Systematic Review of Literature of Cemented Femoral Components: What Is the Durability at Minimum 20 Years Followup?

Background

Cemented femoral total hip arthroplasty may be one of the most successful surgical interventions of all time. However, although results are very encouraging over the early to mid-term followup, relatively few studies have analyzed the durability of these implants beyond 20 years followup. To evaluate the performance of contemporary implants, it is important to understand how previous implants perform at 20 or more years of followup; one way to do this is to aggregate the available data in the form of a systematic review.

Questions/purposes

(1) How durable is cemented femoral fixation in the long term (minimum 20-year followup) with respect to aseptic loosening? (2) Is the durability of cemented femoral fixation dependent on age of the patient? (3) Are the long-term results of the cemented femoral fixation dependent on any identifiable characteristics of the prosthesis such as surface finish?

Methods

A systematic review was performed to identify long-term studies of cemented femoral components. After application of inclusion and exclusion criteria to 1228 articles found with a search in PubMed and EMBASE, 17 studies with a minimum of 20-year followup on cemented femoral components were thoroughly analyzed in an attempt to answer the questions of this review. The quality of the studies reviewed was assessed with the Methodological Index for Nonrandomized Studies (MINORS) instrument. All studies were case series and cohort sizes ranged from 110 to 2000 hips for patients older than 50 years of age and 41 to 93 hips for patients younger than 50 years at the time of surgery.

Results

Among the six case series performed in patients older than 50 years of age, survivorship for aseptic loosening of the femoral component ranged from 86% to 98% at 20 years followup. There were no obvious differences for younger patients when analyzing the five studies in patients younger than age 50 years in which survivorship free from aseptic loosening for these studies ranged from 77% at 20 years in one study and 68% to 94% at 25 years in the other studies. Although data pooling could not be performed because of heterogeneity of the studies included here, it appeared that stems with a rougher surface finish did not perform as well as polished stems; survivorship of stems with rougher surface finishes varied between 86% and 87%, whereas those with smoother finishes ranged between 93.5% and 98% at 20 years.

Conclusions

Excellent long-term fixation in both older and younger patients can be obtained with cemented, polished femoral stems. These results provide material for comparison with procedures performed with newer cementing techniques and newer designs, both cemented and cementless, at this extended duration of followup.     

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Background

Cementing the metaphyseal stem during hip resurfacing surgery improves the initial fixation of the femoral component. However, there may be long-term detrimental effects such as stress shielding or an increased risk of thermal necrosis associated with this technique.

Questions/purposes

We compared (1) long-term survivorship free from radiographic femoral failure, (2) validated pain scores, and (3) radiographic evidence of component fixation between hips resurfaced with a cemented metaphyseal stem and hips resurfaced with the metaphyseal stem left uncemented.

Methods

We retrospectively selected all the patients who had undergone bilateral hip resurfacing with an uncemented metaphyseal stem on one side, a cemented metaphyseal stem on the other side, and had both surgeries performed between July 1998 and February 2005. Forty-three patients matched these inclusion criteria. During that period, the indications for cementing the stem evolved in the practice of the senior author (HCA), passing through four phases; initially, only hips with large femoral defects had a cemented stem, then all stems were cemented, then all stems were left uncemented. Finally, stems were cemented for patients receiving small femoral components (< 48 mm) or having large femoral defects (or both). Of the 43 cemented stems, two, 13, 0, and 28 came from each of those four periods. All 43 patients had complete followup at a minimum of 9 years (mean, 143 ± 21 months for the uncemented stems; and 135 ± 22 months for the cemented stems; p = 0.088). Survivorship analyses were performed with Kaplan-Meier and Cox proportional hazards ratios using radiographic failure of the femoral component as the endpoint. Pain was assessed with University of California Los Angeles (UCLA) pain scores, and radiographic femoral failure was defined as complete radiolucency around the metaphyseal stem or gross migration of the femoral component.

