Introduction

Up to date there are only few reports in literature on the long term survival of uncemented stems. As for cemented THA, 10 year survival of at least 90% is required for any THA.

Introduction: THA in young and active patients remains a major challenge. Uncemented femoral components have been advocated in young patients, but there are only few reports with more than 10 years follow-up.

Materials and Methods: We followed the first 153 consecutive implantations of an uncemented, straight femoral stem (CLS, Zimmer Inc, Warsaw, USA) in 141 patients. Mean time of follow-up evaluation was 17 years (range, 15–20 years), mean age at surgery was 47 years (23–55).

Results: At follow-up, 20 patients (20 hips) had died, and 7 (7 hips) were lost to follow-up. 10 patients (10 hips) underwent femoral revision–1 for infection, 4 for periprosthetic fracture, and 5 for aseptic loosening of the stem. Overall survival was 91% at 17 years (95%-confidence limits, 88%-94%), survival with femoral revision for aseptic loosening as an end point was 95% (95%-confidence limits, 93%–98%). The mean Harris-Hip-Score at follow-up evaluation was 84 points. 116 hips were available for radiolographic evaluation. Radiolucent lines (< 2mm) in Gruen zones 1 and 7 were present in 12,9% (15 hips) and 13,8% (16 hips), respectively. Radiolucencies in zones 2–6 were found in 0,9% (1 hip) – 2,6% (3 hips) on ap x-rays. Only one case of distal osteolysis was found after a previous Wagner resurfacing. No case of severe femoral osteolysis was found at follow-up.

Conclusions: The long-term results with this type of uncemented femoral component are encouraging and compare favorably with those achieved in primary cemented total hip arthroplasty in this group of young and active patients.

Introduction: Despite improved cementing techniques, the long term survival of hip arthroplasty in younger patients have been disappointing. THA in this group of young and active patients remains a major challenge. Consequently, cementless components have been developed. Longer implant survival, preservation of bone stock and ‘easier’ revisions have been advocated as potential benefits of cementless stems. Up to date there are only few reports in the literature on the long term results of uncemented stems. Like in cemented THA, 10 year survival of at least 90% is required for any THA.

Materials and Methods: We followed 133 implantations of an uncemented, grit blasted straight titanium stem (CLS, Zimmer Inc, Warsaw, USA). The mean follow-up evaluation was 14 (10 – 20) years. The mean age at surgery was 37 (16 – 45) years.

Results: At follow-up, 14 patients (10,5%) had died, and 10 (7,5%) were lost to follow-up. 3 patients under-went femoral revision. One for infection an two for aseptic loosening of the stem. There was no case of clinical or radiographic loosening at the time of follow-up. Overall survival was 96% at 14 years, survival with femoral revision for aseptic loosening as an end point was 97% at 14 years. The mean Harris-Hip-Score at follow-up was 81 points (range 45–100). 96 hips were available for radiolographic evaluation. Radiolucent lines (< 2mm) in Gruen zone 1 were present in 7 hips and in Gruen zone 7 in 2 hips, respectively. Small osteolytic lesions (< 1cm) in Gruen zone 1 were present in one hip and in Gruen zone 7 in 5 hips. Larger lesions (> 1cm) were present in one case in Gruen zone 1 and 7. No osteolysis or radiolucency was found in zones 2 – 6. No case of severe femoral osteolysis was found.

Conclusions: The long-term results with this type uncemented stem in a young and active patient group are encouraging and better than those of cemented stems in this age group. We recommend the uncemented CLS stem for hip arthroplasty in young demanding patients.

Aim: Stress-shielding is a common problem after uncemented THA that may lead to proximal femoral atrophy and consecutive aseptic loosening.

Methods: In 143 patients with 154 uncemented CLS-stems periprosthetic bone mineral density (BMD) was measured using DXA after a mean of 12 years (10–15) postoperatively (T1). Five years later the same group of patients was examined at a mean of 17 years (range: 15–20) (T2) using the identical protocol.

