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 Adult Hip Reconstruction Test 7: Total Hip Arthroplasty Results
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The Journal of Bone and Joint Surgery (American) 86:257-261 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Cementless Acetabular Fixation at Fifteen Years

A Comparison with the Same Surgeon's Results Following Acetabular Fixation with Cement

John L. Gaffey, BS1, John J. Callaghan, MD1, Douglas R. Pedersen, PhD1, Devon D. Goetz, MD2, Patrick M. Sullivan, MD2 and Richard C. Johnston, MD1

1 Department of Orthopaedics, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, Iowa 52242. E-mail address for J.J. Callaghan: john-callaghan{at}uiowa.edu
2 Des Moines Orthopaedic Surgeons, 600 Westown Parkway, West Des-Moines, IA 50266

Investigation performed at the University of Iowa Health Care, Iowa City, and the Iowa Methodist Medical Center, Des Moines, Iowa

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health (AR47653) and DePuy. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (DePuy) 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.

Background: Loosening of the acetabular component is the major long-term problem associated with total hip arthroplasty with cement. The purpose of the present study was to evaluate the minimum thirteen-year results associated with cementless acetabular components that had been inserted by a single surgeon and to compare them with the results associated with cemented acetabular components that had been inserted by the same surgeon.

Methods: One hundred and twenty consecutive, nonselected primary total hip replacements were performed in 108 patients with use of a Harris-Galante-I cementless acetabular component and a cemented femoral component with a 28-mm head. The patients were evaluated clinically with use of a standard terminology questionnaire, and they were evaluated radiographically for loosening, component migration, wear, and osteolysis. The rates of revision for aseptic loosening and radiographic evidence of loosening for this cohort were compared with the rates for four previously reviewed consecutive series of hips in which the acetabular component had been inserted with cement. All patients were managed by the same surgeon, were followed for thirteen to fifteen years, and were evaluated with use of the same two criteria (revision and loosening) as the end points for Kaplan-Meier analysis.

Results: Sixty-six patients (seventy-two hips) were living and forty-two patients (forty-eight hips) had died after thirteen to fifteen years of follow-up. No acetabular component had been revised because of aseptic loosening, and no acetabular component had migrated. With revision of the acetabular component for any reason as the end point, the survival rate was 81% ± 8% at fifteen years. With revision of the acetabular component for clinical failure (osteolysis, wear, loosening, or dislocation) as the end point, the survival rate was 94% ± 8% at fifteen years. Among the seventy hips with at least thirteen years of radiographic follow-up, five had pelvic osteolysis and three had had revision of a well-fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm/yr (0.12 mm/yr when one outlier was excluded).

Conclusions: In terms of fixation, Harris-Galante-I cementless acetabular components performed better than did cemented 22-mm-inner-diameter Charnley acetabular components as well as 28-mm-inner-diameter all-polyethylene and metal-backed acetabular components that had been inserted by the same surgeon. However, the rate of wear was greater in association with the Harris-Galante-I cementless components than it was in association with the Charnley cemented all-polyethylene components.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.


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