High survival of uncemented proximally porous-coated titanium alloy femoral stems in osteoporotic bone.
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.
Meding
John B
JB
The Center for Hip and Knee Surgery, St Francis Hospital, Mooresville, 1199 Hadley Road, Mooresville, IN 46158, USA.
Galley
Matthew R
MR
Ritter
Merrill A
MA
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
D000497:Alloys; D020099:Coated Materials, Biocompatible; C031462:titanium alloy (TiAl6V4); D014025:Titanium