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The Journal of Bone and Joint Surgery (American) 84:770-774 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Total Hip Replacement with a Cementless Acetabular Component and a Cemented Femoral Component in Patients Younger than Fifty Years of Age

Young-Hoo Kim, MD, H.-K. Kook, MD and J.-S. Kim, MD

Investigation performed at the Joint Replacement Center of Korea, Seoul, Korea

Young-Hoo Kim, MD
H.-K. Kook, MD
J.-S. Kim, MD
The Joint Replacement Center of Korea, affiliated with Hae Min General Hospital, 627-3, Jayang 1-Dong, Kwang Jin-Gu, Seoul 143-191, Korea. E-mail address for Y.-H. Kim: younghookim{at}netsgo.com

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Presented in part as a poster exhibit at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Francisco, California, February 28 through March 4, 2001.

Background: We have been using hybrid total hip arthroplasty (a cementless acetabular component and a cemented stem) in young patients. The purpose of this study was to determine the prevalence of aseptic loosening, polyethylene wear, and osteolysis after the use of this technique.

Methods: We studied a prospective consecutive series of sixty-four primary hybrid total hip replacements in fifty-five patients younger than fifty years old. There were forty-three men and twelve women; the average age at the time of the index operation was 43.4 years. The average duration of follow-up was 9.4 years. We used a cementless acetabular component without screw-holes and a cemented femoral component with a 22-mm head in all hips. Clinical follow-up with use of Harris hip ratings and radiographic follow-up were performed at six weeks; at three, six, and twelve months; and yearly thereafter. The sequential annual linear and volumetric wear rates were measured, and bone-remodeling and osteolysis were assessed.

Results: The mean preoperative Harris hip score was 44 points, which increased to 95 points at the time of final follow-up. No hip had aseptic loosening. One hip (2%) was revised because of late infection. The average linear wear (and standard deviation) was 0.96 ± 0.066 mm, with an average annual rate of 0.096 ± 0.013 mm. The average volumetric wear was 364.7 ± 25.2 mm 3 , with an average annual rate of 43.4 ± 3.5 mm 3 . Six hips (9%) had an osteolytic lesion of <1 cm in diameter in the calcar femorale (zone 7).

Conclusions: Our results show that a hybrid arthroplasty with a cementless acetabular component and a smooth cemented femoral component (Ra, 0.6 mm) is effective for primary total hip replacement in young patients. Although there was no aseptic loosening and a low prevalence of osteolysis at the latest follow-up evaluation, the high rates of linear and volumetric wear of the polyethylene liner in these young patients remain a concern.


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