Results

There were four failures of the femoral component in the press-fit stem group while the cemented stem group had no femoral failures (p = 0.0471). With the numbers available, we found no differences between the two groups regarding pain relief or radiographic appearance other than in patients whose components developed loosening.

Conclusions

Cementing the metaphyseal stem improves long-term implant survival and does not alter long-term pain relief or the radiographic appearance of the proximal femur as had been a concern based on the results of finite element studies. We believe that patients with small component sizes and large femoral head defects have more to gain from the use of this technique which adds surface area for fixation, and there is no clinical downside to cementing the stem in patients with large component sizes.

Level of Evidence

Level III, therapeutic study     

Is there still a place for the cemented titanium femoral stem?: 10,108 cases from the Norwegian Arthroplasty Register

Background and purpose

Despite the fact that there have been some reports on poor performance, titanium femoral stems intended for cemented fixation are still used at some centers in Europe. In this population-based registry study, we examined the results of the most frequently used cemented titanium stem in Norway.

Patients and methods

11,876 cases implanted with the cemented Titan stem were identified for the period 1987–2008. Hybrid arthroplasties were excluded, leaving 10,108 cases for this study. Stem survival and the influence of age, sex, stem offset and size, and femoral head size were evaluated using Cox regression analyses. Questionnaires were sent to the hospitals to determine the surgical technique used.

Results

Male sex, high stem offset, and small stem size were found to be risk factors for stem revision, (adjusted RR = 2.5 (1.9–3.4), 3.3 (2.3–4.8), and 2.2 (1.4–3.5), respectively). Patients operated in the period 2001–2008 had an adjusted relative risk (RR) of 4.7 (95% CI: 3.0–7.4) for stem revision due to aseptic stem loosening compared to the period 1996–2000. Changes in broaching technique and cementing technique coincided with deterioration of the results in some hospitals.

Interpretation

The increased use of small stem sizes and high-offset stems could only explain the deterioration of results to a certain degree since the year 2000. The influence of discrete changes in surgical technique over time could not be fully evaluated in this registry study. We suggest that this cemented titanium stem should be abandoned. The results of similar implants should be carefully evaluated.Femoral stems made of titanium alloys are widely used for total hip arthroplasty (THA), with cementless fixation. Titanium stems for cemented fixation have been discredited after reports on early revisions due to thigh pain, cortical thickening, and femoral osteolysis. The problems have supposedly been caused by crevice corrosion (Willert et al. 1996). There have also been reports on favorable outcome of cemented titanium stems (Acklin et al. 2001, Eingartner et al. 2001, Baumann et al. 2007), and cemented titanium stems are still used at a number of centers. In Norway, a titanium femoral stem intended for cemented fixation has been widely used since 1984. In a recent registry-based study of cemented THA, the performance of this stem (Titan) deteriorated from about the year 2000 (Espehaug et al. 2009). Furthermore, surgeons with extensive experience of the stem have contacted the registry in the last few years with concerns about cases of early loosening. We have therefore studied the performance of this particular stem design in more detail in our population-based arthroplasty register, especially regarding implant size, offset, and any changes in surgical technique including cementing technique.     

Satisfactory Results of the Exeter Revision Femoral Stem Used for Primary Total Hip Arthroplasty

Background

The Exeter cemented femoral stem has demonstrated excellent clinical and radiographic outcomes as well as long-term survivorship free from aseptic loosening. A shorter revision stem (125 mm) with a 44 offset became available for the purpose of cement-in-cement revision situations. In certain cases, this shorter revision stem may be used for various primary total hip arthroplasties (THAs) where the standard length stem would require distally reaming the femoral canal. We sought to report on the early to midterm results of this specific stem when used for primary THA regarding (1) clinical and radiographic outcomes, (2) complications, and (3) survivorship.

Poor intermediate-term survival of the uncemented Optan anatomically adapted femoral component: A retrospective study of 432 patients with a mean follow-up of 5 years

Purpose

We evaluated the 5-year survival of the uncemented Optan anatomically adapted femoral stem, with revision for aseptic loosening as the endpoint.

