Background: Recent studies have suggested that cemented femoral
components with a polished surface may provide superior long-term fixation
when compared with femoral components with a roughened surface. The purpose of
this study was to evaluate the results of total hip arthroplasty with a
cemented femoral component with a polished surface finish and compare them
with the results of total hip arthroplasty performed with a similar design of
cemented femoral component with a rougher surface finish.
Methods: We retrospectively reviewed a consecutive group of 132
patients (149 hips) in whom primary total hip arthroplasty had been performed
by one surgeon using a cemented collared femoral component with a polished
(0.1-µm Ra) surface finish and a cementless acetabular component.
Ninety-eight patients (115 hips) were followed for a minimum of ten years. We
compared the survivorship of this prosthesis with that of a femoral component
of similar design but with rougher surfaces (matte or grit-blasted).
Results: No polished stems were revised because of aseptic loosening
or demonstrated radiographic evidence of loosening; however, eight hips (5.4%)
with a polished stem demonstrated osteolysis distal to the greater or lesser
tro-chanter. In contrast, six stems (2.0%) with a matte surface finish of
0.8-µm Ra were revised because of aseptic loosening, and an additional five
stems were seen to be loose radiographically. Eleven stems (9.2%) with a
grit-blasted surface finish of 2.1-µm Ra were revised because of aseptic
loosening, and an additional four stems were seen to be loose
radiographically. The difference in the prevalence of revision due to aseptic
loosening between the group with the 0.1-µm Ra surface and the group with
the 2.1-µm Ra surface was significant (p = 0.001), as was the difference
between the prevalence of revision due to aseptic loosening between the group
with the 0.8-µm Ra surface and the group with the 2.1-µm Ra surface (p =
0.001). No cups were revised because of aseptic loosening, and one hip had
radiographic signs of acetabular loosening.
Conclusions: This study demonstrated excellent durability of a
prosthesis consisting of a cemented, collared, polished femoral component and
a cementless acetabular component. While no hips were revised because of
aseptic loosening, distal femoral osteolysis was observed in eight hips
(5.4%), a higher prevalence than has been reported by others after similar
durations of follow-up of tapered, collarless, polished femoral
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.