We report the follow-up of a cohort of 86 patients who underwent total hip replacement (THR) with custom-made stem prosthesis. Fixation mode, cemented (group 1) or uncemented (group 2) is based on the bone quality. Aspects of physical health and changes in mental health are documented using 3 patient-administered questionnaires, pre-operatively and 6 weeks, 3, 6 and 12 months post-operatively.

Harris Hip Score (HHS), Hip disability and osteoarthritis outcome score (HOOS) and SF-36, multi-purpose, short-form health survey were used.

Globally HHS increases significantly (p< 0.01). In group 1 up to 3 months post-operatively and in group 2 up to 1 year. (p < 0.05). In group 2 HHS is significantly higher 6 months and 1 year postoperatively (p< 0.05). No significant differences in HOOS subscores between subjects of group 1 and 2 for subsequent time points were found. The scores related to Pain and Symptoms increased significantly 6 weeks after THR (p< 0.01). Sports and recreation scores increased significantly up to 3 months after THR (p< 0.01). Activities of daily living, and Quality of Life (QoL) improved up to 6 months after surgery (p< 0.01).

No significant difference between the 2 groups in QoL was observed. The physical component summary increased up to 3 months after surgery (p< 0.01). The mental component summary did not change significantly after THR.

The difference noted in HHS between group 1 and 2 may be due to the selection of the fixation technique which is often directly related to the patient’s age. The results of the HOOS score confirm the findings of the HHS. Not all patients responded to the questions relative to recreation and sport of the HOOS score. QoL is an important indicator for success as perceived by the patient. In this study a rapid improvement of QoL is observed (3 months) and there is little change at 6 and 12 months.

Success of a total hip replacement is commonly assessed by the Haris Hip Score (HHS), which provides information on pain reduction and regained mobility. Radiographic images provide information relative to the stability of the prosthesis.

We use the intraoperatively manufactured prosthesis since 1989; the initially performed THR were done with uncoated prostheses. After introduction of the hydroxyapatite coating our prosthesis stems were coated.

We retrospectively evaluated the clinical and radiographic outcome of 3 patient cohorts who received intra-operatively custom made stem prosthesis.

Group 1: Uncoated stem prosthesis fixated with tro-chanteric osteotomy.

Clinical assessment and radiographic assessment is performed using pre-operatively and at each follow-up visit.

Baseline data are the pre-operative HHS and first radiography postoperatively. These data are compared with the data of the latest follow-up visit.

RX’s are scored according to the ARA score.

Records were analysed for 83 patients in group 1, with a mean follow-up period of 93 months. In group 2, 35 patients were followed for 105 months and 54 patients from group 3 were followed for 41 months.

In the 3 groups the HHS at follow-up was > 75, this means an improvement of minimum 25 points for group 1 and 2 (baseline HHS for group 2 was not available)

The mean ARA scores at follow-up were 1.6; 1.7 and 5.3 for respectively group 1; 2 and 3.

Clinical outcome is comparable in the three studied cohorts.

The ARA score is indicating poor outcome for the uncoated prosthesis, regardless of the type of fixation, while the coated prosthesis group has a good to excellent ARA score.

These findings tend to confirm the superiority of the hydroxyapatite coated prosthesis.