TOTAL HIP ARTHROPLASTY WITH CEMENTED COLLARLESS DOUBLE TAPERED STEMS IN PATIENTS YOUNGER THAN FIFTY FIVE YEARS OF AGE

Abstract

Background: Good results have been reported for cemented femoral total hip arthroplasty in young patients from centres with expert surgeons but what is unknown are the results when surgeries are performed by a group of surgeons with varying experience in total hip replacement. The purpose of this study was to evaluate the outcome of primary total hip arthroplasty using a polished cemented polished collarless double tapered stem in young patients aged less than 55 years performed by a group of surgeons with varying experience in total hip replacement.

Methods: One hundred and ninety seven arthroplasties in 169 patients were performed between 1988 to 2005. The procedures were performed by surgeons with varying arthroplasty experience. Follow-up was 2 to 19 years (median 8 years). Clinical outcomes, radiographic evaluations and survivorship analyses were undertaken.

Results: Of the 197 femoral stems, eight were revised, but none for aseptic loosening. Four stems underwent cement within cement revision for recurrent dislocation, leg length discrepancy, infection and to assist cup revision. Two stems were revised for periprosthetic fractures. Two stems were revised for infection. No stems were classified as probably or possibly loose. Median stem within cement subsidence was 1.0mm. Two stems have more than 5mm vertical subsidence and in the absence of radiolucent lines or associated pain they were not considered loose. At long term follow-up the overall incidence of femoral osteolysis was 7% (n=13 hips). At latest patient follow-up the median Harris Hip and pain scores were respectively 81 (range 34 to 100) and 40 (range 10 to 44). Survivorship of the polished collarless double tapered stems at 13 years using the endpoint revision for aseptic loosening was 100% (worst case analysis 96.5%).

Conclusion: This study confirms that good results of cemented polished collarless double tapered stems in the younger patient can be achieved by a group of surgeons with varying experience in total hip replacement. The ability to perform a minor stem revision, cement within cement, for other reasons than aseptic loosening further strengthens the indications for these type of implants in young patients.