Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement

BACKGROUND: Fixation of the femoral component of a total hip arthroplasty without cement has had variable results. While tapered stems appear to have consistently good results, the duration of follow-up in many series has been relatively short. The purpose of this study was to present a longer-term (ten to fifteen-year) follow-up after total hip arthroplasty with insertion of a tapered femoral component without cement. METHODS: Sixty-seven total hip arthroplasties were performed with insertion of a tapered, cobalt-chromium femoral component without cement in fifty-eight patients from 1983 to 1986. Thirteen patients (fifteen hips) died prior to the fifteen-year follow-up examination, and three patients (three hips) were lost to follow-up after ten years, leaving forty-two patients (forty-nine hips) who were followed clinically for a mean of fifteen years. Thirty-seven of the forty-nine hips were followed radiographically for fifteen years, and the remaining twelve were followed for a minimum of ten years. RESULTS: The mean preoperative Charnley score was 3.0 points for pain, 2.7 points for function, and 3.2 points for motion. At the time of the final follow-up, the mean scores were 5.6, 5.6, and 5.2 points, respectively. Although no preoperative Harris hip scores were available, the mean score at the time of the latest follow-up was 92 points (range, 78 to 100 points). There were no revisions because of isolated aseptic loosening of the femoral component (although revision because of aseptic loosening of the acetabular component led to femoral component revision in seven hips). Two femoral components showed radiographic evidence of instability. At fifteen years, the prevalence of thigh pain was 2%. No femoral component that was thought to be stable, with bone ingrowth at two years, lost fixation. CONCLUSIONS: The design features of this cobalt-chromium femoral component (i.e., the collarless, tapered, wedge fit with circumferential porous coating) are thought to be crucial to the achievement of the good-to-excellent results seen in this study.