Bogdan Solomon, MD, presented his team’s findings at the SICOT XXV Triennial World Congress 2011, in Prague.
“Total hip replacement performed in young patients has a high risk of multiple revisions,” he said. “Therefore, an ideal stem design would lead to good long-term outcomes, preserve the femur and, when the time comes, be easily replaced by another standard-length stem. Possibly even more important, this could be done in the hands of a community surgeon.”
The findings of the study, Solomon reported, point toward cemented polished stems resulting in an absence of aseptic loosening, minimum osteolysis and the ability — when revision is necessary — to use standard-length stems and bone preserving techniques.
Solomon and his team investigated 197 primary hip arthroplasties performed on 169 patients younger than 55 years of age. The operations were performed by community surgeons between 1988 and 2005.
Follow-up was from 2 years to 19 years and included clinical, radiographic and survival analyses. Incidence of loosening and osteolysis were measures, as well as the extent of bone damage from stem removal and any need for long stem revision.
Solomon reported a 13-year survivorship of 100%, using an endpoint of revision for aseptic loosening. Up to 19 years, Solomon noted, none of the stems demonstrated radiographic signs of looseness.
Revision with standard length stems was performed in five stems, with femur preservation occurring in four of the stems through cement-in-cement exchange and one through impaction grafting.
Of those femurs that did not undergo revision, Solomon reported, 8% displayed mild osteolysis. Four percent displayed intermediate osteolysis.
“The femur is well preserved through the use of cemented polished stems due to an absence of aseptic loosening, minimal osteolysis and minimal damage to the femur,” Solomon said. “These stems have good long-term outcomes, even when performed by community surgeons.”
- Solomon B, Costi K, McGee M, et al. Cemented polished stems preserve the femur in young patients undergoing primary hip arthroplasty. Paper 28736. Presented at the SICOT XXV Triennial World Congress 2011. Sept. 6-9. Prague.