Clinical and radiographic results of cementless AML total hip arthroplasty in young patients

doi:10.1054/arth.2001.21503

The Journal of Arthroplasty

Volume 16, Issue 3, April 2001, Pages 312-316

https://doi.org/10.1054/arth.2001.21503 Get rights and content

Abstract

A retrospective study was undertaken of the radiographic and clinical results and complications of 52 cementless (AML) total hip arthroplasties in 52 patients with a mean age of 48.3 years. The follow-up ranged from 9 to 12 years with a mean of 10.5 years. Of the patients, 88% had good or excellent results. Forty-two patients (81%) complained of anterior thigh pain at 3 months after surgery when weight bearing was allowed. The pain continued for a mean period of 4.3 months. In 4 patients (8%), this pain persisted after the first postoperative year. Calcar resorption was seen in 21 patients (40%), and 16 patients (31%) showed clinically insignificant heterotopic ossification. Four patients required revisions: 1 for acetabular loosening, 1 for persistent thigh pain, and 2 for massive osteolysis of the proximal femur. There were no dislocations, infections, thromboembolic events, or neurologic injuries.

Section snippets

Materials and methods

A retrospective study was undertaken of the clinical and radiographic results of 61 cementless THAs (60 patients) using a two thirds porous-surfaced femoral component with 32-mm cobalt-chrome articulation with high-density polyethylene and porous-surfaced acetabular component (AML DePuy, Warsaw, IN) performed between 1984 and 1989. Nine hips (8 patients) were lost to follow-up and excluded from the study. Of 52 patients (52 hips), there were 34 men and 18 women with an average age of 48.3 years

Results

The results at last follow-up were 35 excellent (67%), 11 good (21%), 2 fair (4%), and 4 poor (8%) (Fig. 1).

. Results of uncemented total hip arthroplasty in young patients.

Excluding the converted hemiarthroplasty group, the results at last follow-up are similar: 31 excellent (67%), 10 good (22%), 2 fair (4%), and 3 poor (7%). The mean postoperative scores for pain, function, and mobility were 5.4, 5.6, and 5.7. Forty-two patients (81%) developed mild to moderate pain along the anterior thigh 3

Discussion

This study presents a group of young patients, most with the diagnosis of avascular necrosis of the hip, followed for a mean 10.5 years after AML cementless THA. Forty-six patients (88%) had good or excellent results. Two patients (4%) had a fair rating; both of these patients had undergone conversion from cementless hemiarthroplasties. Of the 6 patients who had conversion surgeries, only 1 had an excellent result. Although the results from conversions are worse, the overall results are

References (27)

BG Evans et al.
The rationale for cemented total hip arthroplasty
Orthop Clin North Am
(1993)
PF Sharkey et al.
Five year clinical and radiographic follow-up of the uncemented long-term stable fixation total hip arthroplasty
J Arthroplasty
(1998)
HC Amstutz et al.
Loosening of total hip components: cause and prevention
JJ Callaghan
Total hip arthroplasty: clinical perspectives
Clin Orthop
(1992)
HP Chandler et al.
Total hip replacement in patients younger than thirty years old: a five-year follow-up study
J Bone Joint Surg Am
(1981)
CB Charosky et al.
Total hip replacement failures: A histological evaluation
J Bone Joint Surg Am
(1973)
LD Dorr et al.
Total hip arthroplasties in patients less than forty-five years old
J Bone Joint Surg Am
(1983)
MJ Griffith et al.
Eight year results of Charnley arthroplasties of the hip with special reference to the behavior of cement
Clin Orthop
(1978)
RN Stauffer
Ten-year follow-up study of total hip replacement
J Bone Joint Surg Am
(1982)
HG Willert et al.
Reaction of bone to methacrylate after hip arthroplasty: a long-term gross, light microscopic, and scanning electron microscopic study
J Bone Joint Surg Am
(1974)

CA Engh et al.

Biologic fixation of a modified Moore prosthesis: evaluation of early clinical results

AH Glassman et al.

The removal of porous-coated femoral hip stems

Clin Orthop

(1992)

RD Heekin et al.

The porous-coated anatomic total hip prosthesis, inserted without cement: Results after five to seven years in a prospective study

J Bone Joint Surg Am

(1993)

Cited by (42)

