title: Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
abstract: BACKGROUND
  There has been controversy whether methylmethacrylate precoating of the cemented femoral stem is a solution for aseptic loosening or rather contributes to increased failure rates in cemented total hip arthroplasties.
  
  
  METHODS
  On a retrospective basis, we analyzed 76 primary hybrid total hip arthroplasties from 63 patients with precoated, cemented femoral stems between October 1990 and December 1995. The mean age of the patients was 46.8 years (range, 22 to 77 years) with a minimum follow-up of 14 years (mean, 15.5 years; range, 14 to 19.5 years). Third generation cementing techniques were employed in all cases.
  
  
  RESULTS
  Twenty-four out of 76 cases (31.6%) showed aseptic loosening of the femoral stems, of which 23 stems were revised at an average revision time of 8 years (range, 3 to 14.8 years). The main mode of loosening was cement-stem interface failure in 22 hips (91.7%). Twenty-one out of 24 failed hips (87.5%) demonstrated C2 cementing grades (p < 0.001). Kaplan-Meier survivorship analysis using radiographic aseptic loosening of the femoral stem as the endpoint for failure showed survival rates of 76.5% at 10 years (95% confidence interval [CI], 71.4 to 81.6) and 63.2% at 19 years (95% CI, 57.3 to 69.1).
  
  
  CONCLUSIONS
  An early failure of the precoated femoral stem in this study was mainly due to an insufficient cementing technique. Achievement of good cement mantle may improve the survival rates.
authors.affiliation: Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Dong Hun
authors.initials: DH
authors.lastname: Suh
authors.forename: Ho Hyun
authors.initials: HH
authors.lastname: Yun
authors.forename: Sung Kwang
authors.initials: SK
authors.lastname: Chun
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Shon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D019544:Equipment Failure Analysis; D005260:Female; D005271:Femur Head Necrosis / Q000175:diagnosis / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020366:Methylmethacrylate; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020099:Coated Materials, Biocompatible; D020366:Methylmethacrylate
keywords: Femoral stem; Methylmethacrylate precoating; Total hip arthroplasty