorter stems [41].…”

“…Third, the results could be specific to some degree to the stems utilized. Both stems have been reported to have good clinical result, [8,24] which could minimize associations due to a ceiling affect.…”

“…1). A number of studies have reported high functional scores with both of these designs [7,14,18,24,32,38] which were the two cementless components with which the authors had clinical experience, thus minimizing the concern for learning curve with the process of stem insertion. We considered patients who were over 18 years old and considered candidates for cementless primary THA.…”

Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern

“…Acetabular components were evaluated for bone-prosthesis radiolucencies and acetabular component migration according to the criteria of Massin et al [12,21,28]. The definition of acetabular osteolysis was the same as that for femoral osteolysis.…”

Ultrashort versus Conventional Anatomic Cementless Femoral Stems in the Same Patients Younger Than 55 Years

“…Conventional cementless femoral stems are known to provide a high rate of satisfactory clinical and radiographic performance at long-term followups [1,7,12,14,15,18,33]. However, they may have potential clinical consequences related to stress shielding, thigh pain, periprosthetic fractures, proximodistal dimensional mismatch, and removal during revision [9, 11, 16, 17, 19, 21-23, 35, 38].…”