Three-dimensional computed cementless custom femoral stems in young patients: midterm followup.
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.
Wettstein
Michael
M
Service d'Orthopédie et de Traumatologie, Lausanne University Medical School, Switzerland. Michael.Wettstein@hospvd.ch
Mouhsine
Elyazid
E
Argenson
Jean-Noël
JN
Rubin
Pascal J
PJ
Aubaniac
Jean-Manuel
JM
Leyvraz
Pierre-François
PF
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
D001843:Bone Cements