The Journal of Bone and Joint Surgery (American) 84:1195-1200 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Cementless Hemispheric Porous-Coated Sockets Implanted with Press-Fit Technique without Screws: Average Ten-Year Follow-up
Pacharapol Udomkiat, MD,
Lawrence D. Dorr, MD and
Zhinian Wan, MD
Investigation performed at the Orthopedic Research Institute at
Good Samaritan Hospital, Los Angeles, California
Pacharapol Udomkiat, MD
Lawrence D. Dorr, MD
Zhinian Wan, MD
The Arthritis Institute at Centinela Hospital Medical Center, 501
East Hardy Street, 3rd Floor, Inglewood, CA 90301
In support of their research or preparation of this manuscript, one
or more of the authors received grants or outside funding from the
Orthopedic Research Institute at Good Samaritan Hospital, Los Angeles,
California. In addition, one or more of the authors received payments
or other benefits or a commitment or agreement to provide such benefits
from a commercial entity (Sulzer Medica Royalties). 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.
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:
Press-fit implantation of a porous-coated hemispheric acetabular
component without screws is an option for primary total hip replacement.
The purpose of the present study was to evaluate the results of
this technique after an average duration of follow-up of ten years
to determine if there was any loss of fixation or increase in osteolysis
over time.
Methods:
From June 1988 to November 1990, 132 primary total hip replacements
were performed with a porous-coated socket that was implanted with
use of a press-fit technique. Twenty-two hips were excluded because
the patient had died or had been lost to follow-up, leaving 110
hips (103 patients) available for inclusion in the study after an
average duration of follow-up of 10.2 ± 1.0 years. The
average age of the patients at the time of operation was 60.7 years
(range, 23.7 to 86.2 years). Radiographs were evaluated with regard
to initial gaps, radiolucent lines, migration, polyethylene wear,
and osteolysis. Kaplan-Meier survivorship analysis was performed
to calculate the rate of survival of the acetabular component.
Results:
One hip (0.9%) had revision of the socket because of aseptic loosening,
and four hips (4%) had revision of a stable socket. With the numbers
available, the presence of gaps on the initial postoperative radiographs
was not associated with the occurrence of radiolucent lines (p =
0.039). Pelvic osteolysis was seen in four hips, with an average
time to radiographic appearance of six years. Increased wear was
directly related to an abduction angle of >40°. The twelve-year
survival rate was 99.1% with revision because of failure of fixation
of the metal shell as the end point, 95.3% with revision for any reason
as the end point, and 79.6% with exchange of the liner as the end
point.
Conclusions:
The fixation of this press-fit socket did not deteriorate over time
and was associated with a low rate of osteolysis. The most common
reasons for reoperation were wear and dissociation of the polyethylene
insert.
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