Abstract
Introduction
The longevity of total hip replacements in young active patients is a cause for concern as increased cyclical loading can result in early loosening of implants resulting in multiple revisions during the patient's lifetime. The study presented demonstrates excellent survival of the HAC-coated femoral stems in young active individuals.
Patients/Materials & Methods
33 Patients under 50 years of age underwent 38 total hip arthroplasties using the JRI Furlong HAC-coated femoral stem. The retrospective evaluation of the prospectively collected data of the cohort at 17 to 25 years is presented.
Results
Of the surviving 34 arthroplasties, 1 hip underwent revision of the stem for peri-prosthetic fracture after 21 years and 1 patient was lost to follow-up. Using aseptic loosening as the end-point, 12 hips (31.5%) needed acetabular revisions but none needed revision of the femoral stem demonstrating 100% survival at a mean of 21 years (95% confidence interval 89% to 100%).
Discussion
The excellent survival of the femoral stems can be attributed to various factors. The HAC-coating is present throughout the length of the Furlong stem resulting in bonding along the entirety of the implant. This, further supplemented by the modulus of elasticity of titanium helps the whole proximal femur to function as one unit minimizing the impact of varus or valgus mal-positioning. Furthermore, following osteo-integration, a sealing effect is created in the proximal femur preventing distal migration of the wear particles, which are known to cause osteolysis.
The 12 patients that needed revisions for aseptic loosening in our study were confined to the acetabular side. This is a lesser invasive procedure compared to extraction and reconstruction of femoral stems.
Conclusion
In young patients with high demands, the Furlong HAC–coated femoral stem gives excellent long-term results.