Methods

Between January 2004 and March 2007, 432 total hip arthroplasties (THAs) were performed in 432 patients. After follow-up for a mean time of 5 years, the patients were evaluated using the WOMAC questionnaire and plain radiography. Patients who were unable to attend the follow-up visit were contacted by telephone to determine whether they had had any revision surgery of their THA

Results

Within 5 years, 39 patients (9%) had died of unrelated causes and 63 patients (15%) had been lost to follow-up. Of the remaining cohort, 224 patients (68%) had full follow-up while 88 patients (27%) were evaluated with WOMAC only and 18 patients (5%) were evaluated with radiography only. The mean WOMAC score of all evaluated patients was 21 (10–100). At 5-year follow-up, there were 26 stem revisions reported (6%), 14 hips (3%) showed aseptic loosening, and 12 hips (3%) had had a periprosthetic femoral fracture. The 5-year survival to revision for any reason was 94%. Worst-case analysis yielded a 5-year survival of 79%.

Interpretation

The 5-year survival for aseptic loosening of the Optan anatomically adapted femoral component was disappointing. Radiographic evaluation showed evidence of proximal radiolucencies and distal cortical bone hypertrophy, which we attribute to insufficient proximal bone in-growth and increased load transfer at the tip of the stem. We do not recommend the use of the Optan femoral stem.The Optan femoral stem was designed to reduce proximal femoral bone loss after total hip arthroplasty (THA). It was designed with a specific geometry, stiffness, and surface roughness (Bieger et al. 2011). It is an anatomically shaped femoral component in the sense that it has an anteversion similar to that of the native proximal femur. The uncemented Optan femoral stem is made of a titanium-based alloy with a porous-coated proximal third. Furthermore, the femoral stem has a ventral rib that should prevent rotation. The distal narrowing, the anatomical shape, and the porous-coated proximal third of the stem are designed to lead to a physiological load transfer and therefore optimal bone in-growth of the femoral stem. Despite the theoretical advantages of the Optan femoral stem, no studies have been published on the survival of this uncemented femoral component. We evaluated the mean 5-year survival of the uncemented Optan femoral stem used in primary THA.     

High survival in young patients using a second generation uncemented total hip replacement

Purpose

Whilst excellent long-term results with contemporary uncemented stems have been reported for total hip arthroplasty in young patients, the survival rates for the whole reconstruction are often compromised by high failure rates on the acetabular site due to peri-acetabular osteolysis and accelerated wear.

Methods

In patients 60 years old or younger, we retrospectively reviewed the results at a minimum of ten years of 89 consecutive uncemented total hip replacements in 88 patients using the press-fit Fitmore acetabular component in combination with the CLS Spotorno stem and a 28-mm Metasul metal-on-metal articulation or a 28-mm alumina ceramic on conventional polyethylene bearing. The mean age at the time of surgery was 49 years (range, 25–60). The mean clinical and radiological follow-up was 12 years (range, 10–15).

Results

Six patients (six hips) died and two patients (two hips) were lost to follow-up. Five hips were revised: one for deep infection, one for peri-prosthetic femoral fracture, and one for aseptic stem loosening. In two hips an isolated revision of the acetabular liner was performed (one for recurrent dislocation and one for unexplained pain). No revision was performed for accelerated wear, osteolysis or aseptic loosening of the acetabular shell. We could not detect peri-acetabular osteolysis visible on plain radiographs in those hips evaluated radiographically. The Kaplan-Meier survival with revision for any reason as the endpoint was 94% (95% confidence interval, 86–97) at 12 years.

Conclusions

The survival rates and the radiological outcomes with this implant combination in this young and active patient group are encouraging when compared to the results reported for other uncemented cups in this age group.     

