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Survival of Polished Compared with Precoated Roughened Cemented Femoral ComponentsA Prospective, Randomized Study
Paul F. Lachiewicz, MD1; Scott S. Kelley, MD2; Elizabeth S. Soileau, BSN1
1 Department of Orthopaedics, University of North Carolina at Chapel Hill, 3151 Bioinformatics Building, CB 7055, 130 Mason Farm Road, Chapel Hill, NC 27514. E-mail address for P.F. Lachiewicz: Paul_Lachiewicz@med.unc.edu
2 North Carolina Orthopaedic Clinic, 3609 Southwest Durham Drive, Durham, NC 27707
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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 Zimmer. 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 a commercial entity (Zimmer). Also, a commercial entity (Zimmer) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to the Department of Orthopaedics, University of North Carolina, with which one or more of the authors, or a member of his or her immediate family, are affiliated or associated.
Investigation performed at the Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jul 01;90(7):1457-1463. doi: 10.2106/JBJS.G.01043
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Background: The optimal surface finish for cemented femoral components remains controversial. The purpose of this randomized clinical trial was to compare the survival of two femoral components with similar geometry but substantially different surface finishes.

Methods: During a five-year period, 201 patients (219 hips) were prospectively randomized to be treated with a total hip arthroplasty with either a polished (Ra, 0.18 to 0.3 µm) or a precoated roughened (Ra, 1.8 to 2.3 µm) cemented femoral component with similar geometry. There were no significant differences between the patient groups in terms of age, sex, weight, preoperative diagnosis, component size, or cement grade. So-called third-generation cementing techniques were used. One hundred and thirteen polished components and 106 precoated roughened components were followed for a mean of 5.3 years. Complete clinical and radiographic data were available for 134 hips at a minimum of five years (mean, 6.1 years; range, five to ten years) postoperatively.

Results: In the entire cohort of 219 hips, there was no significant difference (log rank p = 0.66) in survival, with the end point defined as component removal for any reason or definite radiographic loosening, between the precoated components (96.2%; 95% confidence interval, 90.9% to 100%) and the polished components (97.1%; 95% confidence interval, 93.8% to 100%). There was a periprosthetic fracture in three hips with a polished component. Two precoated roughened components were revised because of loosening, and two polished components were revised: one because of loosening and one because of a nonunion of a periprosthetic fracture. There was no significant difference between the groups with regard to the Harris hip scores or the clinical results. There was also no significant difference with regard to the presence or number of bone-cement radiolucent lines.

Conclusions: Kaplan-Meier survival analysis showed no significant differences between two types of cemented femoral components with similar geometry but substantially different surface finishes at seven years. In the patient population selected for treatment with a cemented femoral component, the surface finish may not be a crucial factor affecting component survival at a minimum of five years, provided that good cement technique is used.

Level of Evidence: Therapeutic Level I. 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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