0
Scientific Articles   |    
Total Hip Arthroplasty with Cement and Use of a Collared Matte-Finish Femoral ComponentNineteen to Twenty-Year Follow-up
John J. Callaghan, MD1; Steve S. Liu, MD1; Daniel E. Firestone, MD1; Tameem M. Yehyawi, BS1; Devon D. Goetz, MD2; Jason Sullivan, BS1; David A. Vittetoe, MD2; Michael R. O'Rourke, MD1; Richard C. Johnston, MD1
1 Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for J.J. Callaghan: john-callaghan@uiowa.edu
2 Des Moines Orthopaedic Surgeons, 6001 Westown Parkway, West Des Moines, IA 50266
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes of Health and DePuy. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Zimmer and DePuy). Also, commercial entities (Zimmer and DePuy) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, Iowa City, and Des Moines Orthopaedic Surgeons, West Des Moines, Iowa

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Feb 01;90(2):299-306. doi: 10.2106/JBJS.G.00095
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: In the mid- to late 1970s, on the basis of laboratory and finite element data, many surgeons in the United States began using collared matte-finish femoral components and metal-backed acetabular components in their total hip arthroplasties. The purpose of this study was to evaluate the long-term results of the use of one such construct in arthroplasties performed by a single surgeon in a consecutive nonselected patient cohort.

Methods: Between January 1984 and December 1985, 273 patients underwent a total of 304 consecutive nonselected total hip arthroplasties with cement and use of the Iowa femoral component (which is collared, has a proximal cobra shape, and has a matte finish) and a metal-backed TiBac acetabular component performed by a single surgeon. At nineteen to twenty years postoperatively, only two patients (two hips) were lost to follow-up. For clinical evaluation, we attempted to interview all living patients and the families of the patients who had died to verify the status of the hip prosthesis or any revisions. Radiographic evaluation consisted of analysis for loosening and osteolysis as well as wear of the acetabular component.

Results: At the time of the nineteen to twenty-year follow-up, the rate of revision of the arthroplasty for any reason was 10.5% (thirty-two hips) for all patients and 25% (twenty-three hips) for living patients. The rate of revision due to aseptic femoral loosening was 2.6% (eight hips). There was radiographic evidence of loosening of the femoral component in fifteen hips (4.9%), including those that were revised, and femoral osteolysis was seen distal to the trochanters in twenty-two hips (7.2%). The rate of revision due to aseptic loosening of the acetabular component was 7.9% (twenty-four hips), and there was radiographic evidence of acetabular loosening in forty-two hips (13.8%), including those that were revised.

Conclusions: This study demonstrates the durability of a cemented matte-finish collared femoral component at twenty years postoperatively, with a rate of revision due to aseptic loosening of 2.6%. The metal-backed acetabular component also performed well in many patients, with a 7.9% rate of revision due to aseptic loosening. However, in the living patients, the rate of loosening of the acetabular component, including cases revised because of aseptic loosening, was 30.4%.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    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.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    John J. Callaghan, M.D.
    Posted on February 13, 2008
    Dr. Callaghan responds to Dr. Hamadouche
    University of Iowa and VA Hospital, Iowa City, IA

    Thank you, Dr. Hamadouche, for your comments on our paper “Total Hip Arthroplasty with Cement and Use of a Collared Matte Finished Femoral Component: Nineteen to Twenty Year Follow-up”(1). I agree with you that the surface finish terminology in the literature is confusing. I would, however, refrain from citing a commentary and perspective as the definitive work. I would rather think it is better to describe surface finish by using the best material the manufacturer can provide for us. I would agree that because of this issue, terms such as satin and matte finish should probably be avoided. I would also have to say that in the literature, the optimal surface finish cannot be agreed upon. As our study is relatively long term with excellent radiographic follow-up and as it is a consecutive non- selected series, it may be accepted more widely than other studies in the literature. If at all possible in the future, studies should probably just state the RA values.

