The Journal of Bone and Joint Surgery (American) 84:729-735 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Survival and Polyethylene Wear of Porous-Coated Acetabular Components in Patients Less than Fifty Years Old
Results at Nine to Fourteen Years
James D. Crowther, MD and
Paul F. Lachiewicz, MD
Investigation performed at the Department of Orthopaedics, University
of North Carolina, Chapel Hill, North Carolina
James D. Crowther, MD
Paul F. Lachiewicz, MD
Department of Orthopaedics, University of North Carolina, 242
Burnett-Womack Building, CB #7055, Chapel Hill, NC 27599
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. One or more
of the authors received payments or other benefits or a commitment
or agreement to provide such benefits from a commercial entity (Zimmer,
Warsaw, Indiana). In addition, a commercial entity (Zimmer) paid
or directed, or agreed to pay or direct, benefits to a research
fund, foundation, educational institution, or other charitable or
nonprofit organization with which the authors are affiliated or
associated.
A commentary is available with the electronic versions of this article,
on our web site (www.jbjs.org) and on our quarterly CD-ROM (call
our subscription department, at 781-449-9780, to order the CD-ROM).
Background:
Younger patients (those who are less than fifty years old) have
been shown to have a high rate of failure of cemented acetabular
components following total hip arthroplasty. In this report, we
present the results associated with the use of an uncemented acetabular
component in young patients who were evaluated at a minimum of nine
years postoperatively.
Methods:
Between December 1984 and December 1989, the senior author performed
174 primary total hip arthroplasties with use of a single design
of porous-coated acetabular component. Seventy-one of these procedures
were performed in fifty-six patients who were younger than fifty
years old. Fifty-six of the seventy-one hips were available for
radiographic and clinical analysis after a mean duration of follow-up
of eleven years. All hips had been treated with a Harris-Galante-I porous-coated
acetabular component that had been placed with a line-to-line fit
and fixed with a mean of four screws. Clinical analysis was performed
with use of the Harris hip score. Standardized anteroposterior radiographs
were analyzed with regard to migration, radiolucent lines, pelvic osteolysis,
and two-dimensional linear wear of the polyethylene.
Results:
No metal shell was revised because of aseptic loosening, and no
shell was loose at the time of the latest follow-up. A nonprogressive
radiolucent line was seen in one zone in ten hips (18%) and in two
zones in six hips (11%). No hip had a radiolucent line in all three
zones. Pelvic osteolysis was noted in thirteen hips (23%); the osteolysis
was observed in the ischium in eleven hips and around the screws
in two. Survivorship analysis revealed that the probability of survival
of the metal shell was 98% (95% confidence interval, 96.9% to 99.9%)
at ten years. The mean rate of linear polyethylene wear (and standard
deviation) was 0.15 ± 0.10 mm/yr (range, 0.02 to 0.59
mm/yr). The wear rate was significantly increased in patients with
an excellent Harris hip score (p = 0.004) and a younger age (less
than thirty-eight years) (p = 0.026). With the numbers available,
no relationship could be detected between the wear rate and the
gender or weight of the patient, the polyethylene thickness, the
abduction angle, or the femoral neck length.
Conclusions:
The fixation and survival of porous-coated acetabular metal shells
in patients less than fifty years old was excellent after a mean
duration of follow-up of eleven years. The high rate of linear polyethylene
wear and the high prevalence of pelvic osteolysis are of serious
concern in this patient population. Continued follow-up will be
necessary to evaluate the influence of these findings on the longevity
of the fixation of this prosthesis.
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