Good Mid- to Long-Term THA Outcomes with a Modified Cementless Rectangular Biconical Stem Design

Abstract

Purpose

Second- and third-generation cementless Zweymüller stems have achieved good long-term outcomes in total hip arthroplasty (THA). The PPF cementless proximal press-fit femoral stem (Biomet Inc.) is based on the Zweymüller stem, with some prominent design differences. This study was designed to assess its performance in terms of survivorship, clinical function, and radiographic outcomes.

Methods

We retrospectively analysed 250 patients (303 hips) who underwent THA between 1998 and 2011. Patients attended a follow-up visit a mean 10.9 ± 2.6 years after the procedure. All patients underwent radiographic examination and were clinically assessed for Forgotten Joint Score (FJS) and pain visual analogue scale (VAS). Survivorship was calculated using Kaplan-Meier analysis.

Results

Clinical data were available for 142 patients (192 hips) and radiographic data for 79 patients (109 hips). Stem survival was 99.1% (95% confidence interval [CI] 96.6%-99.8%) at 10 years and 95.6% (95% CI 96.6%-99.8%) at 15 years. The median postoperative FJS was 91 (interquartile range [IQR], 75-100). The median VAS score was 0 (IQR, 0-2). Radiolucent lines were observed in 47 hips (43.1%). 25 hips (22.9%) had Grade I ossification, 17 (15.6%) Grade II, and 2 (1.8%) Grade III. 12 hips (11.0%) had osteolysis in at least 1 femoral zone.

Conclusions

The cementless proximal press-fit femoral stem was associated with good mid- to long-term survival and functional outcomes. The current design can be considered equivalent to the second- and third-generation Zweymüller stems.

Keywords

Osteoarthritis Replacement Survival analysis Total hip arthroplasty Treatment outcome

Get full access to this article

View all access options for this article.

References

McLaughlin

Lee

Uncemented total hip arthroplasty using a tapered femoral component in obese patients: an 18-27 year follow-up study.

J Arthroplasty 2014;29(7):1365–1368

Varini

Cristofolini

Traina

Viceconti

Toni

Can the rasp be used to predict intra-operatively the primary stability that can be achieved by press-fitting the stem in cementless hip arthroplasty?

Clin Biomech (Bristol, Avon) 2008;23(4):408–414

Zweymüller

Good results with an uncoated grit-blasted tapered straight stem at ten years.

Interactive Surgery 2007;2(3):197–205

Eskelinen

Remes

Helenius

Pulkkinen

Nevalainen

Paavolainen

Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish Arthroplasty Register.

Acta Orthop 2006;77(1):57–70

Pospula

Noor

Al Rowaih

Cementless Zweymüller hip replacement: a short-term follow-up in Al Razi Hospital, Kuwait.

Med Princ Pract 2005;14(4):255–259

Delaunay

Effect of hydroxyapatite coating on the radio-clinical results of a grit-blasted titanium alloy femoral taper. A case-control study of 198 cementless primary total hip arthroplasty with the Alloclassic™ system.

Orthop Traumatol Surg Res 2014;100(7):739–744

Pospischill

Knahr

Cementless total hip arthroplasty using a threaded cup and a rectangular tapered stem.

Follow-up for ten to 17 years. J Bone Joint Surg Br 2005;87(9):1210–1215

Labek

Kovac

Levasic

Janda

Zagra

The outcome of the cementless tapered SL-Plus stem: an analysis of arthroplasty register data.

Int Orthop 2012;36(6):1149–1154

Ottink

Barnaart

Westerbeek

van Kampen

Bulstra

van Jonbergen

Survival, clinical and radiological outcome of the Zweymüller SL/Bicon-Plus total hip arthroplasty: a 15-year follow-up study.

Hip Int 2015;25(3):204–208

10.

Janda

Hübl

Stöckl

Thaler

Labek

Performance of the Zweymüller total hip arthroplasty system: a literature review including arthroplasty register data.

Eur Orthop Traumatol 2010;1(1):9–15

11.

