Second-generation cementless total hip arthroplasty - Eight to eleven-yearresults

Background: Second-generation cementless femoral components were designed t o provide more reliable ingrowth and to limit distal osteolysis by incorpor ating circumferential proximal ingrowth surfaces. We examined the eight to eleven-year results of total hip arthroplasty with a cementless, anatomical ly designed femoral component and a cementless hemispheric acetabular compo nent. Methods: Ninety-two consecutive primary total hip arthroplasties with impla ntation of a femoral component with a circumferential proximal porous coati ng (Anatomic Hip) and a cementless hemispheric porous-coated acetabular com ponent (Harris-Galante II) were performed in eighty-five patients. These pa tients were prospectively followed clinically and radiographically. Six pat ients (seven hips) died and five patients (seven hips) were lost to follow- up, leaving seventy-four patients (seventy-eight hips) who had been followe d for a mean of ten years (range, eight to eleven years). The mean age at t he time of the arthroplasty was fifty-two years. Results: The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up; 86% of the hips had a good or excel lent result. Thigh pain was reported as mild to severe after seven hip arth roplasties. No femoral component was revised for any reason, and none were loose radiographically at the time of the last follow-up. Two hips underwen t acetabular revision (one because of dislocation and one because of loosen ing). Kaplan-Meier survivorship analysis was performed with revision or loo sening of any component as the end point. The ten-year survival rate was 96 .4% +/- 2.1% for the total hip prosthesis, 100% for the femoral component, and 96.4% 2.1% for the acetabular component. Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight (93%) of the seventy-three hips with complete radiographic follow-up. Femoral ost eolysis proximal to the lesser trochanter was noted in four hips (5%). No o steolysis was identified distal to the lesser trochanter. Periacetabular os teolysis was identified in twelve hips (16%). Five patients underwent excha nge of the acetabular liner because of polyethylene wear. Conclusions: This second-generation cementless, anatomically designed femor al component provided excellent clinical and radiographic results with a 10 0% survival rate at ten years. The circumferential porous coating of this i mplant improved ingrowth and prevented distal osteolysis at a mean of ten y ears after the arthroplasty.