Results: We obtained a complete prospective set of data of two consecutive DXA measurements in 76 cases (32 men, 44 women). In all cases regular bone ongrowth did occur and there were no signs of radiographic loosening (T1 and T2). On radiographic evaluation there was no significant change in periprosthetic bone formation in all Gruen zones between T1 and T2. There was no significant change in activity and BMD. In male patients we found no significant changes in periprosthetic BMD (netavg T1–T2: −1,19%, p< 0,01), in female patients there was no significant difference either (netavg T1–T2: −1,32%,p< 0,01). We analyzed the differences in BMD in all Gruen zones (zone 1–7) comparing T1 and T2 and found no significant differences in any zone (p< 0,01).

Conclusion: This study showed that there is no significant change in periprosthetic bone mineral density in the long term using the uncemented CLS stem. There was not a single case of stress shielding in the long term. Once osseous integration has occurred the periprostethic BMD changes remain minimal in the long term.

Introduction: THA in young and active patients remains a major challenge. Uncemented femoral components have been advocated in young patients, but there are only few reports with more than 10 years follow-up.

Materials and Methods: We followed the first 153 consecutive implantations of an uncemented, straight femoral stem (CLS, Zimmer Inc, Warsaw, USA) in 141 patients. Mean time of follow-up evaluation was 17 years (range, 15 – 20 years), mean age at surgery was 47 years (23–55).

Results: At follow-up, 20 patients (20 hips) had died, and 7 (7 hips) were lost to follow-up. 10 patients (10 hips) underwent femoral revision- 1 for infection, 4 for periprosthetic fracture, and 5 for aseptic loosening of the stem. Overall survival was 91% at 17 years (95%-confidence limits, 88%–94%), survival with femoral revision for aseptic loosening as an end point was 95% (95%-confidence limits, 93% – 98%). The mean Harris-Hip-Score at follow-up evaluation was 84 points. 116 hips were available for radiolographic evaluation. Radiolucent lines (< 2mm) in Gruen zones 1 and 7 were present in 12,9% (15 hips) and 13,8% (16 hips), respectively. Radiolucencies in zones 2 – 6 were found in 0,9% (1 hip) – 2,6% (3 hips) on ap x-rays. Only one case of distal osteolysis was found after a previous Wagner resurfacing. No case of severe femoral osteolysis was found at follow-up.

Conclusions: The long-term results with this type of uncemented femoral component are encouraging and compare favorably with those achieved in primary cemented total hip arthroplasty in this group of young and active patients.

Aim: The early results of cementless femoral components in young patients have been reported, but there are only few reports with more than 10 years follow-up. Methods: We evaluated the clinical and radiographic results of the þrst consecutive 154 implantations of a cementless, double tapered straight femoral stem (cementless Spotorno (CLS), Sulzer Orthopedics) in 141 patients under the age of 55 (mean 47, 13–55) years. Results: After a mean follow-up of 12 (10Ð15) years, 11 patients (11 hips) had died and 7 (7 hips) could not be located. 5 patients (5 hips) underwent femoral revision- 1 for infection, 1 for periprosthetic fracture and 3 for aseptic loosening of the stem. Overall survival was 97% at 12 years (95%-conþdence limits, 93% Ð 100%), survival with femoral revision for aseptic loosening as an end point was 98% (95%-conþdence limits, 95% Ð 100%). The median Harris-Hip-Score at follow-up was 84 points. No thigh pain was found. Radiolucent lines in Gruen regions 1 and 7 were present in 21 hips (17%). 2 hips had radiolucent lines in regions 2 Ð 6 on anterio-posterior (AP) radiographs. No femoral osteolysis was found. Conclusions: The mid- to long-term survival with this type of femoral component is excellent and compares favorably with cemented stems in this age group. However the high rate of cup loosening and the low Harris Hip Scores are concerning in this group of young patients.