Original Articles
Grit-blasted titanium femoral stem in cementless primary total hip arthroplasty: A 5- to 10-year multicenter study*,**,*,**

https://doi.org/10.1054/arth.2001.17940Get rights and content

Abstract

A total of 133 cementless primary total hip arthroplasties using the Zweymuller-Alloclassic grit-blasted titanium tapered stem were performed in 3 institutions. The patient cohort was divided into 2 subgroups, nonselected and selected, on the basis of excellent bone stock and age (<65 years old at surgery). Acetabular components were all cementless, and bearing surfaces were all alumina-ceramic on polyethylene. After a 7.3-year average follow-up period (range, 5-10 years), 118 primary femoral replacements in 109 patients could be reviewed fully. Mean age at surgery was 55.7 years (range, 27-84 years). According to the Merle d'Aubigne and Charnley rating system, clinical results were graded excellent and good in 89% of hips and fair in 11%. Radiologically, early subsidence >2 mm could be detected in 4 hips (3.4%). Calcar atrophy and spot welds were noted in 77% and 82% of hips. Femoral osteolysis granuloma was noted in 4 hips (3.4%). There has been no stem fracture and no ceramic head breakage. The survivorship at 10 years with definite femoral aseptic loosening (radiographic failure) as the endpoint was 100% (95% Wilson confidence interval, 78.4%-100%; worst scenario, 95.4%). A significant difference between the nonselected and selected patient subgroups was observed only for early reoperation (P =.03) and proximal stress shielding (P =.01). Press-fitting but not filling the femoral canal with a rough titanium, straight, tapered femoral component represents, at intermediate follow-up, a promising cementless option in primary total hip arthroplasty.

Section snippets

Materials and methods

The Alloclassic-SL femoral component (Sulzer Orthopaedics) (Fig. 1) is collarless and made of Protasul-100 titanium alloy (TiA Al Nb, Sulzer Medica, Winterthur, Switzerland), in which vanadium (a metal present in the usual titanium alloy) is replaced with niobium [20].

. The cementless Alloclassic-SL modular tapered femoral component with alumina-ceramic 28-mm head. The prosthesis is fully grit blasted.

The straight taper is flat in transverse section and wedge shaped mediolaterally. It is designed

Perioperative complications

Intraoperative fracture of the greater trochanter was noted in 4 hips (1 in center A, 3 in center B), with 1 requiring cerclage fixation. Venous thrombosis was diagnosed in 4 hips (3%) with no subsequent pulmonary embolism. Sciatic nerve palsy was noted in 2 hips (1.5%), with 1 complete and 1 partial recovery. Postoperative dislocation occurred in 7 hips (5.2%), 6 in center A (NS group), in which a posterolateral approach was used, and 1 in the 2 other centers (S group), in which an

Discussion

In the present series, patients were selected for femoral fixation on the basis of age (<65 years old) and bone stock quality in 2 centers. In the third center, representing 52% of the studied hips, exclusion was limited to poor femoral bone stock, found at surgery. In the series as a whole, there have been no revisions for loosening, no pending revisions, and no radiographic loosening over the study period of 1 to 10 years. Four stems were reoperated on in the early postoperative period for

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  • Cited by (0)

    *

    †Hautepierre Hospital, Strasbourg;

    **

    ‡General Hospital, Selestat; and

    *

    §Hotel-Dieu Hospital, Paris, France.

    **

    Reprint requests: Christian Delaunay, MD, Clinique de l'Yvette, 43, route de Corbeil, 91160, Longjumeau, France.

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