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Total Hip Arthroplasty with Cement and Use of a Collared Matte-Finish Femoral Component

Nineteen to Twenty-Year Follow-up

¹ Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for J.J. Callaghan: john-callaghan{at}uiowa.edu
² Des Moines Orthopaedic Surgeons, 6001 Westown Parkway, West Des Moines, IA 50266

Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, Iowa City, and Des Moines Orthopaedic Surgeons, West Des Moines, Iowa

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes of Health and DePuy. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Zimmer and DePuy). Also, commercial entities (Zimmer and DePuy) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Methods: Between January 1984 and December 1985, 273 patients underwent a total of 304 consecutive nonselected total hip arthroplasties with cement and use of the Iowa femoral component (which is collared, has a proximal cobra shape, and has a matte finish) and a metal-backed TiBac acetabular component performed by a single surgeon. At nineteen to twenty years postoperatively, only two patients (two hips) were lost to follow-up. For clinical evaluation, we attempted to interview all living patients and the families of the patients who had died to verify the status of the hip prosthesis or any revisions. Radiographic evaluation consisted of analysis for loosening and osteolysis as well as wear of the acetabular component.

Results: At the time of the nineteen to twenty-year follow-up, the rate of revision of the arthroplasty for any reason was 10.5% (thirty-two hips) for all patients and 25% (twenty-three hips) for living patients. The rate of revision due to aseptic femoral loosening was 2.6% (eight hips). There was radiographic evidence of loosening of the femoral component in fifteen hips (4.9%), including those that were revised, and femoral osteolysis was seen distal to the trochanters in twenty-two hips (7.2%). The rate of revision due to aseptic loosening of the acetabular component was 7.9% (twenty-four hips), and there was radiographic evidence of acetabular loosening in forty-two hips (13.8%), including those that were revised.

Conclusions: This study demonstrates the durability of a cemented matte-finish collared femoral component at twenty years postoperatively, with a rate of revision due to aseptic loosening of 2.6%. The metal-backed acetabular component also performed well in many patients, with a 7.9% rate of revision due to aseptic loosening. However, in the living patients, the rate of loosening of the acetabular component, including cases revised because of aseptic loosening, was 30.4%.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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