The odyssey of porous-coated fixation

Among all primary total hip arthroplasties (THAs) performed at our institution between 1977 and 1998, we retrospectively reviewed the outcome of 3,314 THAs performed with Anatomic Medullary Locking (AML), Prodigy, and Solution stems (all DePuy, Warsaw, IN). These hips included 460 proximally coated stems and 2,854 extensively coated stems. Survivorship rates for proximally and extensively coated stems were >95% at 15 years, using revision for any reason as an endpoint. Slight differences in thigh pain, stress shielding, and patient satisfaction were not significant. The 2.8% rate of component loosening among proximally coated stems was significantly higher than the 1.1% rate observed with extensively coated stems. Because of the relatively easy, reproducible surgical technique associated with extensively porous-coated stems and the perception of marginally better outcome, we prefer to use extensively porous-coated stems for all primary THAs.