[Long-term results of uncemented stems in total hip arthroplasty: analysis of survival rates with a minimum 15-year follow-up].

BACKGROUND: The use of uncemented femoral components in primary total hip arthroplasty has become a standard procedure with increasing numbers. In contrast to the well-established long-term results of cemented femoral stems, true long-term data on the survival of uncemented femoral components are rare. With regard to high patient demands and increasing cost pressures in the public health system, long-term outcomes of uncemented femoral stems are crucial to further support their clinical use.
MATERIAL AND METHODS: We conducted a systematic literature research in Medline to obtain long-term survival rates of uncemented femoral stems. Strict inclusion criteria concerning patient numbers (n>50 hips for single studies, n>150 hips for register data), follow-up time (minimum 15 years), and patients lost to follow-up (<10%) were established to identify substantial studies. The minimum 15-year survival rates of published single studies and data from arthroplasty registers were extracted in a literature analysis.
RESULTS: Nineteen studies (17 single studies and two studies with data from arthroplasty registers) that met the inclusion criteria were identified. Survival rates for 16 different uncemented femoral stems were obtained. For most implants included in the study, the long-term outcomes of uncemented femoral components in total hip arthroplasty show minimum 15-year survival rates of over 90% independent of patient age.
CONCLUSION: The long-term results with a minimum follow-up of 15 years are good or excellent for most studied uncemented femoral stems and are comparable to the outcomes of cemented femoral components. The existing data confirm the previously reported promising midterm results. Therefore, the clinical use of uncemented femoral stems should be considered a reliable treatment option for all patients with adequate bone quality.