Short-term Outcomes With a Second-Generation Uncemented Stem in Total Hip Arthroplasty
Abstract
An uncemented stem has been used successfully in total hip arthroplasty for 2 decades, and some implants have been updated. The authors have used second-generation uncemented proximal porous coating stems, the Echo Bi-Metric Full Proximal Profile stem (Echo FPP; Biomet, Warsaw, Indiana) and the Echo Reduced Proximal Profile stem (Echo RPP; Biomet). This article reports short-term outcomes with these stems compared with their predecessor, the Bi-Metric stem (Biomet). The authors reviewed 1280 Echo FPP stems, 366 Echo RPP stems, and 1497 Bi-Metric stems. With more than 5 years of follow-up, both the Echo FPP and the Echo RPP stems had 100% survivorship with stem revision as the endpoint, and the Bi-Metric stems also had 100% survivorship for more than 20 years. Average Harris Hip Scores for the Echo FPP, the Echo RPP, and the Bi-Metric stems were 53.3, 49.7, and 51.5 preoperatively, 93.8, 94.6, and 95.2 at 1 year, and 94.0, 95.8, and 95.4 at 3 years postoperatively, respectively. Dislocation after surgery was significantly lower with the Echo FPP and the Echo RPP stems than with the Bi-Metric stems, but this was more relevant to the surgical approach and head size. All radiographs of the Echo FPP, the Echo RPP, and the Bi-Metric stems showed proximal femoral remodeling consistent with osseous ingrowth. Distal cortical hypertrophy around the implanted stem and spot-welding were comparably observed in all 3 cohorts. The short-term outcomes of the updated uncemented stems were as excellent as the previously used stem regarding survivorship, complications, and radiographic assessment. [Orthopedics. 2016; 39(2):e215–e218.]
- 1.Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011; 93(5):500–509.
10.2106/JBJS.J.00774 > Crossref MedlineGoogle Scholar - 2.Corten K, Bourne RB, Charron KD, Au K, Rorabeck CH. What works best, a cemented or cementless primary total hip arthroplasty? Minimum 17-year followup of a randomized controlled trial. Clin Orthop Relat Res. 2011; 469(1):209–217.
10.1007/s11999-010-1459-5 > Crossref MedlineGoogle Scholar - 3.McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. J Bone Joint Surg Am. 2008; 90(6):1290–1296.
10.2106/JBJS.G.00771 > Crossref MedlineGoogle Scholar - 4.Meding JB, Ritter MA, Keating EM, Berend ME. Twenty-year followup of an uncemented stem in primary THA. Clin Orthop Relat Res. 2015; 437(2):543–548.
10.1007/s11999-014-3763-y > CrossrefGoogle Scholar - 5.Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987; 69(1):45–55. > Crossref MedlineGoogle Scholar
- 6.Troelsen A, Malchau E, Sillesen N, Malchau H. A review of current fixation use and registry outcomes in total hip arthroplasty: the uncemented paradox. Clin Orthop Relat Res. 2013; 471(7):2052–2059.
10.1007/s11999-013-2941-7 > Crossref MedlineGoogle Scholar - 7.Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Minimum ten-year followup of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg Am. 2004; 86(1):92–97. > Crossref MedlineGoogle Scholar
- 8.Hennessy DW, Callaghan JJ, Liu SS. Second-generation extensively porous-coated THA stems at minimum 10-year followup. Clin Orthop Relat Res. 2009; 467(9):2290–2296.
10.1007/s11999-009-0831-9 > Crossref MedlineGoogle Scholar - 9.McLaughlin JR, Lee KR. Cementless total hip replacement using second-generation components: a 12- to 16-year follow-up. J Bone Joint Surg Br. 2010; 92(12):1636–1641.
10.1302/0301-620X.92B12.24582 > Crossref MedlineGoogle Scholar - 10.Engh CA, Hopper RH. The odyssey of porous-coated fixation. J Arthroplasty. 2002; 17(4 suppl 1):102–107.
10.1054/arth.2002.32547 > Crossref MedlineGoogle Scholar - 11.Barrack RL. Dislocation after total hip arthroplasty: implant design and orientation. J Am Acad Orthop Surg. 2003; 11(2):89–99.
10.5435/00124635-200303000-00003 > Crossref MedlineGoogle Scholar - 12.Krenzel BA, Berend ME, Malinzak RA, High preoperative range of motion is a significant risk factor for dislocation in primary total hip arthroplasty. J Arthroplasty. 2010; 25(suppl 6):31–35.
10.1016/j.arth.2010.04.007 > Crossref MedlineGoogle Scholar - 13.Cinotti G, Della Rocca A, Sessa P, Ripani FR, Giannicola G. Thigh pain, subsidence and survival using a short cementless femoral stem with pure metaphyseal fixation at minimum 9-year follow-up. Orthop Traumatol Surg Res. 2013; 99(1):30–36.
10.1016/j.otsr.2012.09.016 > Crossref MedlineGoogle Scholar - 14.Reitman RD, Emerson R, Higgins L, Head W. Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cement in patients with type C bone. J Arthroplasty. 2003; 18(7 suppl 1):116–121.
10.1016/S0883-5403(03)00344-9 > Crossref MedlineGoogle Scholar - 15.Pospischill M, Knahr K. Cementless total hip arthroplasty using a threaded cup and a rectangular tapered stem: follow-up for ten to 17 years. J Bone Joint Surg Br. 2005; 87(9):1210–1215.
10.1302/0301-620X.87B9.16107 > Crossref MedlineGoogle Scholar - 16.Capello WN, D'Antonio JA, Geesink RG, Feinberg JR, Naughton M. Late remodeling around a proximally HA-coated tapered titanium femoral component. Clin Orthop Relat Res. 2009; 467(1):155–165.
10.1007/s11999-008-0550-7 > Crossref MedlineGoogle Scholar - 17.Kim YH, Park JW, Kim JS, Kang JS. Long-term results and bone remodeling after THA with a short, metaphyseal-fitting anatomic cementless stem. Clin Orthop Relat Res. 2014; 472(3):943–950.
10.1007/s11999-013-3354-3 > Crossref MedlineGoogle Scholar
