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Primary Total Hip Arthroplasty without the Use of Bone Cement: A 10-Year Follow-up of 157 Hips

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Author(s): Pang-Hsin Hsieh | Chun-Hsiung Shih | Po-Cheng Lee | Chih-Hwa Chen | Wen-E Yang

Journal: Chang Gung Medical Journal
ISSN 2072-0939

Volume: 25;
Issue: 05;
Start page: 298;
Date: 2002;
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Keywords: total hip arthroplasty | cementless | osteolysis

ABSTRACT
Background: The cementless fixation technique in total hip arthroplasty (THA) was developedto solve clinical problems such as aseptic loosening and osteolysiswhich were thought to be associated with the use of bone cement. This retrospectivestudy reports our mid-term results with cementless THA.Methods: A series of 173 consecutive, unselected cementless THA procedures usingthe Omnifit prosthesis was performed by a single surgeon. Sixteen hips wereexcluded from the study because of insufficient follow-up evaluation. Onehundred and fifty-seven THAs with an average follow-up period of 10.2(range, 5-12) years were retrospectively reviewed.Results: The overall revision rate was 7.0%. Ninety-five percent of unrevised hipsachieved a Merle D'Aubigne hip score of 16 points or above.Radiographically, bone ingrowth occurred in all unrevised cups, and in 95%of unrevised stems. Osteolytic lesions, seen on 28.1% of femora and 8.9% ofpelvises, appeared at an average of 3.8 years postoperatively. Femoral osteolyticlesions were confined to the proximal Gruen zones 1 and 7. The meanannual polyethylene wear rate was 0.15 mm. Approximately 1/3 of the hipswere noted to have excessive wear.Conclusion: These results suggest that cementless Omnifit THA provides stable fixationfor as long as 12 years after implantation. Of significant concern is the highincidence of excessive polyethylene wear and associated osteolysis. Ourexperience also indicates that a femoral stem with a circumferential porouscoating in the proximal region can protect the femur from distal osteolysis.
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