To The Editor:
I read with great interest the paper entitled
"Total Hip Arthroplasty with Cement and Use of a Collared Matte-Finish
Femoral Component. Nineteen to Twenty-Year Follow-up"(1) in which they report the longterm results of the Iowa stem. This stem has existed in three surface configurations but, unfortunately, the authors do not describe the surface finishes using current criteria to permit a thorough understanding of their results.
Garvin and Clark(2) have proposed a more appropriate definition of
surface finish: polished (radius of less than 10 microinches or
0.25 micrometers); satin or bead blasted (radius of 20 to 50 microinches
or 0.5 to 1.26 micrometers); and matte (radius of more than 50 microinches
or 1.26 micrometers). By these criteria, the so-called matte stem described in
this study is not a matte stem but a satin finsh stem. All the existing
literature(3-7) on this subject is very clear, indicating that
cemented stems with a surface finish greater than 1 micrometer are associated with
poor long term results and unacceptable rates of aspetic
loosening(8).
Thus, it would be most informative for the authors to provide us with a more correct definition of the surface finishes of the Iowa stems they studied using the criteria of Garvin and Clark(2). By those criteria, it would seem that they reported results of a satin stem, not a matte stem.
The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received 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, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated .
References:
1. Callaghan JJ, Liu SS, Firestone DE, Yehyawi TM, Goetz DD, Sullivan J, Vittetoe DA, O'Rourke MR, Johnston RC. Total hip arthroplasty with cement and use of a collared matte-finish femoral component. J Bone Joint Surge Am. 2008;90:299-306.
2. Garvin K, Clark C. Commentary and perspective. Available at:
http://www.jbjs.org/Comments/2002/c_pclark.shtml. Accessed July 12, 2002.
3. Collis DK, Mohler CG. Comparison of clinical outcomes in total hip
arthroplasty using rough and polished cemented stems with essentially the
same geometry. J Bone Joint Surg Am. 2002;84:586-592.
4. Howie DW, Middleton RG, Costi K. Loosening of matt and polished
cemented femoral stems. J Bone Joint Surg Br. 1998;80:573-576.
5. Mohler CG, Callaghan JJ, Collis DK, Johnston RC. Early loosening of the
femoral component at the cement-prosthesis interface after total hip
replacement. J Bone Joint Surg Am. 1995;77:1315-1322.
6. Ong A, Wong KL, Lai M, Garino JP, Steinberg ME. Early failure of
precoated femoral components in primary total hip arthroplasty. J Bone
Joint Surg Am. 2002;84:786-792.
7. Sporer SM, Callaghan JJ, Olejniczak JP, Goetz DD, Johnston RC. The
effects of surface roughness and polymethylmethacrylate precoating on the
radiographic and clinical results of the Iowa hip prosthesis. A study of
patients less than fifty years old. J Bone Joint Surg Am. 1999;81:481-492.
8. Hamadouche M, Baqué F, Lefevre N, Kerboull M. Minimum 10-year survival
of Kerboull cemented stems according to surface finish. Clin Orthop Relat
Res. 2008;466:322-329.
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