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. 2009 Jan;467(1):79-83.
doi: 10.1007/s11999-008-0570-3. Epub 2008 Oct 30.

Cementing the metaphyseal stem in metal-on-metal resurfacing: when and why

Harlan C Amstutz  1 , Michel J Le Duff
Affiliations

Cementing the metaphyseal stem in metal-on-metal resurfacing: when and why

Harlan C Amstutz et al. Clin Orthop Relat Res. 2009 Jan.

Abstract

Initial fixation of the femoral component in hip resurfacing is key to the enduring survival of the prosthesis. Cementing the metaphyseal stem increases the interface area between bone and cement. We compared the clinical and survivorship results of two groups in a cohort of 1000 hips (838 patients) implanted with Conserve((R)) Plus hip resurfacing; one group was resurfaced with a cemented metaphyseal stem (400 hips; Group 1) and the other with a press-fit stem (600 hips; Group 2). We carried out a time-dependent analysis to determine the indications for cementing the stem. The 5-year Kaplan-Meier survival estimate was 98.2% for Group 1 and 94.4% for Group 2, using any revision as an endpoint. Femoral aseptic failure was reduced in Group 1 compared to Group 2. Cementing the metaphyseal stem is particularly effective for hips with a small femoral component size (< 48 mm) and hips with large femoral defects (> 1 cm). There was no difference between groups in incidence of femoral neck narrowing or femoral neck fractures. Longer followup is needed to determine if cementing the stem can be detrimental to the long-term durability of the femoral implant.

Level of evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1A–B
Fig. 1A–B
Comparative survivorship analyses of hips resurfaced with a cemented metaphyseal stem (Group 1) or with a press-fit stem (Group 2) are shown for (A) hips of small component sizes (femoral component < 48 mm in diameter, n = 385) and (B) hips of large component sizes (femoral component ≥ 48 mm in diameter, n = 615). Revision for aseptic femoral failure (femoral neck fracture and femoral component loosening) was used as an endpoint. Note: The difference between the two curves is associated with a difference in the rate of femoral component loosening since the incidence of femoral neck fractures was not different between Groups 1 and 2.
Fig. 2A–B
Fig. 2A–B
Comparative survivorship analyses of hips resurfaced with a cemented metaphyseal stem (Group 1) or with a press-fit stem (Group 2) are shown for (A) hips with large femoral defects (> 1 cm, n = 354) and (B) hips with small femoral defects (≤ 1 cm) or no defect (n = 646). Revision for aseptic femoral failure (femoral neck fracture and femoral component loosening) was used as an endpoint.
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References

    1. Amstutz H, Ball S, Le Duff M, Dorey F. Hip resurfacing for patients under 50 years of age. Results of 350 Conserve Plus with a 2–9 year follow-up. Clin. Orthop Relat Res. 2007;460:159–164. - PubMed
    1. Amstutz H, Beaulé P, Dorey F, Le Duff M, Campbell P, Gruen T. Metal-on-metal hybrid surface arthroplasty: two to six year follow-up.J. Bone Joint Surg Am. 2004;86:28–39. - PubMed
    1. Amstutz H, Beaulé P, Dorey F, Le Duff M, Campbell P, Gruen T. Metal-on-metal hybrid surface arthroplasty – Surgical technique. J. Bone Joint Surg Am. 2006;88(suppl 1 Part 2):234–249. - DOI - PubMed
    1. Amstutz H, Le Duff M. Eleven years of experience with metal-on-metal hybrid hip resurfacing: a review of 1,000 ConservePlus. J Arthroplasty. 2008;23:36–43. - DOI - PubMed
    1. Amstutz H, Le Duff M. Results of Conserve®Plus hip resurfacing. In: Amstutz HC, ed. Hip Resurfacing: Principles, Indications, Technique and Results. Philadelphia, PA: Elsevier; 2008:103–117.

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