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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 1, 16-22.
doi: 10.1302/0301-620X.90B1.19546  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Collarless polished tapered stem

CLINICAL AND RADIOLOGICAL RESULTS AT A MINIMUM OF TEN YEARS’ FOLLOW-UP

P. J. Yates, BSc(Hons), MRCS, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon & Senior Lecturer1; B. J. Burston, MBChB(Hons), BSc(Hons), MRCS, Specialist Registrar2; E. Whitley, PhD, BSc(Hons), MSc, Medical Statistician2; and G. C. Bannister, MD, MCh(Orth), FRCSEd(Orth), Consultant Orthopaedic Surgeon2

1 Department of Orthopaedics and Trauma Fremantle Hospital, Alma Road, Fremantle, Western Australia 6160, Australia.
2 Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury-on-trym, Bristol BS10 5NB, UK.

Correspondence should be sent to Mr P. J. Yates; e-mail: piersyates{at}hotmail.com

We retrospectively reviewed 175 patients (191 hips) who had undergone primary cemented total hip replacement between November 1992 and November 1995 using a collarless polished double-tapered femoral component after a minimum of ten years (mean 11.08; 10 to 12.8). All stems were implanted using contemporary cementing techniques with a distal cement restrictor, pressurised lavage, retrograde cementing with a gun and proximal pressurisation. Clinical outcome was assessed using the Harris Hip score. Radiological analysis was performed on calibrated plain radiographs taken in two planes. Complete radiological data on 110 patients (120 hips) and clinical follow-up on all the surviving 111 patients (122 hips) was available. The fate of all the hips was known.

At final follow-up, the mean Harris Hip score was 86 (47 to 100), and 87 of 116 patients (75%) had good or excellent scores. Survival with revision of the stem for aseptic loosening as the endpoint was 100%; and survival with revision of the stem for any reason was 95.9% (95% confidence interval 87.8 to 96.8) at ten years. All the stems subsided vertically at the stem-cement interface in a predictable pattern, at an overall mean rate of 0.18 mm per year (0.02 to 2.16), but with a mean rate of 0.80 mm (0.02 to 2.5) during the first year. The mean total subsidence was 1.95 mm (0.21 to 24). Only three stems loosened at the cement-bone interface. There was excellent preservation of proximal femoral bone stock. There was a high incidence of Brooker III and IV heterotopic ossification affecting 25 patients (22%).

The collarless polished tapered stem has an excellent clinical and radiological outcome at a minimum of ten years’ follow-up. The pattern and magnitude of subsidence of the stem within the cement mantle occurred in a predictable pattern, consistent with the design philosophy.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General