Femoral Revision THR Surgery
A titanium cementless calcar replacement prosthesis in revision surgery of the femur: 13-year experience☆,☆☆

https://doi.org/10.1054/arth.2001.28718Get rights and content

Abstract

From January 1987 through December 2000, 1,179 cementless calcar prostheses were implanted at the Texas Center for Joint Replacement. The prosthesis is titanium, has proximal circumferential plasma-spray coating, and is designed for proximal bone loading. The average follow-up for the entire series was 6.2 years, and the projected stem survivorship at 13 years is 95.2%. There have been 9 stem revisions for loosening. When mechanical loosening alone is evaluated, the projected stem survivorship is 99%. There have been 56 revisions in the entire series. Prosthetic survivorship for the entire patient population is projected at 93.6% at 13 years. There have been no cases of distal lysis or late loosening. None of the prostheses are classified as loose at this time, and none are classified as stable fibrous fixation.

Section snippets

Materials and methods

The clinical material for this study consisted of 1,179 calcar prostheses implanted for revision surgery from January 1987 through December 2000. The prosthetic survivorship for the entire patient population is projected at 93.6% at 13 years. To date, there have been 56 revisions (4.75%). The maximal follow-up at present is 13.9 years with the average follow-up being 6.2 years. In this series, there were 610 women and 451 men, with many patients having bilateral procedures. The average patient

Results

Stem survivorship alone as a result of mechanical loosening was 99%. Nine stems were revised for loosening. There were 17 stem revisions for infection. When stem revisions because of loosening and infection are combined, the stem survivorship was 95.2%. There was 1 revision for femoral fracture that occurred at 3.2 years postsurgery secondary to trauma. Seventeen acetabular revisions were performed secondary to polyethylene wear and lysis. Seven hips were revised because of recurrent

Discussion

Consistent clinical results have been obtained with this implant. Reliable bone recovery has been shown as well. Bone loss secondary to stress shielding is a possibility whenever a metal prosthesis is inserted into bone. Titanium is less stiff than cobalt-chrome and incites an osteophyllic reaction 8, 26, 27. Prosthetic design and material and the extent of porous coating have significant effects on bone loss or bone restoration 7, 8, 26, 28, 29. In cementless femoral revision surgery,

Conclusion

From 1987 through 2000, 1,179 calcar replacement prostheses were implanted. The survivorship for the entire series is projected at 93.6% at 13 years using the survivorship analysis method of Murray et al [32]. The maximal follow-up was 13.9 years, and the average follow-up was 6.2 years. When stem survivorship secondary to mechanical loosening alone is evaluated, the stem survivorship at 13 years is 99%. This calcar replacement prosthesis has been a successful revision implant to date. Its

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    ☆

    William C. Head-Royalty receipts from Biomet Inc.; Roger H. Emerson-consultant for Biomet.

    ☆☆

    Reprint requests: William C. Head, MD, Texas Center for Joint Replacement, 5940 West Parker Road, #100, Plano, TX 75093-7732. E-mail: [email protected]

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