Primary cementless total hip arthroplasty in octogenarians - Two to eleven-year follow-up

Background: Cementless total hip arthroplasty is an accepted alternative to total hip arthroplasty with cement in younger patients, but it remains con troversial for elderly patients. The purpose of this study was to evaluate the clinical and radiographic outcomes of cementless total hip arthroplasty with use of a proximally coated stem in patients who were at least eighty years of age at the time of the operation. Methods: One hundred and twenty-three cementless total hip replacements wer e performed for the treatment of osteoarthritis in 114 patients between the ages of eighty and eighty-nine years. Seven patients (eight hips) died wit hin two years after the surgery seventeen patients (eighteen hips) died mor e than two years postoperatively but were not followed for at least two yea rs, and five hips were lost to follow-up; this left ninety-two hips in eigh ty-six patients for review. The mean duration of follow-up was five years ( range, two to eleven years). For the clinical evaluation, the Charnley modi fication of the Merle d'Aubigne and Postel scale was used. In addition, pre operative and postoperative Harris hip scores were available for sixty-nine hips. Seventy-eight hips were followed radiographically for two years or m ore. The focus of the radiographic evaluation was the status of the fixatio n of the femoral and acetabular components as well as cup wear. Results: Perioperative medical complications occurred in association with 2 4% (thirty) of the 123 operations, but there were no deaths. The mean Charn ley scores for pain and function for the ninety-two hips that were followed clinically for at least two years improved by 3.0 and 1.4 points, respecti vely. The sixty-nine hips for which preoperative and postoperative Harris h ip scores were available had a mean improvement of 42 points, with a mean s core of 82 points at the last follow-up evaluation, Mild thigh pain was pre sent in four patients, but it did not limit their activity. There were no f emoral component revisions. All of the femoral components were radiographic ally stable and had bone ingrowth. No acetabular component failed by loosen ing, but 41% (thirty) of the seventy-three hips with radiographs available for measurement of wear showed polyethylene wear. Of the seventy-eight cups that were followed radiographically for two years or more, 4% (three) were associated with lysis, but none had been revised. Conclusions: Cementless fixation in the elderly is safe, effective, and dur able at the time of two to eleven-year follow-up.