Custom Cementless Femoral Stems in Total Hip Arthroplasty

Abstract

Obtaining appropriate prosthetic fit in cementless total hip arthroplasty can be challenging in cases with disparity between the femoral and metaphyseal diameters of the femur or cases of complex deformity. One solution has been to utilize a custom femoral component in total hip arthroplasty. The long-term results of this option with respect to femoral morphology are limited. This cohort was analyzed to determine the survivorship, functional results using Harris Hip Scores (HHSs), and complication rates using these implants. Survivorship and complications were evaluated based on the proximal femoral anatomy and severity of arthritis. The authors retrospectively reviewed 73 cases of custom femoral implants in total hip arthroplasties by a single surgeon. The average age of patients at index surgery was 58.06 years (range, 36.00–73.75 years). The mean follow-up was 8.59 years (range, 0.17–20.33 years) with a minimum of 2-year follow-up required for analysis of HHS data. There were 8 failures at a mean of 67.68 months (range, 2.04–135 months). The reasons for revision were infection (2), osteolysis (1), periprosthetic fracture (3), osteolysis and aseptic loosening (1), and polyethylene wear (1). The mean preoperative HHS was 55.38 (range, 31–90). The mean follow-up HHS was 93.10 (range, 38–100) with a mean improvement of 37.44 (p < 0.0001). Complications included infection (3), fracture (6), and dislocation (3). Preoperative Dorr classification A (n = 44), B (n = 24), and C (n = 1) and Kellgren–Lawrence grades I (n = 0), II (n = 2), III (n = 7), and IV (n = 60) were not predictive of failure or revision (p = 0.45, p = 0.6). There was a near significant association between Dorr classification B femur fractures requiring revision (p < 0.053). Kaplan–Meier predicted survivorship was 20.33 years with revision for any reason as the endpoint and total overall survivorship of 81.7%. Custom cementless femoral stems provide satisfactory survivorship and improvement in hip scores in a variety of patients undergoing cementless total hip arthroplasty. Fracture rates are higher in Dorr class B femurs. The level of evidence was IV.

Keywords

hip - arthroplasty - custom

^∗ Investigation performed at University Hospitals Cleveland Medical Center.

• References

• 1 Lehil MS, Bozic KJ. Trends in total hip arthroplasty implant utilization in the United States. J Arthroplasty 2014; 29 (10) 1915-1918
• 2 Meding JB, Ritter MA, Keating EM, Berend ME. Twenty-year followup of an uncemented stem in primary THA. Clin Orthop Relat Res 2015; 473 (02) 543-548
• 3 Nissen N, Hauge EM, Abrahamsen B, Jensen JEB, Mosekilde L, Brixen K. Geometry of the proximal femur in relation to age and sex: a cross-sectional study in healthy adult Danes. Acta Radiol 2005; 46 (05) 514-518
• 4 Merle C, Waldstein W, Gregory JS. , et al. How many different types of femora are there in primary hip osteoarthritis? An active shape modeling study. J Orthop Res 2014; 32 (03) 413-422
• 5 Benum P, Aamodt A. Uncemented custom femoral components in hip arthroplasty. A prospective clinical study of 191 hips followed for at least 7 years. Acta Orthop 2010; 81 (04) 427-435
• 6 Colen S, Dalemans A, Schouwenaars A, Mulier M. Outcome of custom-made IMP femoral components of total hip arthroplasty: a follow-up of 15 to 22 years. J Arthroplasty 2014; 29 (02) 397-400
• 7 Santori FS, Santori N. Mid-term results of a custom-made short proximal loading femoral component. J Bone Joint Surg Br 2010; 92 (09) 1231-1237
• 8 Flecher X, Pearce O, Parratte S, Aubaniac JM, Argenson JN. Custom cementless stem improves hip function in young patients at 15-year followup. Clin Orthop Relat Res 2010; 468 (03) 747-755
• 9 Muirhead-Allwood SK, Sandiford N, Skinner JA, Hua J, Kabir C, Walker PS. Uncemented custom computer-assisted design and manufacture of hydroxyapatite-coated femoral components: survival at 10 to 17 years. J Bone Joint Surg Br 2010; 92 (08) 1079-1084
• 10 Chow I, Patel RM, Stulberg SD. Short stem metaphyseal-engaging femoral implants: a case-controlled radiographic and clinical evaluation with eight year follow-up. J Arthroplasty 2015; 30 (04) 600-606
• 11 Patel RM, Lo WM, Cayo MA, Dolan MM, Stulberg SD. Stable, dependable fixation of short-stem femoral implants at 5 years. Orthopedics 2013; 36 (03) e301-e307
• 12 Pakos EE, Stafilas KS, Tsovilis AE, Vafiadis JN, Kalos NK, Xenakis TA. Long term outcomes of total hip arthroplasty with custom made femoral implants in patients with congenital disease of hip. J Arthroplasty 2015; 30 (12) 2242-2247
• 13 Al-Khateeb H, Kwok IH, Hanna SA, Sewell MD, Hashemi-Nejad A. Custom cementless THA in patients with Legg-Calve-Perthes Disease. J Arthroplasty 2014; 29 (04) 792-796
• 14 Yang Z, Jian W, Li ZH. , et al. The geometry of the bone structure associated with total hip arthroplasty. PLoS One 2014; 9 (03) e91058
• 15 McCarthy JC, Bono JV, O'Donnell PJ. Custom and modular components in primary total hip replacement. Clin Orthop Relat Res 1997; (344) 162-171
• 16 Akhavan S, Goldberg VM. Clinical outcome of a fiber metal taper stem: minimum 5-year followup. Clin Orthop Relat Res 2007; 465 (465) 106-111
• 17 Nash W, Harris A. The Dorr type and cortical thickness index of the proximal femur for predicting peri-operative complications during hemiarthroplasty. J Orthop Surg (Hong Kong) 2014; 22 (01) 92-95
• 18 Taunton MJ, Dorr LD, Long WT, Dastane MR, Berry DJ. Early postoperative femur fracture after uncemented collarless primary total hip arthroplasty: characterization and results of treatment. J Arthroplasty 2015; 30 (11) 2008-2011