Wagner Cone Midterm Survivorship and Outcomes
2020, Journal of Arthroplasty
Citation Excerpt :
The most commonly used femoral stems in primary THA today are metaphyseal engaging flat-wedge tapers, and revision for aseptic femoral loosening has been reported as less than 1% for the Taperloc (Zimmer-Biomet, Warsaw, IN) [17–19], Trilock (DePuy, Warsaw, IN) [20,21], and Accolade (Stryker, Mahwah, NJ) [22] in midterm and long-term follow-up studies. Similarly, there has been a less than 1% reported rate of revision for aseptic loosening for the anatomic medullary locking (DePuy, Warsaw, IN) [23–25], an extensively porous-coated cylindrical stem. In our series of midterm follow-up of the Wagner cone femoral prosthesis, the 0% rate of revision for aseptic loosening and 0% rate of revision for subsidence compare favorably to previously reported results for commonly used femoral stems.
Total hip arthroplasty (THA) in patients with abnormal proximal femoral anatomy requires an individualized treatment approach to prevent complications. Metaphyseal engaging stems in this population risk fracture, size/offset mismatch, and aseptic loosening. The Wagner conical femoral implant is a short diaphyseal engaging femoral stem that could improve treatment success in this difficult patient population.
We identified 302 consecutive patients undergoing THA using the Wagner cone femoral prosthesis between January 2010 and January 2017. Clinical, radiographic, and patient-reported outcomes were obtained through chart review and radiographic measurements of postoperative X-rays. We used multivariate analysis to determine predictors of poor outcomes. Kaplan-Meier curves were created to demonstrate implant survivorship with reoperation and revision as endpoints. The average follow-up was 3.2 years, with a minimum of 2 years.
The implant retention survival rate during the 3.2-year study period was 98.7%. The overall reoperation rate was 4.2%, with infection followed by fracture being the most common reasons for reoperation. No patients were revised for aseptic loosening, and no patients were revised for subsidence. The average subsidence was 1.1 mm. The Harris Hip Score improved from 48.6 ± 7.3 (range, 28-64) preoperatively to 86.1 ± 8.5 (range, 66-100) at latest follow-up. The patient-reported satisfaction rate was 98.3%.
The Wagner cone femoral prosthesis demonstrated excellent clinical, radiographic, and patient-reported functional outcomes at midterm follow-up. We recommend use of the Wagner cone in THA patients with challenging proximal femoral anatomy, small femoral diameter, or poor metaphyseal bone quality.
Cementless Femoral Components in Young Patients. Review and Meta-Analysis of Total Hip Arthroplasty and Hip Resurfacing
2009, Journal of Arthroplasty
Citation Excerpt :
Both acetabular and femoral components were cemented. The results of modern cementless THA in young patients are quite encouraging [8-28,47]. A meta-analysis of cementless femoral component survivorship in young patients (9 studies) in our study was 95% at 12 years.
The study purpose was to analyze current results of modern cementless femoral components in young patients having total hip arthroplasty (THA) or hip resurfacing. Twenty-two studies (n = 5907; hips = 6408) evaluating modern cementless THA in young patients and 15 studies evaluating hip resurfacing (n = 3002; hips = 3269) were included. Meta-analysis techniques were used to pool failure rates. The pooled failure rate for THA using femoral revision for mechanical failure as an end point was 1.3% (95% confidence interval [CI], 1.0%-1.7%) at a mean 8.4 years of follow-up. At a mean of 3.9 years of follow-up, the pooled mechanical failure rate of the femoral component for hip resurfacing was 2.6% (95% CI, 2.0-3.4). In conclusion, the enthusiasm for hip resurfacing should be tempered by these data. Longer follow-up and direct comparison trials are required to confirm these findings.
Total Hip Arthroplasty with a Collarless, Tapered, Fiber Metal Proximally Coated Femoral Stem. Minimum 5-Year Follow-Up
2009, Journal of Arthroplasty
Citation Excerpt :
The FMT prosthesis, like other proximally coated, tapered stems, was designed to reduce proximal stress shielding. A considerable amount of stress shielding is frequently seen around extensively coated stems [22,23]. Although dual-energy x-ray absorptiometry was not performed in this study, radiographic findings suggestive of stress shielding (calcar rounding and gross proximal femur radiographic osteopenia) were only seen in 21% of hips.
The purpose of this study was to evaluate the midterm results, osteointegration potential, and implant-related complications of a cementless, collarless, proximally coated, distally tapered femoral hip prosthesis. The clinical and radiographic results for 129 hips in 116 patients after total hip arthroplasty with a Fiber Metal Taper (Zimmer, Inc ,Warsaw, Ind) femoral stem are reported. One hundred twenty-two (95%) hips were available for the minimum of 5 years clinical and radiographic follow-up. The mean duration of follow-up was 81 months (range, 60-104 months). The mean Harris hip score improved from 44 to 92 at the most recent follow-up. All femoral components were clinically stable with radiographic evidence of bone ingrowth. There has been no evidence of subsidence greater than 2 mm, no significant thigh pain, and no femoral revisions for any reason. Total hip arthroplasty with the Fiber Metal Taper stem demonstrates good clinical and radiographic results at midterm follow-up.
Midterm Results of "Thrust Plate" Prosthesis
2007, Journal of Arthroplasty
Citation Excerpt :
Kronick et al [24] reported a femoral revision rate of 1.1% after following up on 174 cementless stemmed endoprostheses in patients younger than 50 years for an average period of 8.3 years. Nercessian et al [25] reported a rate of 5.8% in 52 AML stem cases after an average period of 10.5 years, whereas Kim et al [15] did not find any revision of femoral components due to loosening in 118 cementless stemmed prostheses implanted in patients with an average age of 46.8 years after an average follow-up period of 9.8 years. Moreover, in the current study there was no significant difference in the survival rates of TPPs in patients up to 50 years of age and those who were older, which ruled out young age as an influencing factor on failures.
The aim of this investigation was to analyze the midterm results obtained with the metaphyseal fixation principle of the thrust plate prosthesis (TPP). Survival of 214 implants in 204 patients was analyzed. Clinical (Harris hip score) and radiologic examinations were carried out on 157 of 190 TPP with a postimplantation follow-up period of at least 5 years. Failure rate was 7.0% (9 aseptic and 6 septic loosening). Harris hip score increased from 36.9 ± 13.5 points preoperatively to 91.2 ± 13.1 points at follow-up. Eleven TPPs showed radiolucent lines not indicating prosthetic loosening. Thrust plate prosthesis is not an alternative to stemmed endoprostheses. It may be rarely indicated in very young patients where, because of their age, several revision operations can be expected.
Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age: Fifteen to twenty-year results
2009, Journal of Bone and Joint Surgery
Total hip arthroplasty without cement is frequently performed in young active patients, but only limited outcomes data are available after durations of follow-up of more than fifteen years.
We retrospectively evaluated the clinical and radiographic results of a consecutive series of 154 total hip arthroplasties (in 141 patients) performed with an uncemented grit-blasted straight tapered titanium femoral stem combined with a threaded socket in patients under the age of fifty-five years. The median duration of follow-up was seventeen years. Clinical results were evaluated with use of the Harris hip score. The canal fill index was used as the criterion to determine the adequacy of stem sizing. Kaplan-Meier survivorship analysis was performed to predict long-term outcomes.
The stem was undersized, with a canal fill index of ≤80%, in forty-one hips (27%). Late aseptic loosening of the stem occurred in four femora, and the femoral component was undersized in all four. These four stems were stable for ten years and then underwent progressive subsidence, which was associated with pain. Five stems were revised because of a late postoperative periprosthetic fracture following trauma. Localized proximal femoral osteolysis was seen in seven hips without signs of loosening. Survivorship of the stem with revision for any reason as the end point was estimated to be 90% (95% confidence interval, 87% to 97%) at twenty years. Survivorship with aseptic loosening as the end point was estimated to be 95% (95% confidence interval, 91% to 99%) at twenty years. Sixty-seven (44%) of the threaded uncemented acetabular components were revised during the follow-up period.
After a minimum duration of follow-up of fifteen years, the survival of this type of femoral component is excellent in individuals younger than fifty-five years. The main mode of stem failure was a periprosthetic fracture due to trauma, or late aseptic loosening in a small percentage of the hips in which the femoral implant was undersized. The high rate of failure of the acetabular components was attributable to a poor design that is no longer in use.
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
Influence of trabecular bone quality and implantation direction on press-fit mechanics
2017, Journal of Orthopaedic Research

