Straight stem and threaded cup in patients under 60 years of age: 28.8–30.2 years of follow-up

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Abstract

Purpose

The aim of this retrospective observational study of one cohort was to evaluate the long-term outcome in patients younger than 60 years after total hip arthroplasty using a straight uncemented stem and an uncemented threaded cup.

Methods

Between 1986 and 1987, 75 hips of 75 patients (mean age, 53.35 ± 6.17 years) were consecutively implanted with an Alloclassic Zweymüller/Alloclassic SL stem and an Alloclassic CSF cup. Forty-four patients had died over the last 30 years. The remaining 31 patients (mean age, 82.9 ± 6.4 years) were reinvited for follow-up examinations. Clinical and radiographic evaluations were carried out.

Results

At a mean follow-up of 29.5 (28.8–30.2), 4 patients (5.3%) were lost to follow-up.

For the endpoint aseptic loosening (defined as the removal of stem or the cup for 2 cases), the overall survival rate is 97.3%. For the endpoint revision for any reason (22 patients), the survival rate is 70.6%. Eleven patients needed an exchange of head and liner, caused by wear. The average time from implantation until change of head and liner was 21.44 years (SD 5.92). Other reasons for revision surgery were septic loosening (3 cases), aseptic loosening of stem and cup (1 case), aseptic loosening of stem (1 case), periprosthetic calcification (2 cases), implant fracture (1 case), periprosthetic fracture (1 case), intraoperative fissure of stem (1 case), and total wear of liner including cup (1 case).

Conclusion

The combination of a straight stem (Alloclassic) and a screw cup (CSF) shows excellent results in young patients under the age of 60 at ultra-long-term follow-up at 30 years. Revisions due to wear of the polyethylene liner are more likely than in the older patients.

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Most cited references 31

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Revision rate after short-stem total hip arthroplasty

Jakob van Oldenrijk, Jeroen Molleman, Michel Klaver … (2014)

Background and purpose The aim of short-stem total hip arthroplasty is to preserve proximal bone stock for future revisions, to improve biomechanical reconstruction, and to make minimally invasive approaches easier. It is therefore being increasingly considered to be a sound alternative to conventional total hip arthroplasty, especially for young and active patients. However, it is still unknown whether survival rates of short-stem hips match current standards. We made a systematic summary of reported overall survival after short-stem total hip arthroplasty. Materials and methods We conducted a systematic review of English, French, German, and Dutch literature. 2 assessors independently identified clinical studies on short-stem hip arthroplasty. After recalculating reported revision rates, we determined whether each implant had a projected revision rate of 10% or less at 10 years of follow-up or a revision rate per 100 observed component years of 1 or less. Stems were classified as “collum”, “partial collum”, or “trochanter-sparing”. Results and Interpretation We found 49 studies, or 51 cohorts, involving 19 different stems. There was a large increase in recent publications. The majority of studies included had a follow-up of less than 5 years. We found a large number of observational studies on “partial collum” and “trochanter-sparing” stems, demonstrating adequate survival rates at medium-term follow-up. Clinical evidence from “collum stem” studies was limited to a small number of studies with a medium-term follow-up period. These studies did not show a satisfactory overall survival rate.

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The John Charnley Award: Highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial.

Sion Glyn-Jones, Geraint E R Thomas, Patrick Garfjeld-Roberts … (2015)

The use of highly crosslinked polyethylene (HXLPE) is now commonplace for total hip arthroplasty. Hip simulator studies and short-term in vivo measurements suggest that the wear rate of some types of HXLPE is significantly less than conventional ultrahigh-molecular-weight polyethylene (UHMWPE). However, there are few long-term data to support its use.

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Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.

Ragnhild B. Gunderson, Pål I. Holm, H Wangen … (2008)

It is well accepted that youth and high activity levels are among the factors that increase the risk of mechanical failure of total hip prostheses. However, there are few reports of long-term results in very young patients. In this study, we evaluated the results of total 49 hip replacements (THRs) using an uncemented total hip prosthesis in 44 patients (28 females) who were 30 years or younger (range: 15-30 years). The diagnosis was ostearthritis due to congenital dislocations in 28 patients, with the remaining patients having diagnoses of sequelae of fracture, infection, Calve-Legg-Perthes disease, avascular necrosis, chondrodystrophia and epiphyseal dysplasia. In all cases we used an uncemented straight stem fully coated with hydroxyapatite (HA). In 36 cases we used a hemispherical cup inserted with press fit, and in seven cases we used a hemispherical screw cup. The patients were evaluated ten to 16 years (mean: 13 years) after the operation by radiographic and clinical examinations, including the Harris Hip, WOMAC and EuroQol-5D scores. In a sub-group of nine patients with a unilateral prosthesis, the muscle strength of the quadriceps and hamstrings was tested using a Cybex 6000. None of the stems were revised at the follow-up examination, and all were classified as well integrated, with no signs of radiological loosening. Twenty-four hips had revision of the acetabular component due to mechanical failure. The Harris Hip score was, on average, 88 (range: 62-100), the WOMAC score 80 (range: 37-100) and the EuroQol score 0.68 (range: -0.14-1). Isokinetic muscle strength testing showed that seven of the nine tested patients were weaker on the operated side. In conclusion, we found mechanical failures at the acetabular side, but excellent results with a fully HA-coated femoral stem, with no revisions after ten to 16 years.

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Author and article information

Contributors

L. Pisecky:

ORCID: http://orcid.org/0000-0003-4331-5929

Lorenz.pisecky@kepleruniklinikum.at

J. Allerstorfer: Jakob.allerstorfer@kepleruniklinikum.at

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Journal ID (iso-abbrev): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-799X

Publication date (Electronic): 26 November 2020

Publication date PMC-release: 26 November 2020

Publication date Collection: 2020

Volume: 15

Electronic Location Identifier: 563

Affiliations

[1 ]GRID grid.473675.4, Department for Orthopedics and Traumatology, , Kepler University Hospital GmbH, ; Krankenhausstraße 9, 4020 Linz, Austria

[2 ]GRID grid.9970.7, ISNI 0000 0001 1941 5140, Johannes Kepler University Linz, ; Altenberger Strasse 96, 4040 Linz, Austria

Author information

L. Pisecky http://orcid.org/0000-0003-4331-5929

Article

Publisher ID: 2102

DOI: 10.1186/s13018-020-02102-w

PMC ID: 7691067

PubMed ID: 33243270

SO-VID: c025fea3-dd4b-4f11-a407-ca8af410ab92

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 3 March 2020

Date accepted : 19 November 2020

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ScienceOpen disciplines: Surgery

Keywords: total hip arthroplasty, threaded cup csf, straight stem alloclassic sl, long-term follow-up, young patients

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ScienceOpen disciplines: Surgery

Keywords: total hip arthroplasty, threaded cup csf, straight stem alloclassic sl, long-term follow-up, young patients

Straight stem and threaded cup in patients under 60 years of age: 28.8–30.2 years of follow-up

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Most cited references 31

Revision rate after short-stem total hip arthroplasty

The John Charnley Award: Highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial.

Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.

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