Total hip arthroplasty with use of so-called second-generation cementing techniques. A fifteen-year-average follow-up study.

One hundred and forty-nine patients (162 hips) had a standard primary total hip arthroplasty with a grit-blasted femoral component and use of so-called second-generation cementing techniques. No patient was lost to follow up. Fifty-one patients (sixty hips) died within fourteen years after the index operation. The remaining ninety patients (102 hips) were followed for a minimum of fourteen years. Of the fifty-one patients (sixty hips) who died within fourteen years, three patients (three hips; 5 per cent) had had a revision: one, because of aseptic loosening of the acetabular component; one, because of aseptic loosening of the femoral component; and one because of aseptic loosening of both components. Of the ninety patients (102 hips) who were alive fourteen years or more (average duration of follow-up, fifteen years) after the arthroplasty, one patient (two hips; 2 per cent) had a revision because of bilateral aseptic loosening of the femoral component. In seven patients (seven hips; 7 per cent), the femoral component loose according to radiographic criteria but was not revised. For the entire group of 162 hips, four femoral components (2 per cent) were revised because of aseptic loosening. In contrast, the rate of aseptic loosening of the acetabular component was higher and continued to increase. Of the eighty-one hips with an all-polyethylene acetabular component in the patients who were alive at fourteen years or more, eight (10 per cent) had a revision because of aseptic loosening. In addition, twenty-eight (42 per cent) of the sixty-seven all-polyethylene acetabular components that were in place after fourteen years or more, and for which there were current radiographs, were loose. Femoral components implanted with the use of second-generation cementing techniques appear to have fared much better than acetabular components that were inserted with similar techniques in this series of patients. A thin (less than one-millimeter) mantle of cement around the femoral component and defects in the mantle of cement were associated with increased loosening of the femoral component.