Background: Cementless total hip arthroplasty
is an accepted alternative to total hip arthroplasty with cement
in younger patients, but it remains controversial for elderly patients.
The purpose of this study was to evaluate the clinical and radiographic
outcomes of cementless total hip arthroplasty with use of a proximally
coated stem in patients who were at least eighty years of age at
the time of the operation.
Methods: One hundred and twenty-three cementless
total hip replacements were performed for the treatment of osteoarthritis
in 114 patients between the ages of eighty and eighty-nine years.
Seven patients (eight hips) died within two years after the surgery,
seventeen patients (eighteen hips) died more than two years postoperatively
but were not followed for at least two years, and five hips were
lost to follow-up; this left ninety-two hips in eighty-six patients for
review. The mean duration of follow-up was five years (range, two
to eleven years). For the clinical evaluation, the Charnley modification
of the Merle d’Aubigné and Postel scale was used.
In addition, preoperative and postoperative Harris hip scores were
available for sixty-nine hips. Seventy-eight hips were followed
radiographically for two years or more. The focus of the radiographic
evaluation was the status of the fixation of the femoral and acetabular
components as well as cup wear.
Results: Perioperative medical complications occurred
in association with 24% (thirty) of the 123 operations, but
there were no deaths. The mean Charnley scores for pain and function
for the ninety-two hips that were followed clinically for at least
two years improved by 3.0 and 1.4 points, respectively. The sixty-nine
hips for which preoperative and postoperative Harris hip scores
were available had a mean improvement of 42 points, with a mean
score of 82 points at the last follow-up evaluation. Mild thigh pain
was present in four patients, but it did not limit their activity.
There were no femoral component revisions. All of the femoral components
were radiographically stable and had bone ingrowth. No acetabular
component failed by loosening, but 41% (thirty) of the
seventy-three hips with radiographs available for measurement of
wear showed polyethylene wear. Of the seventy-eight cups that were
followed radiographically for two years or more, 4% (three)
were associated with lysis, but none had been revised.
Conclusions: Cementless fixation in the elderly
is safe, effective, and durable at the time of two to eleven-year