Introduction: Modular metaphyseal-diaphyseal femoral stems are infrequent in primary total hip arthroplasty. We analyse the results of a proximally hydroxyapatite coated anatomic two-piece modular femoral stem over a minimum five years follow-up.

Material and Methods. 94 ESOP (Fournitures Hospitalieres, France) stems are analysed. The mean follow–up was 70.45 + 8.6 months. Patients’ mean age was 65.8 + 9.6 years. Proximal osteopenia and radiographic stem fixation are assessed according to Engh et al.

Results: There were 2 aseptic femoral stem loosenings. There were no cases with thigh pain. Three stems presented subsidence. Mean femoral canal filling was 89% and was related to stem subsidence (p< 0.05). Stable bone fixation was obtained in 83 hips and was related to fluted femora (p< 0.0001). The cumulative probability of not having radiographic loosening was 97.8% (94.8% to 100%). The cumulative probability of not having proximal femoral osteolysis was 86.0% (78.9% to 93.1%), cortical widening 88.1% (81.5% to 94.7%), and proximal osteopenia 94.5% (89.8% to 99.2%).

Conclusions: A cementless two-piece modular hydroxyapatite coated femoral stem provides good clinical results with an absence of pain and excellent radiographic results when there is good adaptation between the metaphyseal part of the stem and the femoral anatomy. This design is an option in femora with good bone quality and especially in tunnel-shaped cases. Femoral osteopenia and cortical widening were infrequent in this series. The modular metaphyseal-diaphyseal junction is not an in vivo problem, contrary to previous reports. A longer follow-up is needed to assess the results of this design.

Introduction and purpose: This study analyzes the clinical and radiographic results of two generations of the same uncemented acetabular component.

Materials and methods: The analysis comprised 83 Harris-Galante I (HGI) shells (with a 32 mm femoral head) and 93 Harris-Galante II shells (HGII) (with a 28 mm femoral head. Mean follow-up was 12.5 + 2.52 years for the HGI shells and 7.8 + years for the HGII ones. PE wear was assessed by means of image digitalization and computer software (AutoCAD).

Results: There were two cases of loosening amongst the HGI shells (Kaplan-Meier 96.9%) and one among the HGII ones (98.3%) (p = 0.7107). 4 PE replacements had to be performed due to wear in the HGI (90.7%). There were three dislocations of the PE insert in the HGI shells ( 79.7%) and one in the HGII ones (97.9%) (p = 0.883). Acetabular osteolysis was observed in 7 cases, out of which 5 were HGI and 2 HGII,. The osteolysis was related to a higher initial settling on the PE (position zero) ( p = 0.0062), a higher mean wear rate (p = 0.001), and a higher wear rate at the end of follow-up (p = 0.002). Position zero was 0.15 + 0.04 mm for HGI shells and 0.11 + 0.02 for HGII ones (p < 0.001). The mean wear rate was 0.13 + 0.23 mm/year and 0.11 + 0.09 respectively (p = 0.740). PE insert dislocation appeared after an average of 117 + 60.3 months, with a position zero of 0.15 mm for dislocated shells and y 0.13 mm for non-dislocated ones. The respective mean wear rates were 0.94 mm and 0.10 mm (p = 0.001).

Conclusions: Stable radiographical fixation was observed in the majority of shells of both generations. Osteolysis was related with higher wear. The second generation shows a lower position zero which leads to less wear at the end of follow-up, but not to a lower mean wear rate.