Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Oct;82(5):521-9.
doi: 10.3109/17453674.2011.618908.

Results of 3,668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years

Keijo T Mäkelä  1 , Antti Eskelinen, Pekka Pulkkinen, Pekka Paavolainen, Ville Remes
Affiliations

Results of 3,668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years

Keijo T Mäkelä et al. Acta Orthop. 2011 Oct.

Abstract

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Cox-adjusted survival curves of 3,668 total hip replacements in patients aged less than 55 years with implant group as the strata factor. The endpoint was defined as revision of the stem and/or the cup for any reason. Adjustment was made for age and gender. A. THRs performed 1987–1996. Cementless group #2 had a significantly worse overall survival than the reference group of cemented hip replacements. B. THRs performed 1997–2006. The differences in survival rates between the THR groups were not statistically significant.
Figure 2.
Figure 2.
Cox-adjusted survival curves of 3,668 total hip replacements in patients aged less than 55 years with implant group as the strata factor. The endpoint was defined as revision of the stem and/or the cup for aseptic loosening. Adjustment was made for age and gender. A. THRs performed 1987–1996. Cementless group #1 had a significantly better overall survival than the reference group of cemented THRs. B. THRs performed 1997–2006. The differences in survival rates between the THR groups were not statistically significant.
Figure 3.
Figure 3.
Cox-adjusted survival curves of 3,668 stems in patients aged less than 55 years with stem group as the strata factor. The endpoint was defined as stem revision due to aseptic loosening. Adjustment was made for age and sex. A. THRs performed 1987–1996. Cementless stem group 1 had a significantly better overall survival than the reference group of cemented stems. B. THRs performed 1997–2006. The differences in survival rates between the stem groups were not statistically significant.
Figure 4.
Figure 4.
Cox-adjusted survival curves of 3,668 cups in patients aged less than 55 years with cup group as the strata factor. The end point was defined as cup revision due to aseptic loosening. Adjustment was made for age and sex. A. THRs performed 1987–1996. The differences in survival rates between the cup groups were not statistically significant. B. THRs performed 1997–2006. The differences in survival rates between the cup groups were not statistically significant.
See this image and copyright information in PMC

Comment in

  • Results of 3,668 primary total hip replacements.
    Schreurs BW, Gardeniers JW. Schreurs BW, et al. Acta Orthop. 2012 Apr;83(2):204; author reply 205. doi: 10.3109/17453674.2012.672095. Epub 2012 Mar 8. Acta Orthop. 2012. PMID: 22401674 Free PMC article. No abstract available.

References

    1. Anseth SD, Pulido PA, Adelson WS, Patil S, Sandwell JC, Colwell CW. Fifteen-year to twenty-year results of cementless Harris-Galante Porous femoral and Harris-Galante Porous I and II acetabular components. J Arthroplasty. 2010;25(5):687–91. - PubMed
    1. Bradford L, Baker D, Ries MD, Pruitt LA. Fatigue crack propagation resistance of highly crosslinked polyethylene. Clin Orthop. 2004;429:68–72. - PubMed
    1. Buckwalter AE, Callaghan JJ, Liu SS, Pedersen DR, Goetz DD, Sullivan PM, Leinen JA, Johnston RC. Results of Charnley total hip arthroplasty with use of improved femoral cementing techniques: a concise follow-up, at a minimum of twenty-five years, of a previous report. J Bone Joint Surg (Am) 2006;88(7):1481–5. - PubMed
    1. Callaghan JJ, Templeton JE, Liu SS, Pedersen DR, Goetz DD, Sullivan PM, Johnston RC. Results of Charnley total hip arthroplasty at a minimum of thirty years: a concise follow-up of a previous report. J Bone Joint Surg (Am) 2004;86(4):690–5. - PubMed
    1. Callaghan JJ, Cuckler JM, Huddleston JI, Galante JO. How have alternative bearings (such as metal-on-metal, highly cross-linked polyethylene, and ceramic-on-ceramic) affected the prevention and treatment of osteolysis? J Am Acad Orthop Surg (Suppl 1) 2008;16:33–8. - PubMed