THE CEMENTED CUSTOM FEMORAL STEM – A TEN YEAR REVIEW.

Abstract

We report a series of 668 patients (699 hips) with an average follow up of 10.5 years (range, 10–11 years) following THR using a cemented custom-made titanium femoral stem and a cemented high-density polyethyl-ene acetabular component. The fate of every implant is known.

The mean age at operation was 68 years (24 – 94 years). The indication for THR was as follows: primary OA (629), RA (18), AVN (10), intracapsular femoral neck fracture (5), Perthes disease (3), developmental hip dysplasia (2) and SUFE (1). The mean pre-operative Harris Hip Score was 19 (range 10 – 42).

One hundred and seventy-four patients (26%) were deceased at the time of their 10-year review. Four hundred and ninety-four patients were subsequently reviewed of which 88 patients (13%) were assessed by telephone review as they were too frail to attend.

The average 10-year Harris Hip Score was 92 (range 43 – 100). The average 10-year Oxford Hip Score was 19 (range 12 – 46). 99.2% reviewed at 10 years stated that they were satisfied with their THR.

Revision surgery occurred in 21 cases (3%). Seventeen femoral components were revised for infection, one for recurrent dislocation and one was iatrogenically loosened during socket revision. There were no cases of revision for aseptic loosening of the stem. Dislocation occurred in 18 cases, of which 4 became recurrent (0.6%). Six patients had a postoperative sciatic nerve palsy (0.9%) with 4 making a full recovery. There was one case of femoral nerve palsy. Eleven patients developed a DVT (1.6%). Six patients had a PE (0.9%) all of which were non-fatal. There were 16 deep and 3 superficial wound infections. Thirty-eight patients had symptomatic trochanteric bursitis post-surgery.

In conclusion, the 10-years results of the custom femoral stem are encouraging with an overall high level of patient satisfaction.