title: High 10-year survival rate with an anatomic cementless stem (SPS).
abstract: BACKGROUND
  Proximal cementless fixation using anatomic stems reportedly increases femoral fit and avoids stress-shielding. However, thigh pain was reported with the early stem designs. Therefore, a new anatomic cementless stem design was based on an average three-dimensional metaphyseal femoral shape. However, it is unclear whether this stem reduces the incidence of thigh pain.
  
  
  OBJECTIVE
  We asked whether this stem design was associated with a low incidence of thigh pain and provided durable fixation and high function.
  
  
  METHODS
  One hundred seventy-one patients (176 THAs) who had the anatomic proximal hydroxyapatite-coated stem implanted were reviewed. Eleven (6%) patients were lost to followup and 34 (20%) died without revision surgery. We used the Harris hip score (HHS) to assess pain and function. We evaluated femoral stem fixation and stability with the score of Engh et al. and also calculated a 10-year survival analysis. We assessed 126 patients (131 hips) at a mean followup of 10 years (range, 8-11 years)
  
  
  RESULTS
  At last followup, two patients described slight thigh pain that did not limit their physical activities. All stems appeared radiographically stable and one stem was graded nonintegrated but stable. Five patients had revision surgery: one on the femoral side (for posttraumatic fracture) and four on the acetabular side. Considering stem revision for aseptic loosening as the end point, survivorship was 100% (range, 95.4%-99.9%) at 10 years.
  
  
  CONCLUSIONS
  This anatomic cementless design using only metaphyseal fixation with a wide mediolateral flare, a sagittal curvature, and torsion, allowed durable proximal stem stability and fixation.
authors.affiliation: Department of Orthopaedic Surgery, Hôpital Pitié Salpétrière, 47-83 Bd de l'Hôpital, 75013, Paris, France. hedisari@yahoo.fr
authors.forename: Elhadi
authors.initials: E
authors.lastname: Sariali
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mouttet
authors.forename: Philippe
authors.initials: P
authors.lastname: Mordasini
authors.forename: Yves
authors.initials: Y
authors.lastname: Catonné
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D002516:Ceramics; D020099:Coated Materials, Biocompatible; D017886:Durapatite; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D010297:Paris; D011095:Polyethylenes; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015040:Zirconium
chemical_list: D020099:Coated Materials, Biocompatible; D011095:Polyethylenes; C111601:ultra-high molecular weight polyethylene; D017886:Durapatite; D015040:Zirconium; C028541:zirconium oxide