Wayne Hoskins1, Dirk van Bavel2, Michelle Lorimer3, Richard N de Steiger4. 1. Traumaplasty Melbourne, East Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia. 2. Department of Orthopaedic Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia. 3. Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia. 4. Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia; Epworth Healthcare, University of Melbourne, Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.
Abstract
BACKGROUND: Matt and polished femoral stems have been historically grouped together in registry assessment of the outcome of cemented femoral stems in total hip arthroplasty. This is despite differences in the mode of fixation and biomechanics of loading. The aims of this study are to compare the survivorship of polished tapered stems with matt finished cemented stems. METHODS: Data on primary total hip arthroplasty undertaken for a diagnosis of osteoarthritis from September 1999 to December 2014 were included from a National Joint Registry. Revision rates of the 2 different types of femoral components were compared. RESULTS: There were 96,315 cemented femoral stems included, of which 82,972 were polished tapered and 13,343 matt finish. The cumulative percent revision at 14 years of polished stems was 3.6% (3.0-4.2) compared to 4.9% (4.1-5.7) for matt finish stems. Polished tapered stems had a significantly lower revision rate of femoral revision (hazard ratio 0.56, P < .001). This difference is evident in patients aged <75, and becomes apparent in the mid-term and continues to increase with time. Aseptic loosening accounts for 75% of revisions of matt finish stems compared to 20% for polished tapered stems. CONCLUSION: Although both polished and matt finish stems have excellent early to mid-term results, the long-term survivorship of polished stems is significantly better, with aseptic loosening becoming an issue with matt finish stems. In the future reports of cement fixation for femoral stems may benefit from separate analysis of polished and matt finish.
BACKGROUND: Matt and polished femoral stems have been historically grouped together in registry assessment of the outcome of cemented femoral stems in total hip arthroplasty. This is despite differences in the mode of fixation and biomechanics of loading. The aims of this study are to compare the survivorship of polished tapered stems with matt finished cemented stems. METHODS: Data on primary total hip arthroplasty undertaken for a diagnosis of osteoarthritis from September 1999 to December 2014 were included from a National Joint Registry. Revision rates of the 2 different types of femoral components were compared. RESULTS: There were 96,315 cemented femoral stems included, of which 82,972 were polished tapered and 13,343 matt finish. The cumulative percent revision at 14 years of polished stems was 3.6% (3.0-4.2) compared to 4.9% (4.1-5.7) for matt finish stems. Polished tapered stems had a significantly lower revision rate of femoral revision (hazard ratio 0.56, P < .001). This difference is evident in patients aged <75, and becomes apparent in the mid-term and continues to increase with time. Aseptic loosening accounts for 75% of revisions of matt finish stems compared to 20% for polished tapered stems. CONCLUSION: Although both polished and matt finish stems have excellent early to mid-term results, the long-term survivorship of polished stems is significantly better, with aseptic loosening becoming an issue with matt finish stems. In the future reports of cement fixation for femoral stems may benefit from separate analysis of polished and matt finish.