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Randomized Controlled Trial
. 2014 Jun;38(6):1131-7.
doi: 10.1007/s00264-013-2256-z. Epub 2014 Jan 29.

The effect of a collar and surface finish on cemented femoral stems: a prospective randomised trial of four stem designs

Jonathan Hutt  1 , Alexandra Hazlerigg, Ansari Aneel, Geoffrey Epie, Husam Dabis, Roy Twyman, Andrew Cobb
Affiliations
Randomized Controlled Trial

The effect of a collar and surface finish on cemented femoral stems: a prospective randomised trial of four stem designs

Jonathan Hutt et al. Int Orthop. 2014 Jun.

Abstract

Purpose: The optimal design for a cemented femoral stem remains a matter of debate. Over time, the shape, surface finish and collar have all been modified in various ways. A clear consensus has not yet emerged regarding the relative merits of even the most basic design features of the stem. We undertook a prospective randomised trial comparing surface finish and the effect of a collar on cemented femoral component subsidence, survivorship and clinical function.

Methods: One hundred and sixty three primary total hip replacement patients were recruited prospectively and randomised to one of four groups to receive a cemented femoral stem with either a matt or polished finish, and with or without a collar.

Results: At two years, although there was a trend for increased subsidence in the matt collarless group, this was not statistically significant (p = 0.18). At a mean of 10.1 years follow-up, WOMAC scores for the surviving implants were good, (Range of means 89-93) without significant differences. Using revision or radiographic loosening as the endpoint, survivorship of the entire cohort was 93 % at 11 yrs, (CI 87-97 %). There were no significant differences in survivorship between the two groups with polished stems or the two groups with matt stems. A comparison of the two collarless stems demonstrated a statistically significant difference in survivorship between polished (100 %) and matt (88 %) finishes (p = 0.02).

Conclusions: In the presence of a collar, surface finish did not significantly affect survivorship or function. Between the two collarless groups a polished surface conferred an improved survivorship.

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Figures

Fig. 1
Fig. 1
Anteroposterior (AP) profile of collared and noncollared stems
Fig. 2
Fig. 2
Radiograph showing positions of marker beads implanted in proximal femur
Fig. 3
Fig. 3
Individual subsidence of stems within groups at 2 years
Fig. 4
Fig. 4
Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at latest follow-up
Fig. 5
Fig. 5
Mean stem subsidence in each group over 2 years
Fig. 6
Fig. 6
Survival curves showing cumulative survival at 11 years, with 95 % confidence intervals
Fig. 7
Fig. 7
Consolidated Standards of Reporting Trials (CONSORT) flow diagram
See this image and copyright information in PMC

References

    1. Mulroy RD, Harris WH. The effect of improved cementing techniques on component loosening in total hip replacement. An 11-year radiographic review. J Bone Joint Surg Br. 1990;72:757–760. - PubMed
    1. Barrack RL. Early failure of modern cemented stems. J Arthroplasty. 2000;15:1036–1050. doi: 10.1054/arth.2000.16498. - DOI - PubMed
    1. Shen G. Femoral stem fixation. An engineering interpretation of the long-term outcome of Charnley and Exeter stems. J Bone Joint Surg Br. 1998;80:754–756. doi: 10.1302/0301-620X.80B5.8621. - DOI - PubMed
    1. Scheerlinck T, Casteleyn P-P. The design features of cemented femoral hip implants. J Bone Joint Surg Br. 2006;88:1409–1418. doi: 10.1302/0301-620X.88B11.17836. - DOI - PubMed
    1. Mohler CG, Callaghan JJ, Collis DK, Johnston RC. Early loosening of the femoral component at the cement-prosthesis interface after total hip replacement. J Bone Joint Surg Am. 1995;77:1315–1322. - PubMed

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