Zweymüller

Schwarzinger

Steindl

Radiolucent lines and osteolysis along tapered straight cementless titanium hip stems: a comparison of 6-year and 10-year follow-up results in 95 patients.

Acta Orthop 2006;77(6):871–876

12.

Wick

Lester

Radiological changes in second- and third-generation Zweymüller stems.

J Bone Joint Surg Br 2004;86(8):1108–1114

13.

Steens

Schneeberger

Skripitz

Fennema

Goetze

Bone remodeling in proximal HA-coated versus uncoated cementless SL-Plus((R)) femoral components: a 5-year follow-up study.

Arch Orthop Trauma Surg 2010;130(7):921–926

14.

Pieringer

Auersperg

Labek

Böhler

[Radiological appearance of the cementless ALLOCLASSIC SL-stem implanted in very old patients with primary hip osteoarthritis].

[Article in German.] Z Orthop Ihre Grenzgeb 2004;142(3):322–327

15.

Khanuja

Vakil

Goddard

Mont

Cementless femoral fixation in total hip arthroplasty.

J Bone Joint Surg Am 2011;93(5):500–509

16.

Smith

Dieppe

Vernon

Porter

Blom

National Joint Registry of England and Wales.

Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet 2012;379(9822):1199–1204

17.

Graves

Rothwell

Tucker

Jacobs

Sedrakyan

A multinational assessment of metal-on-metal bearings in hip replacement.

J Bone Joint Surg Am 2011;93(Suppl 3):43–47

18.

Barberá-Tomás

Molas-Gallart

Governance and technological change: the effects of regulation in medical devices.

In: 2013 EU-SPRI Forum Conference, Madrid, Spain, 2103pp. 10–12

19.

Nieuwenhuijse

Nelissen

Schoones

Sedrakyan

Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies.

BMJ 2014;349(sep09 1):g5133

20.

Legenstein

Ungersboeck

Boesch

Mittelfristige und langfristige Ergebnisse mit dem PPF Schaft. In: Effenberger H, Zichner L, Richolt J, eds. Hüftschäfte. MCU Vertrieb, Grieskirchen 2006;319–23

21.

Legenstein

Huber

Ungersboeck

Boesch

Long-term clinical and radiographic outcome of the PPF system in ceramic-on-polyethylene hip bearings.

Hip Int 2006;16(2):75–80

22.

Hardinge

The direct lateral approach to the hip.

J Bone Joint Surg Br 1982;64(1):17–19

23.

Behrend

Giesinger

Kuster

The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure.

J Arthroplasty 2012;27(3):430–6e1

24.

Gruen

McNeice

Amstutz

“Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening.

Clin Orthop Relat Res 1979;(141):17–27

25.

Bugbee

Culpepper

II Engh

Jr Engh

Long-term clinical consequences of stress-shielding after total hip arthroplasty without cement.

J Bone Joint Surg Am 1997;79(7):1007–1012

26.

Engh

Bobyn

Glassman

Porous-coated hip replacement.

The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br 1987;69(1):45–55

27.

Brooker

Bowerman

Robinson

Riley

Ectopic ossification following total hip replacement.

Incidence and a method of classification. J Bone Joint Surg Am 1973;55(8):1629–1632

28.

Huiskes

Stress shielding and bone resorption in THA: clinical versus computer-simulation studies.

Acta Orthop Belg 1993;59(1_suppl):118–129

29.

Pieringer

Auersperg

Griessler

Böhler

Long-term results with the cementless Alloclassic brand hip arthroplasty system.

J Arthroplasty 2003;18(3):321–328

30.

Koster

Leib

Willert

Noncemented hip replacement using a conical screw-in cup and a straight press-fit stem.

A six to eight-year clinical and radiological follow-up study. Hip Int 1998;8(4):208–218

31.

Lintner

Zweymüller

Brand

Tissue reactions to titanium endoprostheses.

Autopsy studies in four cases. J Arthroplasty 1986;1(3):183–195