Timing of femoral prosthesis insertion during cemented arthroplasty: cement curing and static mechanical strength in an in vivo model

Background

Modern cementing techniques aim to fix the implanted femoral prosthesis in the medullary cavity to minimize long-term complications such as aseptic loosening. The cure stage of bone cement into which the femoral component is being inserted is an important variable that is decided at the time of surgery. Late-cure cement is more viscous than early-cure cement and requires greater force on the part of the surgeon to insert the femoral prosthesis. We compared 2 cementing techniques, femoral component insertion into early-cure cement and insertion into late-cure cement, using an in vivo model to identify if cement cure stage affects the strength of the bone–cement interface.

Methods

We performed bilateral hemiarthroplasties using only the femoral component in vivo on paired porcine femora. The femora were harvested and cross-sectioned in preparation for strength testing. We measured bond strength by peak load required to push the femoral prosthesis and surrounding cement mantle free of the cancellous bone.

Results

All radiographs showed good cement interdigitation with no evidence of radiolucent lines at the bone–cement interface. We could not differentiate the early-cure and late-cure groups on postoperative radiographs. The mean failure load for the late-cure arthroplasties was 908 N (standard deviation [SD] 420 N), whereas the mean failure load for the conjugate early-cure arthroplasties was 503 N (SD 342 N).

Conclusion

Femoral component insertion into late-cure cement required significantly higher loads for push-out than femoral component insertion into early-cure cement.     

Impact of Femoral Stem Design on Failure After Anterior Approach Total Hip Arthroplasty

Background

An increased rate of complications related to femoral component failure has been described with less invasive total hip arthroplasty (THA). This study evaluated the incidence of femoral complications associated with the direct anterior approach for THA.

Early failure of precoated femoral components in primary total hip arthroplasty

BACKGROUND: In an effort to decrease the rate of aseptic loosening, certain cemented femoral components were designed to have a roughened or textured surface with a methylmethacrylate precoating. Reports differ as to whether this step has increased or decreased the rate of failure. This study was designed to evaluate this issue. METHODS: Five hundred and fourteen hips treated with a cemented Harris Precoat stem (Zimmer, Warsaw, Indiana) were evaluated clinically and radiographically and compared with 254 hips treated with an uncoated Harris Design-2 stem (Howmedica, East Rutherford, New Jersey). Prostheses that had been removed at revision were examined. The cementing and surgical techniques were identical and the population demographics were similar for these two groups. RESULTS: The mean durations of follow-up were 8.4 and 13.5 years for the Precoat and uncoated Design-2 stems, respectively. At those times, at least forty-nine (9.5%) of the 514 Precoat components and at least ten (3.9%) of the 254 uncoated Design-2 stems had failed (p = 0.006). Five Precoat stems fractured, and no uncoated Design-2 stems fractured. Component failure was associated with use in young, active, heavy men with a diagnosis of avascular necrosis and generally with the use of smaller components. The cementing technique was satisfactory in the majority of the patients, and there were no qualitative differences in cementing technique between the hips that failed and those that did not. The mechanisms of failure of the Precoat prostheses included bone-cement loosening, focal osteolysis, stem fracture, and prosthesis-cement debonding. Fractures of smaller components occurred as a result of fatigue failure and were associated with good distal fixation but proximal stem loosening. CONCLUSIONS: The rate of failure of roughened, precoated, cemented femoral components was considerably higher and occurred earlier than that of femoral components that were neither textured nor precoated with methylmethacrylate. Younger patients with avascular necrosis had a higher risk of failure; however, this factor alone did not completely explain the differences in outcome between these two components. The causes of aseptic loosening are multifactorial and may be related to component design and size as well as to precoating and surface finish.     

10 years results of an uncemented metaphyseal fit modular stem in elderly patients

Background:

There are concerns with regard to the femoral fixation in cementless total hip arthroplasty in elderly patients. We report a retrospective analysis of clinical and radiological results of uncemented metaphyseal fit modular stem in elderly patients irrespective of anatomic characterstics of proximal femur.

Materials and Methods:

This study reviews the outcomes of 60 primary hip replacements using a metaphyseal fit modular stem (third-generation Omniflex stem) conducted in 54 patients, of age 75 years or older. After a mean follow-up of 10,4 years, complete clinical and radiographic records were available for 52 hips of 48 patients. The patients were evaluated by Harris Hip Score (HHS).