View all citing articles on Scopus

^*: No benefits or funds were received in support of this study.

^**: Reprint requests: Ohannes A. Nercessian, MD, Department of Orthopaedic Surgery, New York Presbyterian Hospital, 622 West 168th Street, PH-11, New York, NY 10032.

View full text

Original ArticlesClinical and radiographic results of cementless AML total hip arthroplasty in young patients*,**

Abstract

Section snippets

Materials and methods

Results

Discussion

Orthop Clin North Am

J Arthroplasty

Loosening of total hip components: cause and prevention

Total hip arthroplasty: clinical perspectives

Clin Orthop

Total hip replacement in patients younger than thirty years old: a five-year follow-up study

J Bone Joint Surg Am

Total hip replacement failures: A histological evaluation

J Bone Joint Surg Am

Total hip arthroplasties in patients less than forty-five years old

J Bone Joint Surg Am

Eight year results of Charnley arthroplasties of the hip with special reference to the behavior of cement

Clin Orthop

Ten-year follow-up study of total hip replacement

J Bone Joint Surg Am

Reaction of bone to methacrylate after hip arthroplasty: a long-term gross, light microscopic, and scanning electron microscopic study

J Bone Joint Surg Am

Biologic fixation of a modified Moore prosthesis: evaluation of early clinical results

The removal of porous-coated femoral hip stems

Clin Orthop

The porous-coated anatomic total hip prosthesis, inserted without cement: Results after five to seven years in a prospective study

J Bone Joint Surg Am

Original Articles
Clinical and radiographic results of cementless AML total hip arthroplasty in young patients*,**