Abstract:

BACKGROUND: Increasing elderly patients with hip arthropathy require total hip replacement. However, it remains controversial on fixation type and ideal femoral shaft design due to bone mass loss and poor healing.
OBJECTIVE: To observe the mid-term effect of total hip replacement with a tapered femoral component for elderly patients.
METHODS: From February 2002 to February 2004, 65 cases (70 hips) underwent uncement total hip replacement with a tapered F2L femoral component in Department of Orthopedics, First Hospital Affiliated to Soochow University. The diagnosis included femoral neck fractures in 35 cases, osteoarthritis in 10 cases, avascular necrosis of the femoral head in 8 cases, loosening of artificial femoral head in 9 cases, rheumatoid arthritis in 2 cases, and arthrodesis in 1 case. Clinical and radiographic evaluations were performed at postoperatively 1 week, 3 and 6 months. The patients were followed up every year thereafter to recheck hip function by Harris score and X-ray.
RESULTS AND CONCLUSION: Six patients died of cancer and four died of Cardio-cerebral vascular diseases．The remaining 55 cases (60 hips) were followed up for 6-7 years, with an average follow-up of 6.5 years．At the latest follow-up, the mean Harris hip score was 90 points (85-95 scores); 2 patients (3.3%) reported mild thigh pain, but no case required revision. By the measurement of the X-ray, 36 stems had less than 1.5 mm of subsidence within the l year follow up. The remainer stems had no subsidence. Radiographic evaluation demonstrated all stems to get bone ingrowths fixation with evidence of spot welds, cancellous condensation and cortical hypertrophy visible around Gruen zone 6 at 3 to 6 months postoperatively, including patients of Dorr type C．Reactive 1ines covered the noncoated zone of the femoral stems for some cases. No hip had extensive proximal end osteolysis or distal intramedullary osteolysis and loosening. The patients who used tapered femoral stems which were placed in the marrow obtained the initial stability because of the design features, but also obtained the quadratic stability because walking and weight-bearing could lead to a modest subsidence of the prosthesis. Therefore, it is helpful to improve mid-term clinical results of the cementless total hip replacement for elderly patients