title: Excessive distal migration of fiber-mesh coated femoral stems.
abstract: BACKGROUND
  The surface texture, localization, and magnitude of the surface material applied to the femoral stem can facilitate bone ingrowth and influence the survival of total hip arthroplasties. Clinical and radiographic studies have shown superior bone ingrowth in proximally porous-coated stems with a diaphyseal grit-blasted surface in comparison to a smooth diaphyseal surface. Surface textures-especially porous surface material-have been suggested to have a sealing effect against migration of polyethylene debris along the implant-bone interface and to reduce the inflammatory response, leading to a prolonged implant survival.
  
  
  METHODS
  Between 2004 and 2006, we conducted a randomized, controlled trial (RCT) involving 50 patients with non-inflammatory arthritis. They received either a distally tapered, extended coated stem or a straight, proximally coated stem. During surgery, tantalum markers were inserted into the greater and lesser trochanter. Implant migration was evaluated at 3, 12, and 24 months postoperatively by radiostereometric analysis. The primary endpoint was stem migration 2 years after surgery.
  
  
  RESULTS
  All femoral components in both groups showed pronounced distal translation, with the highest rate of translation occurring between 0 and 3 months. After 2 years, the mean distal translation was 2.67 (95% CI: -3.93 to -1.42) mm for the tapered, extended coated stem and 1.80 (-2.45 to -1.15) mm for the straight, proximally coated stem. Half of the tapered, extended coated stems and two-thirds of the straight, proximally coated stems had migrated more than 1 mm. No difference between the 2 stems could be seen with regard to translation or rotation at any time point. After 2 years, 2 hips have been reoperated due to mechanical loosening of the stem.
  
  
  CONCLUSIONS
  An excessive amount of migration of both stem types was seen 2 years postoperatively. It is of vital importance to follow this patient cohort since radiostereometric analysis is known to be predictive of late implant failure, especially in this study where pronounced early migration was observed. We recommend longer follow-up of both stem types.
authors.affiliation: Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark. ıbaadhansen@dadlnet.dk
authors.forename: Thomas
authors.initials: T
authors.lastname: Baad-Hansen
authors.forename: Søren
authors.initials: S
authors.lastname: Kold
authors.forename: Niels
authors.initials: N
authors.lastname: Olsen
authors.forename: Finn
authors.initials: F
authors.lastname: Christensen
authors.forename: Kjeld
authors.initials: K
authors.lastname: Søballe
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D020099:Coated Materials, Biocompatible; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012399:Rotation; D013499:Surface Properties; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible