Results of 3,668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 yearsMäkelä KT, Eskelinen A, Pulkkinen P, Paavolainen P, Remes V.
BACKGROUND AND PURPOSE: In a previous study based on the Finnish Arthroplasty Register, the survival of cementless stems was better than that of cemented stems in younger patients. However, the survival of cementless cups was poor due to osteolysis. In the present study, we analyzed population-based survival rates of the cemented and cementless total hip replacements in patients under the age of 55 years with primary osteoarthritis in Finland.
PATIENTS AND METHODS: 3,668 implants fulfilled our inclusion criteria. The previous data included years 1980-2001, whereas the current study includes years 1987-2006. The implants were classified in 3 groups: (1) implants with a cementless, straight, proximally circumferentially porous-coated stem and a porous-coated press-fit cup (cementless group 1); (2) implants with a cementless, anatomic, proximally circumferentially porous-coated stem, with or without hydroxyapatite, and a porous-coated press-fit cup with or without hydroxyapatite (cementless group 2); and (3) a cemented stem combined with a cemented all-polyethylene cup (the cemented group). Analyses were performed separately for 2 time periods: those operated 1987-1996 and those operated 1997-2006.
RESULTS: The 15-year survival for any reason of cementless total hip replacement (THR) group 1 operated on 1987-1996 (62%; 95% CI: 57-67) and cementless group 2 (58%; CI: 52-66) operated on during the same time period was worse than that of cemented THRs (71%; CI: 62-80), although the difference was not statistically significant. The revision risk for aseptic loosening of cementless stem group 1 operated on 1987-1996 (0.49; CI: 0.32-0.74) was lower than that for aseptic loosening of cemented stems (p = 0.001).
INTERPRETATION: Excessive wear of the polyethylene liner resulted in numerous revisions of modular cementless cups. The outcomes of total hip arthroplasty appear to have been relatively unsatisfactory for younger patients in Finland.