    Reference:

    1. Callaghan JJ, Liu SS, Firestone DE, Yehyawi TM, Goetz DD, Sullivan J, Vittetoe DA O'Rourke MR, Johnston RC. Total hip arthroplasty with cement and use of a collared matte-finish femoral coponent. Nineteen to twenty-year follow-up. J Bone Joint Surg Am. 2008; 90:299-306.

    Moussa Hamadouche, M.D., Ph.D.
    Posted on February 05, 2008
    Definition of Surface Finish: Satin Is Not Matte
    Department of Orthopaedic Surgery, Universite Paris 5, Hôpital Cochin

    To The Editor:

    I read with great interest the paper entitled "Total Hip Arthroplasty with Cement and Use of a Collared Matte-Finish Femoral Component. Nineteen to Twenty-Year Follow-up"(1) in which they report the longterm results of the Iowa stem. This stem has existed in three surface configurations but, unfortunately, the authors do not describe the surface finishes using current criteria to permit a thorough understanding of their results.

    Garvin and Clark(2) have proposed a more appropriate definition of surface finish: polished (radius of less than 10 microinches or 0.25 micrometers); satin or bead blasted (radius of 20 to 50 microinches or 0.5 to 1.26 micrometers); and matte (radius of more than 50 microinches or 1.26 micrometers). By these criteria, the so-called matte stem described in this study is not a matte stem but a satin finsh stem. All the existing literature(3-7) on this subject is very clear, indicating that cemented stems with a surface finish greater than 1 micrometer are associated with poor long term results and unacceptable rates of aspetic loosening(8).

    Thus, it would be most informative for the authors to provide us with a more correct definition of the surface finishes of the Iowa stems they studied using the criteria of Garvin and Clark(2). By those criteria, it would seem that they reported results of a satin stem, not a matte stem.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received 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, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated .

    References:

    1. Callaghan JJ, Liu SS, Firestone DE, Yehyawi TM, Goetz DD, Sullivan J, Vittetoe DA, O'Rourke MR, Johnston RC. Total hip arthroplasty with cement and use of a collared matte-finish femoral component. J Bone Joint Surge Am. 2008;90:299-306.

    2. Garvin K, Clark C. Commentary and perspective. Available at: http://www.jbjs.org/Comments/2002/c_pclark.shtml. Accessed July 12, 2002.

    3. Collis DK, Mohler CG. Comparison of clinical outcomes in total hip arthroplasty using rough and polished cemented stems with essentially the same geometry. J Bone Joint Surg Am. 2002;84:586-592.

    4. Howie DW, Middleton RG, Costi K. Loosening of matt and polished cemented femoral stems. J Bone Joint Surg Br. 1998;80:573-576.

    5. Mohler CG, Callaghan JJ, Collis DK, Johnston RC. Early loosening of the femoral component at the cement-prosthesis interface after total hip replacement. J Bone Joint Surg Am. 1995;77:1315-1322.

    6. Ong A, Wong KL, Lai M, Garino JP, Steinberg ME. Early failure of precoated femoral components in primary total hip arthroplasty. J Bone Joint Surg Am. 2002;84:786-792.

    7. Sporer SM, Callaghan JJ, Olejniczak JP, Goetz DD, Johnston RC. The effects of surface roughness and polymethylmethacrylate precoating on the radiographic and clinical results of the Iowa hip prosthesis. A study of patients less than fifty years old. J Bone Joint Surg Am. 1999;81:481-492.

    8. Hamadouche M, Baqué F, Lefevre N, Kerboull M. Minimum 10-year survival of Kerboull cemented stems according to surface finish. Clin Orthop Relat Res. 2008;466:322-329.

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Hip
    Related Audio and Videos
    PubMed Articles
    Guidelines
    Results provided by:
    PubMed
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    10/04/2013
    California - Mercy Medical Group
    01/08/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    11/15/2013
    Louisiana - Ochsner Health System