title: High survival of uncemented proximally porous-coated titanium alloy femoral stems in osteoporotic bone.
abstract: Because the initial fixation of an uncemented stem may be compromised in patients with osteoporotic bone (Class C, Dorr et al.), many surgeons prefer a cemented stem in this setting. We therefore determined the survival of an uncemented, proximally porous-coated, straight-stemmed, titanium alloy femoral component in patients with Class C bone when compared with Class A and B bone. We implanted proximally plasma-sprayed, straight-stemmed titanium alloy stems in 1994 patients (2321 hips). Of these, 625 hips (27%), 1569 hips (67%), and 127 hips (6%) were classified as Classes A, B, and C, respectively. Minimum followup was 2 years (mean, 5.9 years; range, 2-19.5 years). We identified no differences in Harris hip scores, pain, radiolucencies, or osteolysis among Classes A, B, and C hips. Stem survival at 5, 10, and 15 years for aseptic loosening (failure) was 100% in all patients with Class A bone; 99+% in all patients with Class B bone; and 100% in all patients with Class C bone. Initial stability and durable fixation can be achieved with the use of this uncemented stem in patients in whom a cemented stem traditionally has been preferred as a result of poor bone quality.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: The Center for Hip and Knee Surgery, St Francis Hospital, Mooresville, 1199 Hadley Road, Mooresville, IN 46158, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Meding
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Galley
authors.forename: Merrill A
authors.initials: MA
authors.lastname: Ritter
mesh_terms: D000368:Aged; D000497:Alloys; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D016062:Porosity; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013499:Surface Properties; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D000497:Alloys; D020099:Coated Materials, Biocompatible; C031462:titanium alloy (TiAl6V4); D014025:Titanium