Results:

There was a significantly improved pain score and Harris Hip Score (41,6 to 83,2). Six stems (11.53%) were revised: four because of periprosthetic fracture; one stem was well fixed, but presented a large osteolytic lesion in the metaphyseal area and the last stem was revised because of aseptic loosening. Stem survival taking aseptic loosening as the end-point was 98%. Bone atrophy in the proximal femur caused by stress shielding was observed in 39 stems (75%), but there was no case of subtrochanteric stress shielding. Moreover, atrophy appeared within two years postoperatively, with no extension thereafter.

Conclusions:

We achieved good clinical and radiographic results by uncemented metaphyseal fit femoral stem regardless of patient''s age and femoral canal type.     

Hinge total knee replacement revisited

Objective

To determine if aseptic loosening is a major problem in hinge total knee replacement.

Design

A cohort study.

Setting

A university-affiliated institute, specializing in elective orthopedic surgery.

Patients

Fifty-eight patients, mainly those requiring revision, in whom the conditions were such that it was felt only a totally constrained implant was appropriate. In 7 patients the implant was press-fitted; in the remainder it was cemented. Five patients required fusion or revision, and 8 died less than 2 years after implantation, leaving 45 for review. Follow-up was 2 to 13 years.

Intervention

Total knee replacement with a Guepar II prosthesis.

Main outcome measures

Radiolucency determined by the Cameron system and clinical scoring using the Hospital for Special Surgery system.

Results

Of the cemented components, 91% of femoral stems were type IA (no lucency), 9% were type IB (partial lucency), with no type II or III lucency. Tibial lucency was 87% type IA and 13% type IB, with no type II or III lucency. Of the noncemented components, 58% of femoral components were type IA and 42% type IB. Tibial lucency was 71% type IA and 29% type IB. Lucency was mainly present in zones 1 and 2 adjacent to the knee. Clinical rating was 18% excellent, 20% good, 20% fair and 42% poor. Postoperative complications included infection (13%), aseptic loosening (7%), quadriceps lag (16%) and extensor mechanism problems (16%).

Conclusions

Aseptic loosening is an uncommon problem in hinge total knee replacement. The complication rate in cases of sufficient severity as to require a hinge replacement remains high. Current indications for a hinge prosthesis are anteroposterior instability with a very large flexion gap, complete absence of the collateral ligaments and complete absence of a functioning extensor mechanism.     

Long-term results of cementless femoral reconstruction following intertrochanteric osteotomy

Purpose

The objective of this retrospective cohort study was to assess the long-term outcome of cementless femoral reconstruction in patients with previous intertrochanteric osteotomy (ITO).

Methods

We evaluated the clinical and radiographic results of a consecutive series of 45 patients (48 hips, mean age 50 years) who had undergone conversion hip replacement following ITO with a cementless, grit-blasted, double-tapered femoral component. Clinical outcome was determined using the Harris hip score. Stem survival for different end points was assessed using Kaplan-Meier survivorship analysis.

Results

At a mean follow-up of 20 (range, 16–24) years, 11 patients (12 hips) had died, and no patient was lost to follow-up. Six patients (six hips) underwent femoral revision, two for infection, three for aseptic loosening and one for periprosthetic fracture. Mean Harris hip score at final follow-up was 78 points (range, 23–100 points). Stem survival for all revisions was 89% (95%CI, 75–95) at 20 years, and survival for aseptic loosening was 93% (95%CI, 80–98).

Conclusions

The long-term results with this type of cementless femoral component in patients with previous intertrochanteric osteotomy are encouraging and compare well to those achieved in patients with normal femoral anatomy.     

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study

Background

This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years.

Methods

We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures.

Results

The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years.

Conclusions

The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.     

A retrospective study of total hip arthroplasty

Aim:

To evaluate the functional and radiological outcome of primary total hip replacement (THR) using modular total hip system at 2-10 years follow-up.

