Is titanium so bad? Medium-term outcome of cemented titanium stems

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Medical device engineering

Background:

• Titanium femoral stems have faced challenges in cemented total hip replacements due to early failures.
• The Ultima straight textured titanium stem was introduced to address some of these concerns.

Purpose of the Study:

• To evaluate the medium-term clinical and radiological outcomes of cemented total hip replacements using the Ultima straight textured titanium stem.
• To assess the survival rate and identify potential failure modes of this specific titanium stem design.

Main Methods:

• Prospective review of 122 consecutive cemented total hip replacements.
• Follow-up period of five to ten years.
• Clinical assessment using modified Harris hip score and radiological evaluation.

Main Results:

• 97% survival rate at a mean of 7.5 years, with no revisions for femoral stem loosening.
• 7.3% revision rate for other reasons (dislocation, infection, cup loosening).
• 74% of non-revised patients reported good or excellent outcomes; two cases of probable loosening; one-third showed non-progressive subsidence; 14.7% had non-progressive radiolucent lines at zone 1.

Conclusions:

• The medium-term results of this specific cemented titanium stem are reassuring regarding loosening.
• Concerns persist about potential debonding and the long-term durability of titanium in cemented femoral stems.
• Further monitoring is needed to fully understand the long-term performance and failure mechanisms.