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. 2012 Feb;83(1):1-6.
doi: 10.3109/17453674.2011.645194. Epub 2011 Dec 29.

Is there still a place for the cemented titanium femoral stem? 10,108 cases from the Norwegian Arthroplasty Register

Geir Hallan  1 , Birgitte Espehaug, Ove Furnes, Helge Wangen, Paul J Høl, Peter Ellison, Leif I Havelin
Affiliations

Is there still a place for the cemented titanium femoral stem? 10,108 cases from the Norwegian Arthroplasty Register

Geir Hallan et al. Acta Orthop. 2012 Feb.

Abstract

Background and purpose: Despite the fact that there have been some reports on poor performance, titanium femoral stems intended for cemented fixation are still used at some centers in Europe. In this population-based registry study, we examined the results of the most frequently used cemented titanium stem in Norway.

Patients and methods: 11,876 cases implanted with the cemented Titan stem were identified for the period 1987-2008. Hybrid arthroplasties were excluded, leaving 10,108 cases for this study. Stem survival and the influence of age, sex, stem offset and size, and femoral head size were evaluated using Cox regression analyses. Questionnaires were sent to the hospitals to determine the surgical technique used.

Results: Male sex, high stem offset, and small stem size were found to be risk factors for stem revision, (adjusted RR = 2.5 (1.9-3.4), 3.3 (2.3-4.8), and 2.2 (1.4-3.5), respectively). Patients operated in the period 2001-2008 had an adjusted relative risk (RR) of 4.7 (95% CI: 3.0-7.4) for stem revision due to aseptic stem loosening compared to the period 1996-2000. Changes in broaching technique and cementing technique coincided with deterioration of the results in some hospitals.

Interpretation: The increased use of small stem sizes and high-offset stems could only explain the deterioration of results to a certain degree since the year 2000. The influence of discrete changes in surgical technique over time could not be fully evaluated in this registry study. We suggest that this cemented titanium stem should be abandoned. The results of similar implants should be carefully evaluated.

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Figures

Figure 1.
Figure 1.
The Titan cemented femoral stem.
Figure 2.
Figure 2.
Survival of the stem in stratified time periods. The endpoint was revision of the stem for aseptic loosening.
Figure 3.
Figure 3.
Example of a revision case 3 years after surgery (A), and 5 years after surgery showing extensive osteolysis (B and C). Another case at 2 years (D) and 6 years (E) with a similar appearance.
Figure 4.
Figure 4.
Survival of the stem according to femoral offset (standard vs. lateralized). The endpoint was stem revision for any reason.
Figure 5.
Figure 5.
Survival of the stem according to stem size. The endpoint was stem revision for any reason.
See this image and copyright information in PMC

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