title: Fixation and loosening of the cemented Muller straight stem: a long-term clinical and radiological review.
abstract: The original forged Müller straight stem (CoNiCr) has shown excellent ten- to 15-year results. We undertook a long-term survival analysis with special emphasis on radiological changes within a 20-year period of follow-up. In all, 165 primary total hip replacements, undertaken between July 1984 and June 1987 were followed prospectively. Clinical follow-up included a standardised clinical examination, and radiological assessment was based on a standardised anteroposterior radiograph of the pelvis, which was studied for the presence of osteolysis, debonding and cortical atrophy. Survival of the stem with revision for any reason was 81% (95% confidence interval (CI), 76 to 86) at 20 years and for aseptic loosening 87% (95% CI, 82 to 90). At the 20-year follow-up, 15 of the surviving 36 stems showed no radiological changes. Debonding (p = 0.005), osteolysis (p = 0.003) and linear polyethylene wear (p = 0.016) were associated with aseptic loosening, whereas cortical atrophy was not associated with failure (p = 0.008). The 20-year results of the Müller straight stem are comparable to those of other successful cemented systems with similar follow-up. Radiological changes are frequently observed, but with a low incidence of progression, and rarely result in revision. Cortical atrophy appears to be an effect of ageing and not a sign of loosening of the femoral component.
authors.affiliation: Department of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, Liestal CH 4410, Switzerland. martin.clauss@ksli.ch
authors.forename: M
authors.initials: M
authors.lastname: Clauss
authors.forename: M
authors.initials: M
authors.lastname: Luem
authors.forename: P E
authors.initials: PE
authors.lastname: Ochsner
authors.forename: T
authors.initials: T
authors.lastname: Ilchmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002484:Cementation / Q000009:adverse effects / Q000379:methods*; D004812:Epidemiologic Methods; D019544:Equipment Failure Analysis; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data