Abstract
Providing a long-lasting total hip arthroplasty for patients younger than 50 years remains one of the greatest challenges for modern arthroplasty surgery. Survival has been considered to be poor in young and active patients. We evaluated the benefit of total osteointegration of the prosthetic components in term of durable biological fixation.
This study concerns a prospective series of 113 patients operated between 1986 and 1994. The femoral component (Corail, Landos-DePuy) and the acetabular shells (Atoll & Tropic, Landos-Depuy) were totaly coated with a 150μ thick layer of pure HA following a plasma-spray process. The mean age at the time of surgery was 40.3 (range 17 to 49.8). Two patients are now deceased, 11 patients (9.7%) are lost to FU. The mean FU for 100 patients still on file is 14 years. AVN represents 29 % of the cohort, primary arthritis 22% and dysplasia 17%.
Functional results are excellent (mean PMA score 17.7 at the last control), as well as the subjective appreciation from the patients (94.9 % excellent or very good). 18 THA’s required components revisions: 6 without any implant removal (head or insert exchange); 1 stem (periprosthetic fracture) and 11 cups (6 well-fixed and 5 for loosening) were removed. Owing the high incidence of wear-related revision, actuarial survivorship, using re-operation for any reason as end-point, was 82% at 18 years ± 8.5, and considering aseptic loosening only, the survival probability of the stem is 99% ± 1.5 and 97 % ± 3.5.
It is clear that HA-coatings have given lesser performance in the cups than in the stems. We advocate for HA and the eradication of wear debris using hard on hard bearings. This combination seems to be a reasonable solution in this subgroup of young patients.
Correspondence should be addressed to Editorial Secretary Mr ML Costa or Assistant Editorial Secretary Mr B.J. Ollivere at BOA, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England; Email: mattcosta@hotmail.com or ben@ollivere.co.uk
