Thursday, March 11, 2004
Researchers examined two consecutive, non-selective cohorts of total hip replacements performed sequentially by a single surgeon sequentially. Group I consisted of 304 hip replacements performed during 1984-1985; Group II included 120 hip replacements performed in 1986. Both groups were evaluated for femoral revision for aseptic loosening and radiographic loosening and osteolysis.
The components used in the Group I hip replacements included a TiBac cemented acetabular with a cemented femoral component that had a 20-to-30 microinch surface roughness. Components used for Group II included a cementless HG I acetabular and a femoral component of identical geometry that had an 80 microinch surface roughness. In both series, the surgeon used contemporary cement technique.
No patient was lost to follow-up. Researchers followed patients with the smoother femoral component and those with a rougher femoral component for 13 to 15 years. In Group I (smoother femoral component) the femoral revision rate for aseptic loosening was 2.0 percent. In Group II (rougher femoral component), it was 10.8 percent. The radiographic loosening rate was 3.6 percent in Group I and 13.3 percent in Group II. Femoral osteolysis occurred in about 7percent of hips in Group I and in 13 percent of hips in Group II. The difference between groups was significant for all three parameters (p=.001).
In this study, researchers unlinked the surgeon, the femoral component geometry, and cement technique as potentially confounding variables. Their results support the use of femoral components with smoother surface roughness in cemented total hip replacements. The smoother stem performed as well as any other cemented femoral component with a 15-year follow-up report.
Researchers included John J. Callaghan, MD, John Gaffey, BS, and Richard C. Johnston, MD, all of Iowa City, Iowa; Steve S. Liu, MD, of Wichita, Kan.; Jesse Ellis Templeton, MD, of Cleveland, Ohio; Devon D. Goetz, MD, and Patrick M. Sullivan, MD, both of West Des Moines, Iowa.
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