Abstract
Since 1982, we have used extensively porous-coated femoral components. Our oldest series of patients is a consecutive non-selected group of 211 hips that have been followed for a mean of 20 years. Combining the loose and the revised, there is a 3% femoral failure. Currently we are following 8,020 hips with a mean follow up of 7 years (0–29 years). Twenty-six percent of the patients have a follow up visit more than 10 years after surgery. The mean age of at the time of surgery was 62 years old (15–97 years). One percent of hips have been revised most commonly for failure of ingrowth-49, infection-19, and stem fracture-7. We have studied patients with disease processes not originally thought to work well with noncemented techniques, including rheumatoid arthritis, avascular necrosis and patients over 65.
In 422 hips with more than 20 year follow up, 96% remain satisfied, with less pain, and increased function. Ten years after surgery 57% can walk more than 60 min. or unlimited distances. Using survivorship analysis 96% of patients continue to live independently or with their family 10 years after surgery. For those patients not retired at the time of surgery, 58% continue to work 10 years after surgery.
Despite the good results, the main concern is that proximal bone loss secondary to the stress shielding caused by a stiff extensively porous-coated femoral component will lead to difficulty at the time of revision. At a mean 14 years, we have not seen any adverse clinical consequences that can be attributed to proximal stress shielding. Extensive proximal bone loss secondary to stress shielding occurs in 25% of cases. In the remaining 70–75% of cases, lesser degrees of proximal bone loss occur which confirm bone ingrowth.
