The use of cemented polished stems may help preserve the femur in young
patients undergoing total hip arthroplasty, according to Australian
Bogdan Solomon, MD, presented his teams findings at the SICOT XXV
Triennial World Congress 2011, in Prague.
Total hip replacement performed in young patients has a high risk
of multiple revisions, he said. Therefore, an ideal stem design
would lead to good long-term outcomes, preserve the femur and, when the time
comes, be easily replaced by another standard-length stem. Possibly even more
important, this could be done in the hands of a community surgeon.
The findings of the study, Solomon reported, point toward cemented
polished stems resulting in an absence of aseptic loosening, minimum osteolysis
and the ability when revision is necessary to use standard-length
stems and bone preserving techniques.
Solomon and his team investigated 197 primary hip arthroplasties
performed on 169 patients younger than 55 years of age. The operations were
performed by community surgeons between 1988 and 2005.
Follow-up was from 2 years to 19 years and included clinical,
radiographic and survival analyses. Incidence of loosening and osteolysis were
measures, as well as the extent of bone damage from stem removal and any need
for long stem revision.
Solomon reported a 13-year survivorship of 100%, using an endpoint of
revision for aseptic loosening. Up to 19 years, Solomon noted, none of the
stems demonstrated radiographic signs of looseness.
Revision with standard length stems was performed in five stems, with
femur preservation occurring in four of the stems through cement-in-cement
exchange and one through impaction grafting.
Of those femurs that did not undergo revision, Solomon reported, 8%
displayed mild osteolysis. Four percent displayed intermediate osteolysis.
The femur is well preserved through the use of cemented polished
stems due to an absence of aseptic loosening, minimal osteolysis and minimal
damage to the femur, Solomon said. These stems have good long-term
outcomes, even when performed by community surgeons.
- Solomon B, Costi K, McGee M, et al. Cemented polished stems
preserve the femur in young patients undergoing primary hip arthroplasty. Paper
28736. Presented at the SICOT XXV Triennial World Congress 2011. Sept. 6-9.
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