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Researcher recommends continued monitoring of patients with titanium stems

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A prospective study investigating a cemented titanium femoral stem indicates aseptic loosening as the most common cause of revision and shows inferior 10-year survivorship compared to modern uncemented implants.

“We think the 10-year survivorship of the stem does not match those of collarless polished tapered stems or modern uncemented implants and we recommend continuing surveillance of these patients,” Benjamin Bloch stated in his presentation at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011.

From 1995 to 2001, 286 patients (average age of 70.8 years; 10.5-year follow-up) with a straight, collarless titanium alloy hip were examined postoperatively through clinical examinations, Harris Hip Scores and annual anteroposterior and lateral radiographs. Nine patients were excluded because they had a different stem and two patients died in the immediate postoperative period. Patients either had a porous coated cup or an all-polyethylene cup in the implant, according to the abstract.

Bloch and his colleagues found that the average time for revision was at 7 years. Harris Hip scores were 34.4 for the preoperative visit and 81.25 for last follow-up. Sixteen components needed revision; two components had deep infections at the 7-year mark. Researchers reported a 10-year Kaplan-Meier survival rate of 91% and a 12-year survival rate of 89.8%.

The majority of the revisions were for aseptic loosening. Vertical subsistence was confirmed through radiographic assessment in 10.9% of cases. Complete radioluscency was present in 4% of cases and radioluscent lines were present in 6.5% of cases where the lines covered less than 50% of the implant, according to the abstract.

Bloch concluded his presentation by stating that his unit no longer uses the implant studied.

Reference:

• Bloch B, Angadi D, Brown S, Crawfurd E. A prospective long term study of a cemented titanium (Ultima) femoral stem. Presented at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011. Sept. 13-16. Dublin.

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