title: Three-dimensional computed cementless custom femoral stems in young patients: midterm followup.
abstract: We prospectively evaluated the results of our custom cementless femoral stems to ascertain whether this technology produced reasonable clinical function, complication rates, and loosening rates at midterm. Fifty-seven consecutive patients had surgery in 62 hips for primary osteoarthritis at a mean age of 57 years using a three-dimensional computed custom cementless stem. Patients were reviewed at a mean followup of 94.9 months. At review, the mean Harris hip score was 98.8 points (range, 84-100) compared with 61.1 (range, 28-78) points preoperatively. No patient complained of thigh pain. No migration or subsidence was observed. All stems were considered stable according to the radiographic criteria defined by Engh et al. There were no dislocations, no infections, and no reoperations. Our results are comparable with published results from clinical and radiologic points of view. Two problems remain unsolved: the price of a custom stem is twice as expensive as a standard stem; and we need longer term results before definitely recommending this technology as a reasonable alternative to current arthroplasties in younger patients. The data support the continued exploration of this technology with controlled clinical followup.
  
  
  METHODS
  Therapeutic study, Level II-1 (prospective cohort study). See the Guidelines to Authors for a complete description of levels of evidence.
authors.affiliation: Service d'Orthopédie et de Traumatologie, Lausanne University Medical School, Switzerland. Michael.Wettstein@hospvd.ch
authors.forename: Michael
authors.initials: M
authors.lastname: Wettstein
authors.forename: Elyazid
authors.initials: E
authors.lastname: Mouhsine
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Argenson
authors.forename: Pascal J
authors.initials: PJ
authors.lastname: Rubin
authors.forename: Jean-Manuel
authors.initials: JM
authors.lastname: Aubaniac
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Leyvraz
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements