title: Survivorship of uncemented proximally porous-coated femoral components.
abstract: Three hundred seventy-five consecutive total hip arthroplasty revisions done using proximally porous-coated femoral components of 6 designs were reviewed a mean of 4.7 years after surgery. Fifty-nine hips have been rerevised for aseptic femoral loosening, and 4 for osteolysis. Moderate or severe pain was present in 23% of surviving hips, and radiographic evidence of femoral loosening was present in 38% of surviving hips at the most recent followup. At 8 years, survivorship free of revision for aseptic femoral failure (for loosening or osteolysis) was 58% (95% confidence intervals, 44.3%, 69.6%); survivorship free of aseptic femoral loosening (revision for aseptic loosening or radiographic loosening) was 20% (95% confidence intervals, 12%, 27%); and survivorship free of symptomatic femoral loosening (revision for aseptic loosening or radiographic femoral loosening with moderate or severe pain) was 45% (95% confidence intervals, 32.3%, 56%). More severe preoperative bone loss correlated with poorer survivorship free of aseptic loosening and subsidence of > or = 5 mm. Differences among the prosthetic-type groups with respect to patient's age, gender, and bone loss severity precluded direct comparison of performance for each prosthetic type; however, all the prostheses had a significant rate of rerevision and aseptic loosening. Stable long-term fixation with the proximally porous-coated femoral components used in this series was not achieved on a predictable and reproducible basis. The damaged, weakened bone often present in the proximal femur during revision probably does not provide an optimal environment for sturdy initial or long-term biologic fixation of these devices that rely on the proximal femoral bone for fixation.
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Berry
authors.forename: W S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: D
authors.initials: D
authors.lastname: Ilstrup
authors.forename: D G
authors.initials: DG
authors.lastname: Lewallen
authors.forename: M E
authors.initials: ME
authors.lastname: Cabanela
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003627:Data Interpretation, Statistical; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis; D010149:Postoperative Pain; D016062:Porosity; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies