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Primary Total Hip Arthroplasty with a Proximally Porous-Coated Femoral Stem
Raj K. Sinha, MD, PhD1; Danton S. Dungy, MD2; Howard B. Yeon, MD3
1 Desert Orthopedic Center, 39000 Bob Hope Drive, Lakeview Building, Rancho Mirage, CA 92270. E-mail address: raj.sinha@comcast.net
2 11316 Tooks Way, Columbia, MD 21044
3 107 Avenue Louis Pasteur, Box 318, Boston, MA 02115
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Jun 01;86(6):1254-1261
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Background: The use of cementless, proximally porous-coated femoral stems for total hip arthroplasty has increased in popularity. The purpose of the present report was to examine the five to ten-year results associated with the use of a so-called second-generation circumferentially proximally porous-coated titanium-alloy stem.

Methods: Between 1991 and 1994, 123 Harris-Galante Multilock femoral stems were implanted in 101 patients. The average age of the patients at the time of surgery was 53.8 years. The patients were followed prospectively and were reevaluated at a minimum of five years postoperatively. No patient was lost to follow-up. Twenty-five patients (thirty hips) were interviewed by telephone, and four patients (five hips) died during the study period because of problems that were unrelated to the operation. The remaining seventy-two patients (eighty-eight hips) had a minimum of five years of clinical and radiographic follow-up.

Results: The average duration of follow-up was seventy-eight months. At the time of the most recent follow-up, the average Harris Hip Score was 95 points. Eighty-seven (99%) of eighty-eight stems were biologically stable, with eighty-four hips (95%) having osseous ingrowth and three hips (3%) having stable fibrous fixation. One stem was revised because of loosening. Thirty-three hips (38%) had minimal proximal osteolysis, and no hip had diaphyseal osteolysis. Seventy-two hips (82%) had some degree of stress-shielding in the proximal metaphysis, but only two hips had cortical resorption. None of these patients required additional surgery, and all reported a satisfactory outcome.

Conclusions: Given the young age and high activity level of these patients, this stem fared well: the levels of patient function and satisfaction were high, the rates of loosening and revision were very low, and distal osteolysis did not occur. Osseous fixation occurred reliably. Proximal stress-shielding was seen but did not seem to be clinically important.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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