HOLLOW OR SOLID CENTRALIZER FOR COLLARLESS, POLISHED AND TAPERED HIP PROSTHESES? A RANDOMIZED CONTROLLED RSA-STUDY WITH 2 YEARS FOLLOW UP

Abstract

Collarless, polished and tapered cemented stems are nowadays commonly used in hip surgery. Normally, a hollow centralizer is applied to the stem tip to allow the prosthesis to sink in the cement mantel in the event of creep and loosening between stem and cement. It is believed that in this way the stem will stabilize and regain its tight bond with the cement. The prosthesis MS-30 (Zimmer) is collarless, polished and triple tapered and has a hollow centralizer, but was previously used with a solid centralizer. We hypothesised that these types of stems, exemplified by the MS-30, used with a hollow centralizer would sink more but stabilize better, become more stable in the important rotational migration and retrovert less than with a solid centralizer. In a prospective, controlled clinical study we randomised 60 patients with primary coxarthrosis into either hollow or solid centralizer used with the MS-30 stem. The effect was evaluated for a 2-year follow up period by repeated RSA examinations, conventional radiographs and clinical follow-ups with the questionnaires WOMAC, SF-12 and Harris Hip Score.

The RSA results showed small early migration in both groups and almost all of it occurred within the cement mantle, i.e. between stem and cement. The group with hollow centralizers migrated distally significantly more than the group with solid centralizers (p< 0.0001) (1.40 mm vs 0.28 mm). In rotation, however, there was no difference (retroversion 0.99° and 0.94°). Neither was there any difference regarding clinical outcome and questionnaires.

As expected the group with hollow centralizers migrated more distally, in the same magnitude as reported in earlier RSA studies for the conceptually similar prostheses Exeter and C-stem. Interestingly, there was no difference regarding the rotational behaviour, and both groups showed less retroversion than reported in the earlier reports. MS-30 seems to have a design that regardless of centralizer type well withstands rotational motion within the cement mantle. This study cannot fortify the need for a hollow centralizer for this collarless, polished and triple tapered prosthesis.