Total hip arthroplasty with cement and use of a collared matte-finish femoral component: nineteen to twenty-year follow-up.

BACKGROUND: In the mid- to late 1970s, on the basis of laboratory and finite element data, many surgeons in the United States began using collared matte-finish femoral components and metal-backed acetabular components in their total hip arthroplasties. The purpose of this study was to evaluate the long-term results of the use of one such construct in arthroplasties performed by a single surgeon in a consecutive nonselected patient cohort.
METHODS: Between January 1984 and December 1985, 273 patients underwent a total of 304 consecutive nonselected total hip arthroplasties with cement and use of the Iowa femoral component (which is collared, has a proximal cobra shape, and has a matte finish) and a metal-backed TiBac acetabular component performed by a single surgeon. At nineteen to twenty years postoperatively, only two patients (two hips) were lost to follow-up. For clinical evaluation, we attempted to interview all living patients and the families of the patients who had died to verify the status of the hip prosthesis or any revisions. Radiographic evaluation consisted of analysis for loosening and osteolysis as well as wear of the acetabular component.
RESULTS: At the time of the nineteen to twenty-year follow-up, the rate of revision of the arthroplasty for any reason was 10.5% (thirty-two hips) for all patients and 25% (twenty-three hips) for living patients. The rate of revision due to aseptic femoral loosening was 2.6% (eight hips). There was radiographic evidence of loosening of the femoral component in fifteen hips (4.9%), including those that were revised, and femoral osteolysis was seen distal to the trochanters in twenty-two hips (7.2%). The rate of revision due to aseptic loosening of the acetabular component was 7.9% (twenty-four hips), and there was radiographic evidence of acetabular loosening in forty-two hips (13.8%), including those that were revised.
CONCLUSIONS: This study demonstrates the durability of a cemented matte-finish collared femoral component at twenty years postoperatively, with a rate of revision due to aseptic loosening of 2.6%. The metal-backed acetabular component also performed well in many patients, with a 7.9% rate of revision due to aseptic loosening. However, in the living patients, the rate of loosening of the acetabular component, including cases revised because of aseptic loosening, was 30.4%.