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Hybrid total hip arthroplasty with a precoated offset stem. Four to nine-year results.
J Bone Joint Surg Am 2000; 82(9):1291-9JB

Abstract

BACKGROUND

Use of modern cementing techniques for fixation of femoral components in total hip arthroplasty has had excellent clinical and radiographic results in most patients. However, several authors have described early loosening of femoral components with roughened and precoated finishes. The purpose of this study was to examine the performance of the precoated Iowa stem, which has increased offset, and to compare the results with those of another cemented precoated femoral component with standard offset used at our institution.

METHODS

We carried out a prospective analysis of 102 primary hybrid total hip arthroplasties (a cementless acetabular component and a cemented femoral component) performed with use of the Iowa femoral component in ninety-five patients at our institution. The Iowa stem was used in hips that required greater offset than is available with standard stems as determined by preoperative templating. The average age of the patients at the time of the index procedure was sixty-nine years. Sixteen patients (seventeen hips) died before the forty-eight-month minimum follow-up period had elapsed. Two patients were lost to follow-up, and radiographic follow-up was incomplete for one. The mean duration of clinical and radiographic follow-up of the remaining eighty-two hips in the seventy-six surviving patients was sixty-five months (range, forty-eight to 104 months).

RESULTS

The average preoperative Harris hip score of 47 points (range, 16 to 69 points) improved to an average of 87 points (range, 24 to 100 points) at the time of the review. Two hips underwent femoral component revision. Four femoral stems were radiographically loose at an average of thirty-four months. Femoral osteolysis was seen in five hips (6 percent) at an average of fifty-four months postoperatively. No acetabular component was revised because of aseptic loosening. According to Kaplan-Meier analysis, the seven-year survival rate, with an end point of femoral revision, osteolysis, or stem debonding, was 90.6 percent (95 percent confidence interval, 0.87 to 0.94).

CONCLUSIONS

The prevalence of revision, osteolysis, and loosening after total hip arthroplasty with the Iowa femoral component at our institution was higher than that seen in our series of Harris Precoat stems, which had a survival rate of 98.4 percent (95 percent confidence interval, 0.97 to 1.00) at ten years with the same end points. The design of the Iowa stem may make it difficult to achieve a good cement mantle, and, in combination with the geometry and increased offset of the stem, may compromise the long-term survival of this cemented femoral component.

Authors+Show Affiliations

Arthritis and Orthopaedics Institute, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago, Illinois 60612, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

11005520

Citation

Cannestra, V P., et al. "Hybrid Total Hip Arthroplasty With a Precoated Offset Stem. Four to Nine-year Results." The Journal of Bone and Joint Surgery. American Volume, vol. 82, no. 9, 2000, pp. 1291-9.
Cannestra VP, Berger RA, Quigley LR, et al. Hybrid total hip arthroplasty with a precoated offset stem. Four to nine-year results. J Bone Joint Surg Am. 2000;82(9):1291-9.
Cannestra, V. P., Berger, R. A., Quigley, L. R., Jacobs, J. J., Rosenberg, A. G., & Galante, J. O. (2000). Hybrid total hip arthroplasty with a precoated offset stem. Four to nine-year results. The Journal of Bone and Joint Surgery. American Volume, 82(9), pp. 1291-9.
Cannestra VP, et al. Hybrid Total Hip Arthroplasty With a Precoated Offset Stem. Four to Nine-year Results. J Bone Joint Surg Am. 2000;82(9):1291-9. PubMed PMID: 11005520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hybrid total hip arthroplasty with a precoated offset stem. Four to nine-year results. AU - Cannestra,V P, AU - Berger,R A, AU - Quigley,L R, AU - Jacobs,J J, AU - Rosenberg,A G, AU - Galante,J O, PY - 2000/9/27/pubmed PY - 2001/2/28/medline PY - 2000/9/27/entrez SP - 1291 EP - 9 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 82 IS - 9 N2 - BACKGROUND: Use of modern cementing techniques for fixation of femoral components in total hip arthroplasty has had excellent clinical and radiographic results in most patients. However, several authors have described early loosening of femoral components with roughened and precoated finishes. The purpose of this study was to examine the performance of the precoated Iowa stem, which has increased offset, and to compare the results with those of another cemented precoated femoral component with standard offset used at our institution. METHODS: We carried out a prospective analysis of 102 primary hybrid total hip arthroplasties (a cementless acetabular component and a cemented femoral component) performed with use of the Iowa femoral component in ninety-five patients at our institution. The Iowa stem was used in hips that required greater offset than is available with standard stems as determined by preoperative templating. The average age of the patients at the time of the index procedure was sixty-nine years. Sixteen patients (seventeen hips) died before the forty-eight-month minimum follow-up period had elapsed. Two patients were lost to follow-up, and radiographic follow-up was incomplete for one. The mean duration of clinical and radiographic follow-up of the remaining eighty-two hips in the seventy-six surviving patients was sixty-five months (range, forty-eight to 104 months). RESULTS: The average preoperative Harris hip score of 47 points (range, 16 to 69 points) improved to an average of 87 points (range, 24 to 100 points) at the time of the review. Two hips underwent femoral component revision. Four femoral stems were radiographically loose at an average of thirty-four months. Femoral osteolysis was seen in five hips (6 percent) at an average of fifty-four months postoperatively. No acetabular component was revised because of aseptic loosening. According to Kaplan-Meier analysis, the seven-year survival rate, with an end point of femoral revision, osteolysis, or stem debonding, was 90.6 percent (95 percent confidence interval, 0.87 to 0.94). CONCLUSIONS: The prevalence of revision, osteolysis, and loosening after total hip arthroplasty with the Iowa femoral component at our institution was higher than that seen in our series of Harris Precoat stems, which had a survival rate of 98.4 percent (95 percent confidence interval, 0.97 to 1.00) at ten years with the same end points. The design of the Iowa stem may make it difficult to achieve a good cement mantle, and, in combination with the geometry and increased offset of the stem, may compromise the long-term survival of this cemented femoral component. SN - 0021-9355 UR - https://www.unboundmedicine.com/medline/citation/11005520/Hybrid_total_hip_arthroplasty_with_a_precoated_offset_stem__Four_to_nine_year_results_ L2 - http://Insights.ovid.com/pubmed?pmid=11005520 DB - PRIME DP - Unbound Medicine ER -