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
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.