Review ArticlesEarly failure of modern cemented stems*,**
Section snippets
Surgical technique
Among the most dramatic reports of early stem failures is that of the Capital THA (3-M Healthcare Limited, Loughborough, UK). This stem was described as being “similar to that of the Charnley prosthesis.” [23] It was touted as a low-cost option in place of the Charnley stem and was fabricated of titanium alloy and had a titanium nitrite-coated modular head as an option [23]. Definite loosening was present in 16% with an additional 8% possibly loose at follow-up of 26 months. Approximately 5,000
Stem design
Many changes have occurred in the design details of cemented stems, many of which have been associated directly or indirectly with early failure. A series of failures that was relatively rare but dramatic and was associated with a design detail was that of 10 fractured forged cobalt-chrome stems reported by Woolson et al in 1997. These 10 fractured stems represented 2% of the implants in that series [45]. Fracture of a forged cobalt-chrome cemented stem previously had been considered to be rare
Patient selection
There is evidence that certain cemented stems of more recent design are more prone to failure in certain types of patients. In the series of early failures with the Centralign stem reported by Santore [51], the average patient age was 49 years. When Sporer et al [52] examined the precoated Iowa Hip in patients <50 years old, the revision rate was 18% at 5 to 10 years compared with only 3% for the group of Iowa hips overall. The precoated Iowa stems were compared with the same stem with a
Variability of results
The most striking aspect of numerous clinical series of modern cemented stems is the extreme variability in the reported rates of revision and osteolysis. The prime example is probably the Precoat stem (Zimmer, Inc, Warsaw, IN). Dowd et al [27], Woolson et al [43], and Ong et al [56] reported failure rates of 5% to 14% at 6 years, whereas an equal number of series reported failure rates of <1% at longer-term follow-up of 8 to 10 years (Table 3) 42, 58, 59.
Discussion
Although the percentage of cementless femoral stems implanted has increased, cemented femoral stems still constitute most components implanted, particularly in the United States [64]. A resurgence in popularity of cemented stems is due to many factors, including perceived lower cost; emergence of problems with early-generation cementless devices; and reports of excellent long-term results that emerged with early-generation designs, such as the Charnley, Exeter, HD2, and Spectron. Excellent
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Cited by (0)
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Funds were received from Smith & Nephew, Inc, in support of the research material described in this article.
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Reprint requests: Robert L. Barrack, MD, Tulane University School of Medicine, Department of Orthopaedic Surgery, 1430 Tulane Avenue, SL 32, New Orleans, LA 70112.