Cementless Total Hip Arthroplasty Using the Conical Femoral Stem

Sang Soo Park; Sang Hong Lee; Woong Hee Kim; Sang Ho Ha

doi:10.4055/jkoa.2013.48.6.426

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Park, Lee, Kim, and Ha: Cementless Total Hip Arthroplasty Using the Conical Femoral Stem

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(6): 426-432.

Published online: 26 October 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.6.426

Cementless Total Hip Arthroplasty Using the Conical Femoral Stem

Sang Soo Park, M.D., Sang Hong Lee, M.D., Woong Hee Kim, M.D., Sang Ho Ha, M.D.

Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Correspondence to: Sang Hong Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. TEL: +82-62-220-3147, FAX: +82-62-226-3379, shalee@chosun.ac.kr

Received 22 May 2013 Revised 21 June 2013 Accepted 5 September 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the clinical and radiological results of cementless total hip arthroplasty using a conical stem.

Materials and Methods

From June 2005 to December 2007, total hip arthroplasty using the conical stem was performed in 47 patients and 51 hips. The most common causes for total hip arthroplaty were osteonecrosis of the femoral head in 32 cases. The mean follow-up period was 74.3 months (range: 62-93 months) and the mean age was 51.2 years (range: 36-84 years). The clinical evaluation included the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and pain on the inguinal area or thigh. Radiographic evaluation was performed for determination of the fixation status of the implant, the radiolucent line, subsidence, loosening and heterotopic ossification around the acetabular cup and the femoral stem.

Results

At the most recent follow-up, the mean Harris hip score was 94.1 points and the WOMAC score was 11.3 points. Radiologically, bone ongrowth was seen in all cases without migration of acetabular cup, femoral stem, changing of the position, subsidence and loosening. Complications included two cases of posterior dislocation, one case of heterotopic ossification, and one case of deep vein thrombosis.

Conclusion

Cementless total hip arthroplasty using the conical femoral stem shows good clinical and radiologic results in treatment of osteonecrosis of the femoral head with normal canal flare index and femur neck fracture with stove pipe type.

Keywords: conical femoral stem, cementless total hip arthroplasty

Figures and Tables

Figure 1

(A) Characteristics of the Wagner cone stem. It has a tapered angle of 5 degrees with eight sharp longitudinal ridges. It consists of a coarse blasted titanium surface for osseointegration. (B) haracteristics of the Fitmore cup. The outer surface of the implant consists of a 4-layered grid made of titanium. If press-fit stability is not achieved, screw fixation is necessary for optional stabilization.

Figure 2

(A) Radiograph of a 50-year-old male with avascular necrosis of the left hip with stove pipe canal type. (B) Immediate postoperative anteroposterior hip radiograph. (C, D) The hip anterioposterior and lateral radiograph shows no subsidence or osteolysis at six years after the operation.

Figure 3

(A) Radiograph of a 70-year-old male with avascular necrosis of the right hip with stove pipe canal type. (B) Immediate postoperative anteroposterior hip radiograph. (C, D) Hip anterioposterior and lateral radiograph showing no subsidence or osteolysis at 6.5 years after the operation.

Notes

This study was supported by research fund from Chosun University, 2011.

References

1. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988; 231:7–28.

2. McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented femoral component. Excellent results at ten-year follow-up. J Bone Joint Surg Br. 1997; 79:900–907.

3. Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. Clin Orthop Relat Res. 1988; 235:148–165.

4. Dinse GE, Lagakos SW. Nonparametric estimation of lifetime and disease onset distributions from incomplete observations. Biometrics. 1982; 38:921–932.

5. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15:1833–1840.

6. Lee S, Kim JH, Ko DO, Jeon YW, Yang SJ, Ryu CW. Ceramic on ceramic hybrid type total hip arthroplasty in patients with more than 65 years of age -minimum 5-year follow-up results. J Korean Hip Soc. 2008; 20:91–97.

7. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976; 121:20–32.

8. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of ient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15:1833–1840.

9. Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg Am. 2001; 83:1333–1338.

10. Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; 141:17–27.

11. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990; 257:107–128.

12. Rothman RH, Hozack WJ, Ranawat A, Moriarty L. Hydroxyapatite-coated femoral stems. A matched-pair analysis of coated and uncoated implants. J Bone Joint Surg Am. 1996; 78:319–324.

13. Zicat B, Engh CA, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am. 1995; 77:432–439.

14. Callaghan JJ, Dysart SH, Savory CG. The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg Am. 1988; 70:337–346.

15. Wagner H, Wagner M. Cone prosthesis for the hip joint. Arch Orthop Trauma Surg. 2000; 120:88–95.

16. Linde F, Jensen J. Socket loosening in arthroplasty for congenital dislocation of the hip. Acta Orthop Scand. 1988; 59:254–257.

17. Lubahn JD, Evarts CM, Feltner JB. Conversion of ankylosed hips to total hip arthroplasty. Clin Orthop Relat Res. 1980; 153:146–152.

18. Nagano H, Inoue H, Usui M, Mitani S, Satoh T. Long-term results of Charnley low-friction arthroplasty for coxarthrosis with congenital hip dysplasia. 15 year follow-up study. Bull Hosp Jt Dis. 1997; 56:197–203.

19. Dickob M, Martini T. The cementless PM hip arthroplasty. Four-to-seven-year results. J Bone Joint Surg Br. 1996; 78:195–199.

20. Schenk RK, Wehrli U. Reaction of the bone to a cement-free SL femur revision prosthesis. Histologic findings in an autopsy specimen 5 1/2 months after surgery. Orthopade. 1989; 18:454–462.

21. Wong M, Eulenberger J, Schenk R, Hunziker E. Effect of surface topology on the osseointegration of implant materials in trabecular bone. J Biomed Mater Res. 1995; 29:1567–1575.

22. Jasty M, Bragdon CR, Rubash H, Schutzer SF, Haire T, Harris W. Unrecognized femoral fractures during cementless total hip arthroplasty in the dog and their effect on bone ingrowth. J Arthroplasty. 1992; 7:501–508.

23. Engh CA, Bobyn JD. Principles, techniques, results, and complications with a porous-coated sintered metal system. Instr Course Lect. 1986; 35:169–183.

24. Willert HG, Buchhorn GH, Fayyazi A, et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 2005; 87:28–36.

25. Korovessis P, Petsinis G, Repanti M, Repantis T. Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up. J Bone Joint Surg Am. 2006; 88:1183–1191.

26. Davies AP, Willert HG, Campbell PA, Learmonth ID, Case CP. An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am. 2005; 87:18–27.

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