Materials and Methods:

The cohort comprised 100 operated cases for total hip replacement using modular hip system, with an average follow-up of 6.02 years ranging from 2-10 years. In 61 cases cemented THR, in 36 cases hybrid and in three cases uncemented THR was done. Harris hip score was used for clinical evaluation. Osteolysis was recorded in three acetabular zones described by DeLee and Charnley and the seven femoral zones described by Gruen et al.

Results:

The average age at operation was 52.46±9.58 years. Mean follow-up duration was 6.02 years ranging from 2-10 years. Four patients died due to causes unrelated to surgery. At the last follow-up mean Harris Hip score was 83.5. Radiolucent lines were present in 39(39%) acetabular and 32 (32%) femoral components. Osteolysis was most common in Zone 7 of the femoral and Zone II and III of the acetabular component. Eight hips have been revised, five for aseptic loosening as proved by negative culture at revision and three hips for posttraumatic periprosthetic femoral fracture. One girdle stone resection was done for deep infection. Out of 96 hips available at latest follow-up, 87 primary arthroplasties were intact and functioning well.

Conclusion:

The results of our study support the continued use of the modular hip system. The acetabular loosening was more common than femoral in our study.     

Long-term results of total hip arthroplasty using Charnley Elite-Plus stem and the effect of stem geometry on radiographic distal femoral cortical hypertrophy

Background

The Elite-Plus stem has two shape variations: roundback and flanged. The correlation between the radiographic results and stem geometry has not been previously investigated. The objective of this study was to evaluate the long-term primary total hip arthroplasty results using Elite-Plus stems, and the effect of stem geometry on radiographic distal femoral cortical hypertrophy.

Satisfying Outcomes Scores and Survivorship Achieved With Impaction Grafting for Revision THA in Young Patients

Background

The increasing number of total hip arthroplasties (THAs) performed in younger patients will inevitably generate larger numbers of revision procedures for this specific group of patients. Unfortunately, no satisfying revision method with acceptable survivorship 10 years after revision has been described for these patients so far.

Questions/purposes

The purposes of this study were to (1) analyze the clinical outcome; (2) complication rate; (3) survivorship; and (4) radiographic outcome of cemented revision THA performed with impaction bone grafting (IBG) on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.

Methods

During the period 1991 to 2007, 86 complete THA revisions were performed at our institution in patients younger than 55 years. In 34 of these 86 revisions (40%), IBG was used on both the acetabular and femoral sides in 33 patients. Mean patient age at revision surgery was 46.4 years (SD 7.6). No patient was lost to followup, but three patients died during followup. None of the deaths were related to the revision surgery. The mean followup for the surviving hips was 11.7 years (SD 4.6). We also analyzed complication rate.

Results

The mean Harris hip score improved from 55 (SD 18) preoperatively to 80 points (SD 16) at latest followup (p = 0.009). Six hips underwent a rerevision (18%): in four patients, both components were rerevised; and in two hips, only the cup was revised. Patient 10-year survival rate with the endpoint of rerevision for any component for any reason was 87% (95% confidence interval [CI], 67%–95%) and with the endpoint of rerevision for aseptic loosening, the survival rate was 97% (95% CI, 80%–100%). In total six cups were considered radiographically loose, of which four were rerevised. Three stems were radiographically loose, of which none was rerevised.

Conclusions

IBG is a valuable biological revision technique that may restore bone stock in younger patients. Bone stock reconstruction is important, because these patients likely will outlive their revision implants. Bone reconstruction with impaction grafting may facilitate future revisions.

Level of Evidence

Level IV, therapeutic study.     

Advantages in Using Cemented Polished Tapered Stems When Performing Total Hip Arthroplasty in Very Young Patients

Background

The risk of revision following primary total hip arthroplasty (THA) is increased in young patients who undergo THA for pathologies other than primary osteoarthritis. We report the results of primary THA performed with cemented polished stems in patients aged 40 years and younger for pathologies other than primary osteoarthritis.