Custom cementless stem improves hip function in young patients at 15-year followup.
THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D'Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%-97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%-97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Flecher
Xavier
X
Department of Orthopaedic Surgery, Center for Arthritis Surgery, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France.
Pearce
Oliver
O
Parratte
Sebastien
S
Aubaniac
Jean-Manuel
JM
Argenson
Jean-Noel
JN
D000293:Adolescent; D000328:Adult; D001843:Bone Cements; D002484:Cementation; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008875:Middle Aged; D010014:Osteolysis; D010146:Pain / Q000503:physiopathology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D055815:Young Adult
D001843:Bone Cements
J Bone Joint Surg Br. 1987 Jan;69(1):45-55
3818732
J Arthroplasty. 2002 Feb;17(2):184-8
11847617
J Arthroplasty. 2000 Jan;15(1):93-101
10654469
J Arthroplasty. 1997 Apr;12(3):256-66
9113539
Clin Orthop Relat Res. 2005 Aug;(437):169-75
16056046
Clin Orthop Relat Res. 2009 Jun;467(6):1516-21
18719971
Int Orthop. 2007 Apr;31(2):217-22
16736144
BMC Musculoskelet Disord. 2003 May 30;4:10
12777182
J Bone Joint Surg Am. 2003 May;85(5):885-9
12728040
J Bone Joint Surg Am. 1994 Oct;76(10):1464-70
7929493
J Bone Joint Surg Am. 2003 Jun;85(6):1066-72
12784004
Rev Chir Orthop Reparatrice Appar Mot. 2006 Jun;92(4):332-42
16948460
Acta Orthop Scand. 2003 Jun;74(3):253-8
12899543
Acta Orthop Scand. 2000 Aug;71(4):337-53
11028881
J Arthroplasty. 2006 Jun;21(4):547-52
16781408
J Arthroplasty. 2009 Jan;24(1):65-70
18617364
J Bone Joint Surg Am. 1997 Jul;79(7):1007-12
9234876
J Bone Joint Surg Am. 1975 Jul;57(5):619-25
1150702
Rev Chir Orthop Reparatrice Appar Mot. 2000 Oct;86(6):590-7
11060433
Clin Orthop Relat Res. 2000 Apr;(373):153-63
10810473
Acta Orthop. 2008 Apr;79(2):194-202
18484244
J Bone Joint Surg Am. 2004 Nov;86(11):2475-81
15523021
Acta Orthop. 2008 Apr;79(2):203-10
18484245
Clin Orthop Relat Res. 2004 Jan;(418):119-25
15043102
J Bone Joint Surg Am. 2003 Jan;85(1):109-14
12533580
Rev Chir Orthop Reparatrice Appar Mot. 2008 Jun;94(4):361-7
18555862
Clin Orthop Relat Res. 2004 Oct;(427):157-61
15552152
Arch Orthop Trauma Surg. 2000;120(7-8):407-12
10968528
Clin Orthop Relat Res. 1979 Jun;(141):17-27
477100
Clin Orthop Relat Res. 1989 Dec;(249):73-8
2582679
Acta Orthop. 2005 Feb;76(1):28-41
15788305
Clin Orthop Relat Res. 2007 Dec;465:40-5
17906591
J Bone Joint Surg Am. 1979 Jan;61(1):15-23
365863
J Bone Joint Surg Br. 2005 Sep;87(9):1192-6
16129740
J Bone Joint Surg Am. 1954 Jun;36-A(3):451-75
13163078
J Bone Joint Surg Br. 1992 Jul;74(4):507-10
1624506
Clin Orthop Relat Res. 2001 Jul;(388):125-34
11451111
J Bone Joint Surg Br. 1992 Jan;74(1):28-32
1732260
Clin Orthop Relat Res. 1989 Dec;(249):79-96
2684468
Osteoarthritis Cartilage. 2008 May;16(5):551-9
18296074
Clin Orthop Relat Res. 1988 Jun;(231):7-28
3370887
J Arthroplasty. 1993 Apr;8(2):129-32
8478629
J Arthroplasty. 2001 Apr;16(3):312-6
11307128
Clin Orthop Relat Res. 1998 Oct;(355):189-99
9917604
J Arthroplasty. 1997 Jun;12(4):444-50
9195321
J Bone Joint Surg Am. 1969 Jun;51(4):737-55
5783851
J Bone Joint Surg Am. 1991 Apr;73(4):593-7
2013599
Orthopedics. 1999 Dec;22(12):1154-60; quiz 1161-2
10604809
J Bone Joint Surg Am. 1997 Jul;79(7):1023-9
9234878
Clin Orthop Relat Res. 2001 Dec;(393):101-11
11764338
J Bone Joint Surg Am. 2004 Jun;86(6):1254-61
15173300
Z Orthop Ihre Grenzgeb. 1995 Nov-Dec;133(6):558-61
8571660
J Arthroplasty. 2009 Dec;24(8):1184-7
19195836